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.
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
All pupils and college students return fully. People can meet one other person outside, not just for exercise. Care home residents can receive one regular, named visitor. The “stay at home” order will otherwise stay in place.
(March 29, 2021) Step 1, part 2
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 will be allowed. The official stay at home order will end, but people will be encouraged to stay local. People will still be asked to work from home where possible, with no overseas travel allowed beyond the current small number of exceptions.
(April 12, 2021) Step 2
The official outline plan states that the next steps will rely on data, and the dates given mean "no earlier than". In step two, there will be a reopening of non-essential retail, hair and nail salons, and public buildings such as libraries and museums. Most outdoor venues can open, 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 reopening will be settings such as zoos and theme parks. However, social contact rules will 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, 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
Again with the caveat "no earlier than 17 May", depending on data, vaccination levels and current transmission rates.
Step 3 entails that most mixing rules are lifted outdoors, with a limit of 30 people meeting in parks or gardens. Indoor mixing will be allowed, up to six people or, if it is more people, two households. Indoor venues such as the inside of pubs and restaurants, hotels and B&Bs, play centres, cinemas and group exercise classes will reopen. The new indoor and outdoor mixing limits will remain for pubs and other hospitality venues.
For sport, indoor venues can have up to 1,000 spectators or half capacity, whichever is lower; outdoors the limit will be 4,000 people or half capacity, whichever is lower. Very large outdoor seated venues, such as big football stadiums, where crowds can be spread out, will have a limit of 10,000 people, or a quarter full, whichever is fewer. Weddings will be allowed a limit of 30 people, with other events such as christenings and barmitzvahs also permitted.
This will be the earliest date at which international holidays could resume, subject to a separate review.
(June 21, 2021) Step 4
No earlier than 21 June, all legal limits will be removed on mixing, and the last sectors to remain closed, such as nightclubs, will reopen. Large events can take place.
Peter Walker Political correspondent
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.”