COVID-19 vaccine: working to protect our whole population

By Dr Linda Charles-Ozuzu, Regional Director of Commissioning, NHS England and NHS Improvement – North West

In October 2020, the NHS in the North West and across the rest of England was preparing to deliver the biggest vaccination programme in this country’s history, with no knowledge or certainty about whether any of the vaccines then in clinical trials would gain approval.

As I write this in October 2021, here in the North West we have administered more than 10 million doses of COVID-19 vaccines as part of a national programme that has delivered more than 80 million doses and is estimated to have already prevented 24.1 million COVID-19 infections and 127,500 deaths (up to 24 September 2021).

84% of our adult population in the North West (Office for National Statistics mid-2020 estimate) have had two doses of a COVID-19 vaccine and we are currently rolling out booster doses and third doses to those who need them.

I would like to give really huge thanks to everyone who is or ever has been involved in the programme – NHS staff, our partners, volunteers and of course, the public, who have come forward in their millions for vaccination.

It has been a colossal effort and a remarkable achievement. COVID-19 has not gone away and vaccination is our way out of this pandemic.

However, within this astonishing uptake there is some variation. Our Black Caribbean, Black African and Pakistani communities have adult uptake rates which are 30%, 23% and 14% lower respectively than for our White British population. (GP registration population data.)  Uptake among those in the most deprived tenth of our population is around 20% less than in the least deprived tenth. The data shows that through long-term engagement with our different communities, these gaps are gradually being reduced.

Key principles for the vaccination roll-out in the North West include systematically addressing the unacceptable, unjust and avoidable differences in health between population groups that we call health inequalities. This is particularly important in our area, which has some of the greatest health inequalities in the country.

In 2020, after the first wave of the pandemic threw health inequalities into stark relief, we developed a COVID-19 Community Risk Reduction Framework to support partnerships at local, town/city and regional level to proactively reach out to and protect the people at highest risk.

Its approach – using data, insight and local intelligence, combined with real knowledge of and relationships with communities, to target interventions to the people who need them – gave us a head start when it came to delivering the vaccination programme.

Research shows that three key elements determine how likely people are to be vaccinated:

• confidence in the vaccine’s safety and effectiveness
• convenience – how easy it is for people to access
• complacency – how concerned people are about their risk of infection or serious illness, with those who are complacent being less likely to take up vaccination.

Building on what we already knew about health inequalities, the vaccination programme works tirelessly to increase confidence, maximise convenience, and tackle complacency.

People can only have confidence if they understand what is being offered so:

• close engagement with communities has established what languages are spoken locally – including non-written languages
• doctors, nurses and other health professionals speak to communities online and face to face, and make films giving the facts about the COVID-19 vaccines
• accurate, easy to follow information from clinicians and trusted faith and community leaders is available in a wide range of languages and easily accessible to everyone who wanted it
• in areas where few people use the internet and social media, teams speaking a range of languages go door to door, answering people’s questions and signing them up for appointments
• many of our amazing GPs and their teams spend hours on the phone, talking through patients’ worries and gently explaining how the COVID-19 vaccines were developed so quickly and the evidence that shows they are safe.

Even given all this work, building vaccine confidence is about more than just answering questions. We recognise that some people experience real fear at the thought of an injection or cannot bear the noise and bustle of a busy vaccination centre. Staff in the North West are responding over and over again to these needs with amazing examples of thoughtful care.

For instance, a dedicated COVID-19 vaccination clinic for people with learning disabilities and autism in South Wirral gave people more time, reduced throughput to minimise noise and crowding, displayed easy-read information, and had a mobile unit for people who needed their vaccination outside. A pharmacist vaccinated a young man with autism in his parents’ car. GP practice staff sang Hamilton songs with Emma, who has Down’s Syndrome, until she was ready to go ahead with the vaccine. Vaccinators talked gently to people who were very scared of needles and, where needed, could vaccinate them on a bed to reduce their fear of fainting.

These are all examples of making reasonable adjustments to services to meet people’s needs. To support our frontline teams delivering the vaccines, we developed a Menu of Reasonable Adjustments with a wide range of resources, ideas and suggestions drawn from real-life practice. For instance:

• women-only vaccination clinics in Manchester to allay any concerns from, for example, Muslim women, about exposing any of their body to receive the vaccine
• a two-day vaccination campaign for homeless people, drug and alcohol users and people in probation hostels in Liverpool which went to larger hostels more than once

• Lancashire and South Cumbria NHS Foundation Trust offering vaccination to all eligible people using its domestic abuse services
• military teams vaccinating thousands of housebound people in the most deprived areas of the North West
• vaccine buses and vans taking the vaccine into the heart of communities including in remote areas.

All of these, and other reasonable adjustments such as maternity services offering vaccinations as a routine part of antenatal care, increase convenience to make it easy for people to say yes to the vaccine.

We also ran a weekend of walk-ins in June – known as WOW – when people who may not have been able to commit to a fixed booking could just turn up at a time that suited them. This was such a success it has become part of our regular way of doing things and is supported by the national grab a jab website.

When it comes to tackling complacency, clear consistent communication is key. As well as all the work to give people accurate information about the vaccine already described, we run campaigns aimed at family carers, health and social care staff, young people – and whoever else needs an extra nudge.

We are working more closely with our partners in local government than ever before and have established stronger and more meaningful ties with our communities.

We have also set up a NW regional health inequalities hub to consolidate expertise and provide ongoing support as we move from immediate and medium term work on health inequalities to longer term work across the region. It provides expert support to local systems on everything from data and analytics to programme evaluation.

We are grateful for the fantastic data that has been provided to us by the national team and our own analysts both to support the COVID-19 vaccination programme and health inequalities improvement. It is invaluable in enabling us to tailor and target our interventions to those who most need our support.

The vaccination programme has formed deep bonds and relationships with our communities and our partners which will endure and will help us to improve health and tackle health inequalities for current and future generations.