Renewing our bold call for door-to-door vaccination units: we cannot afford to leave anyone behind this winter

COVID-19 has painfully exposed the devastating impact inequalities in our society can have. With the benefit of hindsight, we cannot afford to leave our ethnic minorities communities behind this winter. Dr Halima Begum, CEO of the Runnymede Trust, on the case for door-to-door vaccination units.

Throughout this pandemic, our ethnic minority communities have been disproportionately impacted, both in terms of mortality and health disparities, and in bearing the brunt of the economic fallout.

Bangladeshi hospital fatalities from COVID-19 were twice the rate of those of the white British group, Pakistani fatalities 2.9 times as high and Black African deaths 3.7 times. Employment figures published by the Office for National Statistics in August 2021 showed that over the last year, the percentage of people from Black and ethnic minority communities who were out of work had risen from 6.1 to 8%, compared with 3.6 to 4% among white people.

These disparities are not new and are sadly unsurprising given the structural inequalities which our Black and minority ethnic communities face daily. Our Black and minority ethnic women are twice as likely to work in low-paid, high-risk jobs – where they have less employment rights than white women – and a high exposure to the virus. One in eight BME women working in the UK are in these insecure roles, in comparison to one in 16 white women and one in 18 white men.

Households with the highest rates of overcrowding are in the Bangladeshi (24%), Pakistani (18%), Black African (16%), Arab (15%) and Mixed White and Black African (14%) ethnic groups.

Such factors partially explain the higher rate at which our Black and minority ethnic communities have been exposed to, and suffered from, this dreadful virus. Work undertaken by the Runnymede Trust earlier this year led the government to add ethnicity as a risk factor to Covid. In this instance, inequality has been proven and recognised to be a matter of life or death.

Our vaccine rollout cannot fall foul to this same trend. It is profoundly worrying that ethnic minority families continue to bear the brunt of this pandemic, particularly since our schools reopened. One in four secondary school children – one in three in England – are from ethnic minority groups, and ethnic minority communities are, on average, younger than their white counterparts.

Some 30% of Black communities, 27% of Asian communities, and 49% of Mixed ethnic communities are under the age of 18. The majority of these groups are unprotected right now, in terms of the vaccine.

The disproportionate impact of Covid-19 across ethnic minority communities has been glaringly clear for well over a year now. We need mitigation measures in place and, with the benefit of hindsight one year on, know what can be implemented to better support our ethnic minority communities as we begin to come out of this pandemic.

As such, there is the very real danger that, because the NHS is a universal demand-driven system – free at the point of need -, the assumption is that access to the vaccine is a given. But many Black and minority ethnic groups have had difficulty in accessing such services, including the vaccine.

People from some minority groups – particularly Asian groups – were more likely to report poor experiences at their GP surgery. They were also more likely to report not getting enough support from other local services to help manage their health condition, and to say that they felt less confident about managing their own health, compared with white people.

In accessing the vaccine, more than 1 in 5 of respondents to a survey conducted by Healthwatch said that the location of where they were asked to get their vaccine could be a barrier to them, with more than 1 in 10 expressing concern about having to take public transport to access their vaccine. When broken down by ethnicity, respondents from Black communities were 50% more likely to see the location of vaccine centres as a barrier and almost twice as likely to express a nervousness about having to use public transport to get there.

The Runnymede Trust has previously called for door-to-door vaccinations, which would see units sent to high-density urban areas where uptake of the vaccine is still low. These methods have proven effective in low-resource environments in humanitarian and emergency contexts overseas, and was successfully piloted in Luton and Bradford in April with a wider national rollout expected.

Here in the UK, the risk factors presented from multigenerational households expose specific groups who live with grandparents and will face risks this winter with the return to school of unvaccinated children. We must ensure we are all prepared and protected against another potential wave this winter, we cannot afford to leave anyone behind. This winter is going to be unlike any other with rising prices for essential goods like fuel and gas and electricity kicking in, leaving the poorest families insecure.

It’s no longer a question of reluctance or hesitancy – the dominant tropes we have seen formulated in public health messages in the UK. We need to be talking about vaccine equity, meaning groups who are less likely to access services can find it easier to receive the services if we just take those services closer to them. In the past we have seen the effectiveness of mobile smear testing in communities to help drive up access and take-up.

Unless access to the vaccine is equitable and made simple, we run the risk of creating a two-tiered system in which certain groups are cut off from the services they both seek and need, this can and has had devastating consequences.

If COVID-19 has taught us one thing in Britain, it must be that globally infectious diseases have uneven impacts and consequences on different communities, and these impacts are not the results from choice or public behaviours or lifestyles, rather they reflect how inequalities in race and socio-economics can make risks and vulnerabilities worse for groups.

A more compassionate approach to health services in the UK would combine effective interventions to support equity to groups who are less likely to access services, and during major epidemics such as COVID-19 a fast, effective ramp-up of mobile services to boost real time access to protect traditionally excluded groups.