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People with blood cancers are among the most clinically vulnerable individuals to COVID-19 in the UK, and a new analysis of over 12 million patient health records has revealed inequalities in COVID-19 vaccine uptake among this group.

Despite a higher risk of poor outcomes from COVID-19 infection, vaccine uptake has decreased with each subsequent dose, according to new research from the University of Oxford Department of Primary Care.

Additionally, the decline is more severe for minority ethnic groups, particularly the Pakistani ethnic group and those of Black ethnicity, and for groups experiencing social deprivation/inequalities.

Patients with lymphoma and other blood cancers were prioritised for COVID-19 vaccination due to their higher risk of complications and death from the virus.

While over 90% of the UK population had received at least one vaccine, previous research has shown that uptake is lower among certain ethnic minority groups, more economically deprived groups, and younger people.

Additionally, fewer people have accepted the offer of a second, third, or even fourth dose of the COVID-19 vaccine (or ‘boosters’), despite the vaccine being considered safe and effective for most people, including those with blood cancers.

Research Fellow in Medical Statistics/Data Science at the Nuffield Department of Primary Care Health Sciences Emma Copland said, "We know that whenever a new health treatment or therapy is introduced, we typically see health disparities worsen, rather than improve," referring to the 'inverse equity hypothesis’. “We wanted to see if this trend was still present in clinically vulnerable groups like those with blood cancers, and our funders, Blood Cancer UK, were interested in seeing this too.”

Researchers found over 97,000 people aged 12 and over, who were eligible for vaccination due to a diagnosis of blood cancer before the COVID-19 vaccination programme began, by searching the QResearch database, a multi-million person electronic healthcare record database.

Overall, the study found that people from the most disadvantaged groups had a 13% lower uptake of the first vaccine dose compared to the most affluent groups, and that the gap widened to 25% by the fourth vaccination.

“Concerningly, these results supported the inverse equity hypothesis; suggesting that this effect among ethnic minority groups extends to the most vulnerable individuals," said Dr Jennifer Hirst, Senior Research Fellow at the University of Oxford Department of Primary Care and lead author of the study. “This would imply the potential need for more specific interventions in clinical settings.”

Patients with some types of blood cancer were found to be more likely to receive the COVID-19 vaccine than others.

Study funder Blood Cancer UK's CEO, Helen Rowntree said, "These findings will be important for policy makers planning public health and vaccination campaigns, in particular booster vaccine campaigns. We intend to share our findings with those affected by blood cancer and the appropriate policymakers.

Worrying as the findings may be, they are not completely unexpected. Vaccination programmes against COVID-19 and other preventative measures should have anticipated the findings of the inverse equity hypothesis.”

The study authors go on to suggest that concerns about vaccination safety and effectiveness, and a lack of reliable sources of information and accessible communications, particularly among ethnic minority groups, may contribute to reluctance regarding COVID-19 vaccines.

Dr Emma Mi, Academic Clinical Fellow at the Nuffield Department of Primary Care said “Current policies, communication on, and delivery of, COVID-19 vaccines to people with blood cancers need to be improved to ensure equitable uptake. To enable confident and accurate communication of benefits/risks of vaccination, further research is needed to understand the effectiveness and safety of vaccination in patients with blood cancer.”

The findings are published in the European Journal of Cancer.


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