COVID-19 vaccine uptake amongst underserved populations in East London
Research type
Research Study
Full title
COVER-ME: Covid-19 vaccination coverage among underserved populations: Developing and Evaluating community-based interventions in East London minority ethnicity (ME) populations; underserved migrants and persons with low income.
IRAS ID
316860
Contact name
Dominik Zenner
Contact email
Sponsor organisation
Queen Mary University of London
Clinicaltrials.gov Identifier
Duration of Study in the UK
1 years, 6 months, days
Research summary
Lay summary of study results: Many people who would benefit from vaccination against COVID or Flu do not take up their invitation for the vaccine. Whilst we know that uptake of the jab is lower in people from lower socio-economic groups and those from ethnic minority groups, we do not fully know why and what to do about it. In East London, there are many people from these key groups. Many individuals live in over-crowded, multi-generational accommodation where transmission of COVID or flu to those at higher risk is likely. Widespread vaccination can be one of the best ways to prevent spreading the virus within households and the community and preventing serious illness.
We researched, what local communities in East London with lower vaccine uptake rates think about COVID and flu vaccination and explored what solutions they suggest to improve uptake. We wanted to make sure that any tools are adapted to community needs, available in different languages, genuinely practical and accessible and can be used easily even by those with low digital and English literacy. People suggested a number of different approaches for information materials, more convenient appointment types and places, and use of technology, including text messaging and they also suggested the best wording. Based on their suggestions we then developed and refined a patient engagement tool (PET), which consisted of an interactive and personalised text messaging service allowing for direct booking of a vaccination slot, alongside tailored information about the vaccine in the patient’s language.
Following this, we carried out a pilot study to explore whether it is feasible to recruit patients to use the PET for either flu or COVID vaccination and whether this would improve the numbers of people with vaccination. We carried this out in six East London GP practices and randomly offered patients the PET or usual care.Recruitment was successful; although around one fifth of persons either declined participation or were not contactable. We also found that if GPs did not release enough appointment slots, the text messaging was held up until slots were released, leading to a high proportion (half to two-thirds, this varied by practice and vaccination venue) not receiving messages in time. Overall, our study did not show an effect on vaccination uptake, and this was in part because it was a pilot study, not a full trial with large enough groups, but also at least in part because the intervention did not reach participants. We explored patient acceptability through a brief survey after the intervention and found high acceptability of the PET among patients and GP practice staff. Most patients agreed they felt more confident about the importance of being vaccinated, were happy to book through the text messaging service, that the PET was easy to use and did not interfere with their daily lives. Almost two fifths agreed that since using the PET and messaging service they felt more willing to get vaccinated.
Our pilot study showed the feasibility and acceptability of a PET to improve COVID and influenza vaccination uptake among underserved patients in East London with important lessons regarding implementation, which will be addressed when designing a full trial.
Vaccination uptake is low amongst minority ethnicity (ME) and migrant populations due to socioeconomic, cultural, and health system factors. A recent review concluded the need to develop strategies that address barriers affecting vaccination uptake among migrants and refugees; to identify their heterogeneity and co-design suitable interventions improving vaccination uptake. Research exploring knowledge and beliefs in the context of cultural and linguistic diversity, barriers to care, or describing effective co-designed interventions, where end users are “meaningfully involved” are scarce. This evidence gap is particularly relevant for vulnerable communities in East London with its highly diverse population, high levels of deprivation and population density, which has been significantly affected by COVID-19 morbidity and mortality. This can partly be explained by common risk factors such as, low socio-economic status, and overcrowded accommodation. As with previous vaccination programs, vulnerable population groups may be underserved. Vaccine acceptance rates in high-risk populations of COVID-19 including people of EM backgrounds are low. Particular ethnic groups include individuals with Pakistani and Bangladeshi origin, and those from socioeconomic disadvantaged backgrounds; this has particularly affected uptake of the second dose of the vaccine.
Under-vaccinated population groups have higher individual risk, resulting in a disproportionate burden of morbidity and mortality, but may also contribute to increased transmissions and future COVID waves in specific communities. There is need for boosters in the event of wanting immunity and/or emergence of more COVID-19 mutations and lessons will be applicable to other vaccination programmes, and health promotion interventions.
This study will be conducted on a smaller scale as a randomised pilot study to assess feasibility, practicality and acceptability. Furthermore, it will also iron out issues in recruitment and randomisation prior to the definitive trial. A larger study in the future, will then be fully powered to evaluate efficacy of whether the intervention designed to increase vaccination uptake for underserved at-risk populations (migrants and persons with EM backgrounds) in East London increases uptake significantly.REC name
London - Westminster Research Ethics Committee
REC reference
23/LO/0587
Date of REC Opinion
21 Sep 2023
REC opinion
Further Information Favourable Opinion