Objectives: Vaccine uptake amongst ethnic minority populations has been persistently lower, which may be because of socio-economic factors such as health literacy and health insurance status. This review aimed to assess to what extent COVID-19 clinical trials have considered the impact of race and ethnicity on COVID-19 vaccine safety and efficacy.

Study design: This was a systematic review.

Methods: Data regarding ethnicity in COVID-19 vaccine clinical trials were systematically reviewed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in this systematic review, which ran from inception until June 2021. Three international databases, PubMed, Scopus and Web of Science, were used to conduct systematic article searches. Only two studies reported vaccine efficacy among ethnic minority groups.

Results: The efficacy of the mRNA-1273 vaccine was confirmed to be 95% in Caucasians and 97.5% in 'people of colour' in a study by Baden et al. In another study by Polack et al., BNT162b2 mRNA vaccine efficacy was reported to be 95.2% in Caucasians, 100% in Afro-Caribbean or African Americans, 94.2% in Hispanic or Latinx and 95.4% in non-Hispanic, non-Latinx people.

Conclusions: Given the highly differing effect of COVID-19 on the Afro-Caribbean, Hispanic and South Asian populations, it is imperative for COVID-19 vaccine clinical trials to thoroughly assess the safety and efficacy of vaccines in different ethnicities and, if necessary, develop ethnicity-specific protocols, which can minimise the disproportionate effect of COVID-19 on ethnic minority populations.