The “vaccine postcode lottery”’ is driving morale of healthcare workers down in its random and seemingly unjust distribution, says Clara Munro

I have worked in a non-clinical role at The BMJ since October 2020, so I have been privy to a unique perspective on my return to clinical work over the Christmas period. The benefit of distance has allowed a new appreciation of changes not always observable from within the ranks. When covering an on-call rota over the festive period it saddened me to notice a stark difference in the morale of the colleagues I had worked with during the first covid-19 wave and over the first period of the pandemic. Why was morale so low? Like many they feel undervalued and overlooked. The nervous energy and anxious anticipation that characterised the spring and early summer, primed for a short, but terrible pandemic has gone. Replacing it is a chronic exhaustion and a downtrodden lack of enthusiasm, secondary to a slow, but consistent trampling by the juggernaut force of a virus that refuses to be beaten. 

I have watched colleagues plug energy into remaining positive and upbeat every day, but this energy is not limitless. Cynicism has grown out of not only working through a pandemic, but all of the tiny fights that come with attempting to care for their patients and leave precious little space for looking after themselves. A small gesture that would go a long way would be to provide equitable distribution of the vaccine that the government promised to a workforce that is now fatigued and overstretched. Instead the “postcode lottery” associated with vaccine roll out to healthcare workers is driving morale down yet further in its random and seemingly unjust distribution.

Listening to the news we are led to believe that there is a neat queue in every hospital throughout the UK where risk stratification is ubiquitously performed and healthcare workers are receiving their vaccines in a timely and organised manner. This is certainly the case in some hospitals (and hats off to them!) but to suggest it is the same across the board would be incorrect. I have heard stories of management being vaccinated before intensive care or emergency department staff and, perhaps worse, where emails are sent to a seemingly indiscriminate selection of staff advising them of “first come first served slots” resulting in scenes of doctors running through corridors to receive their vaccine.

While there is sense in the distribution of vaccinations being delegated to individual trusts and hospitals who know their staff, this has led to a lack of consistency across the UK. You would be excused for thinking there might be one, or even two ways of risk stratifying and vaccinating healthcare staff but the reality is innumerable methods that often lack transparency or rigor. 

To understand why this has had such a deleterious effect on morale, it is important to understand there are two things that British people really love – queues and rules. The innate and unwavering desire to form a queue is thought to come from queuing for rationed food in the war. At the risk of being branded a “moet medic” I cite European ski lifts as the perfect ethnographic immersion to experience the unadultered joy that the British acquire from forming an orderly queue, often to the chagrin of our European neighbours. The disdain shown when someone, even inadvertently, doesn’t follow the unspoken cultural rules of queuing is palpable.  Understanding our need for order and equity allows us to appreciate why the inconsistent and seemingly scattergun approach to vaccinating our workforce would excite furore among healthcare workers and inevitably influence staff morale to such an extent. 

Rollout of the vaccine to frontline healthcare workers has been patchy at best. A quick straw-poll of my medical colleagues throughout the UK reveals that while some hospitals and trusts where they were unaware that they could or should be getting the vaccine, compared with others where prioritisation was done with military precision. If you are in an at risk minority ethnic group and over 60, working on the frontline throughout the pandemic, as is  the case of one consultant I have worked with, you can imagine the sting when you see low risk staff working in non-patient facing roles expressing their glee at receiving the vaccine. The cocktail of injustice and exclusion is deadly to a workforce that needs its resilience now more than ever. 

While healthcare workers appreciated the clapping and freebies, what they really need is to feel adequately protected against the virus that they have relentlessly faced, while others were forced to stay at home.  This past year has not only been defined by a fight against a virus, it has been characterised by a series of fights (and wins) against a lack of personal protective equipment, inconsistent testing, corona-sceptics, an evidence vacuum, and now a seemingly inequitable distribution of the vaccine that was promised to protect our “frontline heroes.” If we want healthcare workers to dig deep and find resilience to get through the coming months then we need to provide them with the vaccine in a fair and just way. A random vaccine rollout ignoring those healthcare workers most at risk, and undervaluing those who have placed their own safety second to that of their patients, threatens to bring an already exhausted workforce to its knees. 

Clara Munro, Editorial registrar and clinical fellow, The BMJ, and general surgical trainee, North East England.

Competing interests: None declared.