Ifra Ali
Researcher, London School of Hygiene & Tropical Medicine (LSHTM), United Kingdom
Ethnic minority groups are one of several underserved populations that have received significant attention in public health for their reported ‘vaccination hesitancy’ and suboptimal vaccination uptake (Dowden, 2019). Having a lack of awareness of vaccination programmes and their benefits, marginalization, accessibility issues, and language barriers are just some of the reported factors contributing to the low vaccination uptake observed amongst ethnic minority groups (MacDonald, 2015). However, the Bangladeshi community in the UK, a significantly underserved, ethnic minority group, appears to have diverged from this trend, with recent studies highlighting their positive uptake of childhood vaccines relative to several other ethnic groups (Mixer, Jamrozik & Newsom, 2007).
Firstly, to introduce this empowering community, a large number of Bangladeshis immigrated to the UK in the 1970s, with most settling in the East London borough of Tower Hamlets (Alexander et al., 2010). As such, Bangladeshis form a relatively large population in England and Wales (0.8%) (Office for National Statistics, 2011). Importantly, this growing community is considered one of the most socioeconomically disadvantaged groups in the UK, with approximately 65% of British Bangladeshis living in low-income households (Alexander, 2005). Bangladeshis also have notably poorer health, with high morbidity and mortality rates compared to other ethnic groups (Akhter et al., 2021; Hawthorne et al., 2007). Given the highly disadvantaged socioeconomic profile of British Bangladeshis, which is typically associated with suboptimal vaccination uptake, the present study sought to undercover the factors which may be driving their surprisingly positive uptake of childhood vaccinations.
A comprehensive, qualitative research study was conducted with Bangladeshi parents in Tower Hamlets. Several interviews were conducted with Bangladeshi parents, healthcare professionals and community service providers working in the field of childhood immunisations. Many health system facilitators were uncovered across interviews in this study, including positive relationships with healthcare professionals, vaccination reminders, and accessible vaccination services. However, parental trust in childhood vaccinations and healthcare professionals appeared to be the most crucial factor facilitating the decision of Bangladeshi parents to vaccinate their children. The findings indicated this trust may have been cultivated through the effective design of vaccination services in East London, which have over time become attuned to the needs of the large Bangladeshi community they serve. For example, there appears to be a system-level understanding of the communities’ cultural and religious healthcare needs within GP practices, which has strengthened parental trust in healthcare professionals and facilitated vaccination uptake.
Overall, working with the unique Bangladeshi community in East London was an intriguing experience that uncovered key insight into how vaccination uptake may be improved amongst underserved populations. In particular, the findings reinforced the importance of ensuring vaccination services are designed with knowledge of the population they serve, particularly for vulnerable migrant populations whose needs are often poorly met and understood. It is anticipated this insight from the Bangladeshi community will inform improvements in the delivery of childhood vaccinations amongst other vulnerable, underserved populations, to ultimately reduce the burden of preventable infectious diseases.
References
- Akhter, N., Begum, K., Nahar, P., Cooper, G., Vallis, D., Kasim, A. and Bentley, G.R., 2021. Risk factors for non-communicable diseases related to obesity among first-and second-generation Bangladeshi migrants living in north-east or south-east England. International Journal of Obesity, 45(7), pp.1588-1598.
- Alexander, C., Firoz, S. and Rashid, N., 2010. The Bengali Diaspora in Britain: A review of the literature. London, UK.
- Dowden, A., 2019. Tackling the declining uptake of childhood vaccinations. Prescriber, 30(5), pp.34-37.
- Hawthorne, K., Pill, R., Chowdhury, J. and Prior, L., 2007. Understanding family, social and health experience patterns in British Bangladeshi families: are people as diverse as they seem?. Primary Health Care Research & Development, 8(4), pp.333-344.
- MacDonald, N.E., 2015. Vaccine hesitancy: Definition, scope and determinants. Vaccine, 33(34), pp.4161-4164.
- Mixer, R.E., Jamrozik, K. and Newsom, D., 2007. Ethnicity as a correlate of the uptake of the first dose of mumps, measles and rubella vaccine. Journal of Epidemiology & Community Health, 61(9), pp.797-801.
- ONS. (2011a). 2011 Census: Ethnic group, local authorities in the United Kingdom. Table KS201UK. [Online]. Available at: https://webarchive.nationalarchives.gov.uk/ukgwa/20160105160709/ http://www.ons.gov.uk/ons/rel/census/2011-census/key-statistics-and-quick-statistics-for-local-authorities-in-the-united-kingdom—part-1/rft-ks201uk.xls. [Accessed: 09.09.2022].