UK thinktank calls for door-to-door Covid jabs to tackle vaccine disparities

Exclusive: Runnymede Trust chief says uptake gap risks Covid becoming a disease of poverty

Ministers are being urged to offer vaccines door to door in hard-to-reach, deprived and minority ethnic communities amid fears that coronavirus could become a disease of poverty.

As leaders set out plans to reopen society, with one in three UK adults already having received their first dose, experts said the stark disparity in vaccine uptake in pockets of the country risked leading to the “vaccine-rich” being protected while the virus continued to circulate in disadvantaged areas.

Speaking to the Guardian, Dr Halima Begum, the chief executive of the Runnymede Trust thinktank, said if people were not able or willing to go to GP surgeries, hospitals or vaccination centres, members of the NHS vaccine army should go to them.

Currently, a vaccine is offered to people in their own homes if they are registered with their GP as housebound or immobile. NHS England said in some areas GPs were increasing their efforts, highlighting the case of the London-based GP Dr Farzana Hussain, who has phoned every patient from her surgery who has been offered but not yet accepted their jab. But there are no plans to roll out a door-to-door vaccine scheme for those in hard-to-reach areas.


Begum said black, Asian and minority ethnic (BAME) communities were particularly vulnerable to being left unvaccinated. “We would urge the government to take the jab door to door where necessary,” she said. “Although there are a lot of vaccination centres in inner cities, a lot of elderly and immobile people are simply unable to get there.”

Data last week revealed a huge disparity in vaccine uptake between areas with high and low BAME populations. In Birmingham’s Sparkbrook and Balsall Heath East, an inner-city area home to a large Somali population and where 90% of residents are BAME, just 57% of over-80s had received their first jab compared with an estimated 93.4% nationally.

The ward is one of many in Birmingham with large BAME communities to have low vaccine take-up, compared with areas such as Rubery and Rednal, which has a BAME population of 9% and where 91% of over-80s had received their first dose.

Birmingham map

Dr Mike Tildesley, a professor of infectious disease modelling at the University of Warwick and a member of the UK government’s SPI-M advisory group, said on Tuesday that failure to ensure all communities were protected could lead to a societal split.

“We know there are certain areas – in particularly inner-city areas, deprived areas – where vaccine uptake is not as high. This is a real concern … that we may end up in a situation where we have the ‘vaccine-rich’, as it were, who are able to access the vaccine, who have taken up the vaccine and are at much lower risk, and maybe the people in society who have not taken up the vaccine.

“Potentially these individuals could be clustered in particular parts of the country, and there is increased risk there,” he told BBC Radio 4.

Asked about the “alarming prospect” of society opening up thanks to the vaccine but Covid remaining as a “disease of the poor”, he said: “This is a real concern for me.”

Begum said the UK could not afford to have a vaccine divide. “Dr Tildesley is right with his predictions and confirms that those groups who are the poorest in society will be disproportionately impacted unless we focus on innovative ways to improve access to the vaccine,” she said.

“Because we have a universal health system in the UK, access to the vaccine is presumed as a given. But what people don’t see is the unequal access to health services which have led to less take-up of health services in deprived communities and areas across the UK.

“Usually, the affluent middle classes who can demand more from their health services will end up accessing services better, whereas those with less voice and who might experience … racism will experience barriers to health access.”

The Runnymede Trust said urgent practical solutions were needed and that going door to door giving people jabs in their homes should be considered. Failure to act could risk communities being blamed for allowing Covid to keep spreading, Begum said.

“Unless we can level up the huge inequalities in health access, including access to the vaccine, we stand the risk that our BAME communities will be blamed for not playing their part in the national Covid recovery,” she said.

Evidence that minority ethnic people are at elevated risk of contracting and dying from Covid compared with their white counterparts is well established. This month ministers were criticised for failing to act more urgently on coronavirus vaccine disparities after data showed that white people were almost twice as likely to have been vaccinated as black people among over-80s in England.

The Labour MP Apsana Begum said on-the-ground interventions would help improve low uptake. “Where we have really densely populated areas, which has been identified as a factor behind high transmission rates, it would make sense for mobile units to come out on to some of our estates and offer the vaccine there,” said Begum, the MP for Poplar and Limehouse in east London.

“That would enable us to really quickly inoculate populations and also means it’s readily there and everything possible has been done to offer and make the vaccine available. Having those direct conversations with people is helpful.”

Last month a Covid vaccination bus was launched in Crawley, West Sussex, to target hard-to-reach and vulnerable communities. The mobile centre, on a converted Metrobus, has been set up by a group of 44 GP services called the Alliance for Better Care.

The Birmingham Labour MP Shabana Mahmood said any in-person engagement needed to come from people who understood the communities they were speaking to, and warned against a “one-size-fits-all approach” for different groups.

After Boris Johnson set out his roadmap out of lockdown for England on Monday, the health secretary, Matt Hancock, issued a renewed appeal for people to get the coronavirus jab. He said the government was working “incredibly hard” to ensure as many people as possible received the vaccine. “We want to see that vaccine uptake go as high as possible. But it’s absolutely on all of us to come forward and get the vaccine. It’s the right thing to do,” he said.

(March 8, 2021)  Step 1, part 1

In effect from 8 March, all pupils and college students returned fully. Care home residents could receive one regular, named visitor. 

(March 29, 2021)  Step 1, part 2

In effect from 29 March, outdoor gatherings allowed of up to six people, or two households if this is larger, not just in parks but also gardens. Outdoor sport for children and adults allowed. The official stay at home order ended, but people encouraged to stay local. People still asked to work from home where possible, with no overseas travel allowed beyond the current small number of exceptions.

(April 12, 2021)  Step 2

In effect from 12 April, non-essential retail, hair and nail salons, and some public buildings such as libraries and commercial art galleries  reopened. Most outdoor venues can reopen, including pubs and restaurants, but only for outdoor tables and beer gardens. Customers will have to be seated but there will be no need to have a meal with alcohol.

Also reopen are settings such as zoos and theme parks. However, social contact rules still apply here, so no indoor mixing between households and limits on outdoor mixing. Indoor leisure facilities such as gyms and pools can also open, but again people can only go alone or with their own household. Reopening of holiday lets with no shared facilities is also allowed, but only for one household. Funerals can have up to 30 attendees, while weddings, receptions and wakes can have 15.

(May 17, 2021)  Step 3

From 17 May people can be able to meet indoors in groups of up to six or as two households, or outdoors in groups of up to 30 people. People can also choose whether to socially distance with close family and friends, meaning that they can sit close together and hug. In care homes, residents can have up to five named visitors and be entitled to make low risk visits out of the home.

People can meet in private homes, or in pubs, bars and restaurants, which will all be able to reopen indoors. Weddings, receptions and other life events can take place with up to 30 people. The cap on numbers attending funerals will depend on the size of the venue.

Most forms of indoor entertainment where social distancing is possible will also be able to resume, including cinemas, museums and children’s play areas. Theatres, concert halls, conference centres and sports stadia will have capacity limits in place.

Organised adult sport and exercise classes can resume indoors and saunas and steam rooms will reopen. Hotels, hostels and B&Bs in the UK will allow overnight stays in groups of up to six people or two households.

People will also be able to travel to a small number of countries on the green list and will not have to quarantine on return.

Pupils will no longer be expected to wear face coverings in classrooms or in communal areas in secondary schools and colleges as a result of decreasing infection rates. Twice weekly home testing will remain in place. School trips with overnight stays will also now be possible.

(June 21, 2021)  Step 4

No earlier than 21 June, the government had planned that all legal limits would be removed on mixing, and the last sectors to remain closed, such as nightclubs, would reopen. Large events would be able take place. However, the prime minister has said that the rise of the B.1.617.2 variant of coronavirus first detected in India may threaten this date, and health secretary Matt Hancock said it will not be confirmed before 14 June whether the government plans to stick to the timetable.

Peter Walker Political correspondent and Rachel Hall

Some Tory backbenchers, who criticised the government over the slow pace of the easing of restrictions, said the country should not be “held back” by those who refused the vaccine.

“We know the uptake of the vaccine is over 90% in the top groups that have been vaccinated, [or even] above 95% [but the government has] assumed 15% of the population don’t take the vaccine,” Mark Harper, the chairman of the Covid Recovery Group of MPs, told LBC radio on Tuesday.

“I have two problems with that. One is that isn’t realistic, that’s not what’s happening. But secondly there is a real question about whether the rest of the country should be held back for two months because some people choose not to take the vaccine.”


Nazia Parveen and Jessica Murray

The GuardianTramp

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