London, United Kingdom – Black, Asian and other minorities in the United Kingdom have been disproportionately struck by COVID-19, with some communities still experiencing a higher rate of hospitalisations and deaths as the pandemic continues.
Over the past year, several reports and studies have underscored that this bleak reality is a consequence of structural racism.
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In an interview with Al Jazeera, British Medical Association chief Chaand Nagpaul says the government must now acknowledge the “structural inequalities that have plagued our society for decades” if it is to address healthcare disparities.
He spoke about the UK’s handling of the pandemic, how lessons from a public inquiry will help save lives in the future, and why some ethnic minorities are reluctant to take the vaccine.
Al Jazeera: Ethnic minority communities have been disproportionately affected by COVID. Did the government get something wrong?
Chaand Nagpaul: The government should have anticipated certain populations were bound to be at greater risk and could not be protected when it implemented lockdown on the premise people stay home.
Healthcare staff, public transport workers, supermarket staff and taxi drivers comprise a high number of Black, Asian and minority ethnic (BAME) people who are necessary for the nation to function.
Government messaging advised people to use cars instead of public transport. How could that possibly be a culturally sensitive message? It meant nothing to those from a low-income background.
There was [advice] on using a spare bathroom if someone in your household had got COVID. Again, completely missing the point that populations at risk are in overcrowded environments. Up to 30 percent of Bangladeshis live in overcrowded conditions compared to 2 percent of the white population. We didn’t need COVID to tell us that.
None of this was realistic. It wasn’t possible for BAME communities to stay home. Even worse, there was no protection when they did go to work, exposing themselves to the virus.
During the first wave, the government hadn’t implemented COVID-secure specifications. There were no screens or no barriers between staff and customers at supermarkets. Healthcare policy has not been tailored for the needs of BAME populations, which is why we’ve seen these inequities prior to COVID.
Al Jazeera: Some minority communities have been highly reluctant to take the vaccine. Why is this?
Nagpaul: A pre-existing lack of trust among BAME populations became worse during COVID, and trust in authorities and government messaging [about the vaccine] further diminished.
Then, the government implemented one of the [stringent] “tier three” lockdowns during Eid. There was no logical reason why that decision could not have been taken earlier, which would have given communities greater chance to prepare for celebrating a different way.
Many ethnic minorities then saw this as hypocrisy when Christmas rules were relaxed [in some areas] at a time when infection was rampant.
These factors led BAME communities to feel government messaging was not looking out for them. So, this lack of trust played a large part in why we haven’t seen the full uptake of the vaccine among BAME communities.
Al Jazeera: The rate of deaths among ethnic minority healthcare staff, many of whom were working to save the lives of COVID patients, is also higher than white NHS workers …
Nagpaul: We have known for decades BAME doctors are twice as likely to be bullied and harassed. They are more worried about being blamed than the issue being addressed.
They’re also twice as likely to feel pressure to see patients without proper personal protective equipment (PPE) and half as likely to speak out about it. Again, they were worried about adverse repercussions. As a result, we believe significant numbers have put themselves at risk because they did not feel protected, but didn’t challenge it either.
Disparities we had before were played out during the COVID pandemic. And in our view, would in part, explain the alarming numbers of deaths that have occurred among BAME healthcare workers.
Al Jazeera: What does the government need to do now to protect ethnic minorities, and boost vaccination uptake?
Nagpaul: The government should acknowledge it has not engendered the trust of [minority] communities. It needs to repair the damage that occurred over the pandemic and prior to that. It was obvious the vaccine programme would have required a culturally tailored approach if we were to get a higher uptake of vaccinations.
The government has now started making greater use of community leaders and people that BAME communities are more likely to trust. It’s rather late in the day, but at least it’s being done now.
Al Jazeera: The BMA has been vocal about launching a public inquiry into the government’s handling of the pandemic. What can this achieve?
Nagpaul: We are looking at a pandemic that has cost the lives of more than 123,000 people in the UK.
It’s really vital there is an inquiry because it will form the basis of lessons that are fundamental in how we respond to a future national health crisis. We have to recognise a pandemic can strike any time.
We need to make sure we do not repeat mistakes; we’re talking about policy that costs lives. Actions must be put in place to ensure we do all the right things and correct pre-existing structural inequalities.
Al Jazeera: How realistic is the UK government’s road map to zero social distancing after June 21?
Nagpaul: This is doublespeak from the government. On the one hand, Prime Minister [Boris Johnson] has repeatedly announced we will be guided by data, not dates. In the same breath, he’s putting forward dates when we don’t know what the impact of relaxing lockdown will be.
This is the same prime minister who last summer said we will be “back to normal” in December. Two months later we went into national lockdown with tier three restrictions.
A lot can change between now and June; there may be new variants of the virus. In August, we had less than 500 new cases on some days. Now there are 6,000 new cases a day.
The argument shouldn’t be: “We’ve got low infections and therefore we can relax.”
This infection can spread again and we need to stay vigilant and not give false hope based upon a moment-in-time situation because this can change without notice.
Al Jazeera: The UK’s vaccine rollout is coming in stages, based mostly on age. Is this the best strategy?
The vaccination programme should have also factored in health inequalities and people from deprived populations. A 60-year-old Bangladeshi taxi driver living in overcrowded conditions with diabetes would not have been eligible in the Joint Commission on Vaccination and Immunisation’s (JCVI) priorities.
A risk tool called QCovid has identified 800,000 more high-risk people not on the JCVI list, and who are now being called for vaccination. Many will be from BAME populations, so yes, again this was something we knew about before.
Al Jazeera: Which country is handling the pandemic most effectively and what can the UK learn?
Nagpaul: Countries used to pandemics in the past acted much better. South Korea and China swiftly used public health measures to prevent infection spread. It was quite incredible how society resumed normality in those nations.
They had an approach to travel restrictions and mask-wearing. We were allowing people to come in from Lombardy, Italy.
The UK’s whole test-and-trace approach failed because the government took the foot off the accelerator and said people should just self isolate. There was no community test-and-trace system and the virus went out of control.
In South Korea, if there was one outbreak in a single nightclub, they went over it like a rash. They put in place full measures of contact tracing. Last weekend, New Zealand Prime Minister Jacinda Ardern implemented a lockdown on the basis of one infection.
This inquiry needs to look at international comparisons. It should not be an inquiry restricted to what happened in the UK, but should also look at learning from other parts of the world.
This interview was edited for clarity and brevity.