The UK and other countries are now facing the logistics of rolling out the largest, most complex vaccination programme in history. The potential gains for individual and community safety are enormous. There is, however, a serious possibility that the programme could lead to widening health and economic inequalities. These have been a feature of the pandemic to date with disadvantaged communities and ethnic minority groups suffering disproportionally and the north south divide being accentuated. [1,2]
The successful delivery of this major population programme depends on rebuilding public trust, lost to some extent through the government’s poor handling of the pandemic so far. Trust is more likely if basic public health principles are followed and we rely on professionals more than our current political leaders. Equality of access must be addressed. Mass vaccination must not be a programme where the solution is in the hands of private sector companies who are inexperienced in these matters. For example, delivering services in the car parks of race courses or other venues on the outskirts of cities immediately disadvantages all those without cars. Around 20% of white people have no access to a car, but 40% of black people do not.  Public health expertise is needed to manage data collection and monitoring in order to quickly pinpoint low uptake communities and put in place local interventions. It requires the successful integration and involvement of primary care and excellent levels of local community engagement.
Sizeable minorities of people are taking their time to think carefully whether to have the vaccination. Their concerns may be due to their own complex health needs, cultural values, concerns about the risk of an adverse effect, or concerns due to previous government serious errors of judgement during this pandemic.  The initial trials of the covid vaccines report a generally low incidence of severe side effects.  Easy access to reliable, independent information on trial data will help people make an informed choice. This will need to be an ongoing process as the programme is rolled out.
There is almost 95% uptake of childhood vaccinations in the UK, so why is there continued doubt about having the covid vaccine?  The overwhelming amount of information and disinformation in the media about covid disease and covid immunization has generated confusion and fear amongst some groups. Low uptake is potentially a problem which we know is associated with disadvantaged communities and is likely to lead to even more inequality. The reasons for low uptake need to be identified quickly in order to be addressed.
At mass vaccination sessions, time for individual discussion will be limited. Some people, for example those who are clinically vulnerable, or those with mental illness or learning disabilities may need more discussion, ideally with a familiar health professional. Minority ethnic groups may need information in their strongest language from a trusted source within their community. The solutions to these issues require good data collection, ongoing monitoring and extensive local input, building on existing links with communities whose voices are seldom heard.
The successful development and licensing of a covid vaccine, with the promise of more vaccines to follow, is a tribute to all the scientists involved. It is also a testament to the longstanding and stable infrastructure for the regulation of medications and vaccines which has been in place for many years in the UK. Politically, the vaccine has been presented as a silver bullet. Hopefully the incidence of covid will drop next year, but in order to achieve zero covid, we must have a very effective way to find cases, contact trace, isolate, and support people to deal with remaining cases or outbreaks.
Public trust would be engendered if the programme is managed competently through the NHS by professional healthcare workers who can adequately address people’s concerns, collect monitoring data assiduously, provide long-term follow up, and pay scrupulous attention to detail such as accurate recording of vaccine type and batch numbers.
The vaccine roll out must be seen to be effective and fair. It will assist in enabling us to rebuild our lives and in economic recovery, both of which will have positive public health consequences. Evidence suggests that vaccination will reduce individual risk of illness and harm, but we must start to think more clearly about the common good. To achieve herd- immunity it is likely to need at least three quarters of the population to be vaccinated. Only when this happens will the R number be reduced. Unless the government handles this fairly and with an emphasis on people who will find it difficult or challenging to be vaccinated, we are in danger of repeating the UK Government’s mismanagement and locking ourselves into an ongoing cycle of covid outbreaks. Basic public health methods are the essential ingredients for public trust to be restored and this vaccine programme to succeed.
Paul Redgrave, former Director of Public Health, UK on behalf of Sheffield Community Contact Tracers (SCCT):
Tom Heller, former GP Sheffield, UK
Fran Pitt, former Director of Health Protection PHE, UK
Mair Richards, former Paediatrician Sheffield, UK
Abdul Shaif, Sheffield Yemeni Community Association, UK
Steve Pagden, volunteer SCCT, UK
Andy Jackson, manager Heeley Community Trust Sheffield, UK
Paulina Ramirez, Department of Business and Labour Economics, University of Birmingham, UK
Competing interests: no competing interests
- Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020 Aug;584(7821):430-436.
- Covid deepens south and north of England inequalities, study finds | Inequality | The Guardian
- Ethnicity facts and figures – GOV.UK (ethnicity-facts-figures.service.gov.uk)
- Coronavirus: Had enough of experts? This government is turning to them like never before | The Independent | The Independent