The emergence of viable vaccines to protect against COVID-19 was marked as one of the most significant medical breakthroughs in recent history, providing a beacon of hope and a step towards a sense of normality for many. But with these breakthroughs how do you ensure that those that are most in need of the vaccine have the opportunity to receive them, and following receipt of a vaccine any outcomes or events that follow?
Early in the pandemic, it became evident that minority ethnic groups were disproportionately affected by COVID-19, with infection rates higher and the severity of the reaction in those that tested positive to the virus significantly worse.
As the rollout of the vaccine began in December 2020 and quickly progressed, evidence suggested that vaccine uptake among minority groups would also be lower than the population average in Wales.
Public Health Wales (PHW) working in partnership with Digital Health and Care Wales (DHCW) and the One Wales team linked anonymised data from the Welsh Immunisation System (WIS) with near real-time anonymised COVID-19 data to gather insight on the vaccine rollout.
For the first time in Wales, it was possible to visualise vaccination uptake amongst the population of these ethnic groups. This insight allowed the teams responsible for the vaccine rollout to effectively monitor and intervene to ensure that the delivery of vaccinations was equitable, whilst providing insight to enable a planned approach to engagement with groups and areas of Wales that was yet to accept the call to be vaccinated.
Malorie Perry is a Senior Epidemiologist at PHW working in the Vaccine Preventable Disease Programme (VPDP) and PhD student at Swansea University. Since the start of the pandemic, Malorie has led work with colleagues from the SAIL Databank and Swansea University’s Population Data Science Group to develop routine reports and intelligence that could, when a COVID-19 vaccine became available, monitor equality and effectiveness of the vaccination in Wales.
“Plans to look at uptake by ethnic group for other vaccines in Wales were already in the Public Health Wales vaccine programme plan for reducing inequities in vaccination coverage, but this work became particularly important for COVID-19 due to concerns that minority ethnic groups were being disproportionately affected with severe outcomes.”
To aid this understanding, Ashley Akbari, a Senior Researcher for HDR UK and ADR Wales – partners in the One Wales response to tackle COVID-19 in Wales – developed an anonymous ethnicity spine by utilising the population-scale anonymised person-level linked data available within SAIL.
“This brought together over 20 data sources which contained various ways of recording ethnicity. This was harmonised into a single source and version of ethnicity groups/categories based on national standardised groupings.”
“When linked with other sources of anonymised health, administrative and COVID-19 data sources, such as vaccination and COVID-19 test data, this enables impactful research and intelligence into the evaluation of the vaccine uptake and safety on a national scale.”
As early as February 2021, analysis using the ethnicity spine was able to identify the following:
In Black, Asian, Mixed and Other ethnic groups aged 80+, 71.5% received a first dose of a COVID-19 vaccine compared to 85.6% in the White ethnic group – a gap of 14.1%.
The gap in coverage between these groups was 12.8% for adults aged 75 to 79 years, and 10% for adults aged 70 to 74 years. Although the gap reduced to 11.3% by March for those age 80+, the gap remained stable or increased in the other age groups.
Malorie continues, “The availability of this national ethnicity spine in conjunction with other anonymised data about the population of Wales has provided important intelligence that has enabled NHS colleagues to evaluate and continue to tailor the immunisation programme in Wales making sure that the vaccine programme is available to all.
“As the vaccine programme continues so does our monitoring using this anonymised data analysis method. We continue to look at equity in vaccination uptake and it is hoped that this can be expanded to aid understanding around other groups disproportionately affected by the COVID-19 pandemic.”
These analyses and intelligence reports are presented regularly to the Welsh Government Technical Advisory Group (TAG) and directly to the COVID-19 Vaccine Board. Details of the analysis can be found here.
One Wales brings together colleagues from both within Swansea and across Wales under the direction of the Welsh Government Technical Advisory Cell (TAC) and includes the following groups and organisations: the Secure Anonymised Information Linkage (SAIL) Databank, Administrative Data Research (ADR) Wales, NHS Wales Informatics Service (NWIS), Public Health Wales, NHS Shared Services Partnership and the Welsh Ambulance Service Trust (WAST). All research conducted has been completed under the permission and approval of the SAIL independent Information Governance Review Panel (IGRP) project number 0911. This unity of expertise from across Wales has resulted in an agile and responsive approach to tackling data analysis and intelligence generation based on both the constant and newly developing priorities for tackling COVID-19 in Wales.
By Cathrine Richards, Swansea University