Ten questions on the next phase of the UK’s COVID-19 response

6. How is information about underlying inequalities which have been exposed by COVID-19 featuring in decision-making - and what action will be taken longer term?

As the pandemic has progressed, there has been clear evidence that it has not affected all groups equally: older age, the presence of pre-existing conditions, geographical area, gender are all associated with risk of infection, more severe symptoms, and higher rates of death. It has now also been established that ethnicity is an indicator of risk, with those from Black, Asian and Minority Ethnic communities more affected compared with the White British population.

The reasons for this are multi-faceted and associated with increased exposure to COVID-19 (through factors associated with occupation, use of public transport, and housing); increased risk of complications and death (due, in part, to a higher incidence of chronic and multiple long term conditions occurring in BAME communities); and structural racism and discrimination (affecting, in particular, many BAME key workers, but also affecting how BAME groups accessed testing and treatment). Crucially, however, COVID-19 has also exposed and exacerbated longstanding pre-existing inequalities - both in terms of how people experience the virus, and how they have experienced measures to combat the virus. Some of these effects will be long term, and many will continue unabated with further restrictions.

Questions around unequal impacts should also feature in discussions that should be taking place around prioritisation and allocation of treatments and vaccines. Longer-term they must be part of a wider question about what action will be taken beyond suppressing the virus and towards addressing those inequalities long term.