February 20 is World Day of Social Justice. The United Nations sponsors this event to address the gross inequalities that exist both within and across countries. By removing barriers that people face because of gender, age, race, ethnicity, religion, culture or disability, the world is better positioned to work together to advance social justice .1
While examples of disparities are many, the COVID-19 pandemic devastatingly highlighted health equity issues. Sobering statistics include:
- U.S.: Black, Indigenous and people of color (BIPOC) are disproportionately impacted by the disease (Table 1),2,3 with higher rates of cases, hospitalizations and deaths compared to their White neighbors. As a result, COVID-19 is the third leading cause of death among BIPOC. 2,3
- U.K.: Black, Asian and minority ethnic (BAME) groups are more likely to suffer poorer outcomes than Whites.4,5 Intensive Care National Audit and Research Centre found that 35% of COVID-19 cases studied were non-White, nearly triple the 13% proportion they represent in the U.K.5
- India: “The pandemic has reinforced some of the most latent inequalities in India, both socially and economically,” says Jayati Ghosh, professor of economics at the University of Massachusetts Amherst.”6
Source: Centers for Disease Control and Prevention. COVID-19 Hospitalization and Death by Race/Ethnicity. November 2020.
Even with these sobering statistics, there are barriers to equitable vaccination. While vaccination campaigns have begun in many geographies, some low-income countries have not yet been able to procure supply, limiting their access. In those countries that do have supply and are actively deploying vaccines to their populations, some minority groups have substantial hesitancy about getting the COVID-19 vaccine.
In the U.S., Whites are two to three times more likely to get vaccinated compared to Black Americans.7 This is due to vaccination hesitancy, as well as systemic racism within the medical system. These factors make BIPOC less likely to seek vaccination.8 Similarly, in the U.K., research in the BAME population showed that up to 72% suggested they would not get vaccinated.5 More broadly, the Middle East, Russia, Africa and several European countries have higher rates of hesitancy toward the COVID-19 vaccine, which will impact those countries’ ability to get to the recommended 70% vaccination rate (Figure 1)9
Source: medRxiv. COVID-19 Vaccine Hesitancy Worldwide: A Systematic Review of Vaccine Acceptance Rates. 2020.
What Employers Can Do
As employers review their COVID-19 response strategy, here are some actions that can be taken to address this health inequity:
- Vaccine promotion begins with building trust. Vaccine hesitancy can stem from misinformation, but also from long-standing social injustices. Any company communication plan promoting vaccination requires a foundation of trust.8
- To help understand concerns and how to address them, engage with employer resource groups when creating communications.
- When communicating with the broader employee population, it is important for the person delivering the message to “look like me.” Some employers are selecting diverse leaders within their business, community or the medical profession as the ones to have these frank discussions with employees.
- Have an authentic conversation instead of what could be perceived skeptically as ‘rubber stamp’ talking points.8 Allow people to ask questions to dispel common myths and conspiracy theories.8
- Sharing personal anecdotes about how the virus has impacted the life of people who the group identifies with humanizes the communication campaign.8
- Collaborate with local community centers to help guide the broader community to get buy-in and dispel myths (e.g., churches/mosques, barbershops/beauty shops, sports clubs, cultural centers)7
- Recognize that vaccine availability will vary. One-quarter of the world (mostly those in low- and middle -income countries) may not receive access to the vaccine until 2022.10 This is because as of November 2020, high-income countries representing 14% of the world’s population had reserved over 50% of the available doses.10 Infectious disease knows no borders. We are all only as safe as our most vulnerable global citizen. The scientific community has advised that at this stage of vaccination deployment, existing public health protection measures must continue. This includes masking, handwashing and physical distancing. Therefore, workplace safety protocols put in place during the pandemic should continue.
- Address inequities in company health plan access. In certain markets and industries, eligibility for the company’s supplemental health plan is restricted to upper-level roles (such as managers, directors, executives). This practice further exacerbates existing health inequities, largely because the most vulnerable are excluded. This situation has had significant consequences during the pandemic, especially since public health care systems have become increasingly strained.11,12
- Understand social determinants of health. COVID-19 exposed the social determinants of health impacting communities. As an employer, it is useful to understand and address social determinants of health. For more information, please see the Business Group Employer Guide, Social Determinants: Acting to Achieve Well-being for All.
Business Group members may access these related resources:
- Social Determinants: Acting to Achieve Well-being for All
- Global Minimum Core Benefits: Business Case and Framework
- 1 | United Nations. World Day of Social Justice. 2020. https://www.un.org/en/observances/social-justice-day. Accessed January 13, 2021.
- 2 | Joyce A. Analysis: COVID-19 ranks as a top 3 leading cause of death in the U.S., higher than in almost all other peer countries. Kaiser Family Foundation. October 22, 2020. https://www.kff.org/coronavirus-covid-19/press-release/analysis-covid-19-ranks-as-a-top-3-leading-cause-of-death-in-the-u-s-higher-than-in-almost-all-other-peer-countries/. Accessed January 13, 2021.
- 3 | Centers for Disease Control and Prevention. COVID-19 Hospitalization and Death by Race/Ethnicity. November 2020. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html. Accessed January 13, 2021.
- 4 | Razai MS, Kankam HKN, Majeed A, Esmail A, Williams DR. Mitigating ethnic disparities in COVID-19 and beyond. BMJ. 2021;372:m4921. https://www.bmj.com/content/372/bmj.m4921. Accessed January 20, 2021.
- 5 | Gumber A. Rapid response: Differential effects of COVID-19 by gender and ethnicity. BMJ. 2020;369:m1548. https://doi.org/10.1136/bmj.m1548. Accessed January 20, 2021.
- 6 | Kapur M. The stock market vs. the hungeriIndex: The painful display of India’s inequality during the pandemic. Quartz India. January 18, 2021. https://qz.com/india/1956840/indias-covid-19-paradox-mukesh-ambani-stock-market-and-poverty/. Accessed January 20, 2021.
- 7 | Recht H, Weber L. Black Americans are getting vaccinated at lower rates than White Americans. Kaiser Health News. January 17, 2021. https://khn.org/news/article/black-americans-are-getting-vaccinated-at-lower-rates-than-white-americans/. Accessed January 17, 2021.
- 8 | Minority Health Institute and UCLA BRITE Center for Science, Research and Policy. Virtual Summit on COVID-19 Vaccination: It Matters in Saving Black Lives. January 16, 2021.
- 9 | Sallam M. COVID-19 vaccine hesitancy worldwide: A systematic review of vaccine acceptance rates. medRxiv. 2020;.12.28.20248950; doi: https://doi.org/10.1101/2020.12.28.20248950. Accessed January 20, 2021.
- 10 | Silverman E. One-quarter of the world may not get a Covid-19 vaccine until 2022, experts warn. Stat. December 15, 2020. https://www.statnews.com/pharmalot/2020/12/15/covid19-coronavirus-vaccine-covaxi-who/. Accessed January 14, 2021.
- 11 | Ortiz-Hernández et al. Social inequalities in the progression of COVID-19 in the Mexican population. Rev Panam Salud Publica. 44, September 2020. https://iris.paho.org/handle/10665.2/52680. Accessed January 14, 2021.
- 12 | Aljazeer. How the coronavirus crisis exposes India’s social inequalities. Aljazeera. June 26, 2020. https://www.aljazeera.com/news/2020/6/26/how-the-coronavirus-crisis-exposes-indias-social-inequalities. Accessed January 14, 2021.