Published: 29 July 2020
Six new projects to improve our understanding of the links between COVID-19 and ethnicity have been funded by the NIHR and UK Research and Innovation (UKRI).
These projects will seek to explain and mitigate the disproportionate death rate from COVID-19 among people from Black, Asian and minority ethnic (BAME) backgrounds, including BAME health and social care workers.
Emerging evidence shows that, after taking account of age and other sociodemographic factors, people from BAME backgrounds are nearly twice as likely to die of COVID-19 than white people. There is an urgent need for more detailed data on why COVID-19 disproportionately affects people from BAME backgrounds, building the essential evidence base needed to make recommendations to decision makers and protect the health of these groups.
The projects, which total £4.3 million worth of funding, will explore; the impact of the virus specifically on migrant and refugee groups; work with key voices within BAME communities to create targeted, digital health messages; the introduction of a new framework to ensure the representation of people from BAME backgrounds in clinical trials testing new treatments and vaccines for COVID-19; and the creation of one the UK’s largest COVID-19 cohorts.
One of the projects will establish a unique partnership between national healthcare organisations to specifically address the prevalence of COVID-19 amongst BAME healthcare workers - who have been significantly overrepresented among the deaths from the virus. The mixed-method project will bring together existing datasets to calculate the risk of COVID-19 to all BAME healthcare workers and follow a group of these healthcare workers over the next 12 months to assess their physical and mental health - as well as engage directly with a smaller group of workers to gather qualitative data.
Dr Manish Pareek, Principal Investigator of the UK-REACH study, University of Leicester and Honorary Consultant at University Hospitals of Leicester NHS Trust, said: "Globally, we have evidence that people from BAME backgrounds have a higher chance of going to intensive care and dying from COVID-19 – this may also be the case for healthcare staff. Our study is the first to be conducted on a large scale, investigating why BAME healthcare workers could be at greater risk.
"A recent PHE report highlighted how 63% of healthcare workers that died from COVID-19 were from a BAME background. We want this research to improve the lives of healthcare staff – to this end, we have a stakeholder group of major national organisations to research and publicise our findings.”
The newly funded projects form part of a rolling funding call by NIHR and UKRI for rapid research to support the response to the COVID-19 pandemic.
Chief Medical Officer for England and Head of the NIHR Professor Chris Whitty said "With evidence showing that people from Black, Asian and minority ethnic backgrounds are more severely affected by COVID-19, it is critical that we understand what factors are driving this risk to address them effectively."
“The diverse range of projects funded by the NIHR and UKRI will help examine this association in detail, so that new treatments and approaches to care can be developed to target the ethnicities most at risk. This research will have embedded patient and public involvement with Black, Asian and minority ethnic groups at all stages of the research."
Health Minister Lord Bethell said: “I am deeply concerned by the disproportionate impact of this horrible virus on some minority communities. We need to find out what’s causing this, so we can stop these deaths. These research awards will give Britain’s scientists the resources they need to answer the urgent questions behind these disparities so we can address the root causes and save lives.”
Science Minister Amanda Solloway said: “COVID-19 has had an enormous impact on all of our lives, but sadly we have seen that people from Black, Asian and minority ethnic backgrounds are disproportionately affected by this terrible disease."
"There is an urgent need to better understand the complex reasons behind this. These six new projects will enable researchers to work directly with ethnic minority groups to improve our evidence base and, crucially, save lives."
UKRI Chief Executive, Professor Dame Ottoline Leyser, said: “It is now abundantly clear that COVID-19 disproportionately affects people from Black, Asian and minority ethnic backgrounds. Urgent action must be taken to determine and address the factors underlying this disparity.
“There is unlikely to be a simple answer and we must consider all possibilities, so that we can save as many lives as possible during this pandemic and any future outbreaks.”
The NIHR is also working to encourage people from BAME backgrounds to take part in COVID-19 research and ensure that researchers include these communities in their studies. These activities support NIHR’s commitment to promoting equality, diversity and inclusion in research.
The NIHR has launched a public campaign to raise awareness and interest in participating in COVID-19 research among BAME communities, in collaboration with the NIHR-funded Centre for BME Health, and a series of short dramas about people’s experiences of COVID-19 research.
The NIHR has also partnered with the Centre for BME Health to offer tips and advice for researchers on designing and delivering health and care research that is sensitive to and inclusive of people from BAME groups.
1) Understanding risk and behaviours in healthcare workers
Dr Manish Pareek, University of Leicester and Leicester Royal Infirmary- £2.1m
The UK Research Study into Ethnicity And COVID-19 outcomes in Healthcare workers (UK-REACH) will calculate the risk of contracting and dying from COVID-19 for ethnic minority healthcare workers, with access to over two million healthcare records held by national healthcare organisations. This group of healthcare workers will include non-clinical staff integral to the day to day running of healthcare institutions including cleaners, kitchen staff and porters.
The research will follow a group of healthcare workers from BAME backgrounds over 12 months to see what changes occur in their physical and mental health. In addition, the study will interview a smaller group of healthcare workers to understand the risks of their jobs, and how they may have changed their professional and social behaviours in response to COVID-19.
Finally, in order for the findings to be useful for healthcare workers, the team have put together a stakeholder group of major national organisations including the General Medical Council, the Nurse and Midwifery Council, General Dental Council, NHS Employers and BAME Professionals’ Associations to help conduct the research and provide evidence to policymakers so that decisions can be made in near real time.
2) Tracking COVID-19 in minority ethnic and migrant groups
Dr Robert Aldridge, UCL - £1.4m
This project aims to better understand the impact of COVID-19 on minority ethnic and migrant groups and how to tackle it in community settings.
The researchers will build on ‘Virus Watch’, a study previously funded by UKRI and NIHR that is following 25,000 individuals across the country in a nationally representative household cohort to monitor spread of the novel coronavirus across England.
This new funding will enable the researchers to recruit approximately 12,000 more people from minority ethnic and migrant groups. Their symptoms will be followed over time, and subsets of participants will receive antigen and antibody tests. The study will consider factors such as household transmission, occupation, comorbidity, healthcare usage, and mental health and economic impacts.
Separately, the researchers will also use data from the Million Migrant Cohort study of healthcare and mortality outcomes in non-EU migrants and refugees to England since 2015. In collaboration with Public Health England, they will link this with data on COVID-19 diagnosis and hospitalisation to determine how often these groups are diagnosed, hospitalised and die with COVID-19 and how this is affected by their socioeconomic situation and pre-existing health conditions.
3) Designing culturally relevant COVID-19 health messages
Professor Aftab Ala, Royal Surrey NHS Foundation Trust and Kings College Hospital, Honorary Professor at the University of Surrey - £371k
This project aims to design culturally relevant health messages for Black and South Asian groups and deliver these messages through specific and trusted communications channels, to influence behaviour that reduce the transmission of COVID-19, such as perceived risks and susceptibility, proximity and social distancing, and infection control.
The research team will work alongside local, regional and national BAME community groups, community and faith leaders and public health and allied health professionals, to co-produce written and visual aids, short films mainly for smartphone viewing and mobile apps. The exact content of these messages will be a combination of public health advice and targeted, culturally appropriate messaging.
The information gained from the project will be shared with the Black and South Asian community, community leaders and policymakers including NHS England and Public Health England.
4) Understanding risk of infection and death from COVID-19 in individual ethnicity groups
Professor Julia Hippisley-Cox, University of Oxford, and Dr Hajira Dambha-Miller, University of Southampton - £327k
This study will determine the risk of infection and death from COVID-19 in individual ethnicity groups and seek to explain why these differences might exist.
The team will combine over 40 million patient GP records across rural and urban areas of England to create one of the largest COVID-19 cohorts in the UK. They will describe patterns of COVID-19 disease and death according to ethnicity and use statistical modelling to understand these differences.
There is an urgent need for more clarity on the issue of ethnicity and COVID-19 related deaths to identify and protect people who might be most at risk from the virus. This study includes an early reporting phase to identify people most at risk who might benefit from interventions to reduce their risk.
5) Using Biobank data to determine why minority ethnic groups may be at increased risk of COVID-19
Professor Thomas Yates, University of Leicester - £126k
This research project aims to unpick why minority ethnic groups may be at increased risk of COVID-19 and whether this increased risk is observed equally across the population. For example, is the increased risk explained by a higher burden of other diseases such as heart disease or diabetes or by living in more polluted or deprived areas? Do otherwise healthy individuals from minority ethnic groups still have an increased risk?
This study will use the UK Biobank patient data cohort, which has been linked to national COVID-19 data. Using this dataset, the team will use statistical modelling to examine whether the increased risk of developing severe COVID-19 in minority ethnic groups is explained by differences in underlying health status, lifestyle behaviours such as physical activity, and environmental factors including measures of social inequality.
6) Testing a framework to support inclusion of BAME participants in COVID-19 research
Professor Shaun Treweek, University of Aberdeen - £15k
This project will see the rapid completion of a tool called the INCLUDE Ethnicity Framework, which will help researchers designing clinical trials to consider the factors that may reduce the inclusion of BAME participants, such as existing disease, culture, treatment being tested, and trial information and procedures.
The framework will be applied to three to five trials to produce an example set for other trialists to use when planning future COVID-19 trials. It will also help those not involved directly in the trial interpret and report the results in a way to make judgements about the applicability of trial results to BAME communities.