‘I’ve had to fight to protect my residents'

Blackburn with Darwen has seen the highest total number of COVID-19 infections per head of population of any council area in the country. It has meant Director of Public Health Professor Dominic Harrison has, at times, found himself at the centre of some tense exchanges with central government and its agencies. 

“There have been some really frustrating moments,” said Professor Harrison, who retires in April. “Government policy and its response to COVID-19 has been very centralised and the result has been damaging for areas like mine. What may appear nationally to be a sensible decision can have very different results in some areas compared to others. That has been particularly felt in Blackburn with Darwen – and has simply widened inequalities.”

‘My battle over vaccine rollout’

Professor Harrison said a perfect example of this was the initial rollout of the vaccination programme. The JCVI prioritised older age groups on the basis that if they were infected they were at the highest risk of infection.

“That does not take into account your risk of getting infected in the first place. As people in Blackburn have been at higher risk of infection because of structural reasons – we have more houses of multiple occupancy and fewer people able to work from home – my residents were disadvantaged. They had higher risks of transmission but were provided with less vaccine protection.

“The older populations in the south west, for example, got much quicker access to vaccines than the younger population here despite the higher transmission risk we faced. I made this point to the government and JCVI, both privately and publicly, but they were not convinced.”

There was however a change in approach in April when Blackburn became the second area after Bolton to see a surge in cases driven by the Delta variant. Both were given extra supplies of the vaccines to rollout jabs more quickly.

“We couldn’t go down the age groups more quickly than was happening nationally, but what it meant was that we were able to go through the priority groups at a faster pace and get our most at-risk vaccinated.

“I think this has had an impact on keeping our rates low since that wave passed. Since the summer we have had lower rates than the national average. It has not all been down to vaccination. The fact we have had so many infections means that infection acquired immunity has been higher than the national average. We also had a big push on testing and community engagement as well. I think those first months of the Delta epidemic are probably what I am most proud of in the whole pandemic. We all worked together – in fact the community have really provided an extra, hidden layer of protection.”

‘Community trust me to fight their corner’

That relationship between Professor Harrison and his public health team and the local community is something that was strong before the pandemic started, but has been further strengthened over the past 20 months, be believes.

In the early months of the pandemic, a pan-Lancashire COVID-19 BAME health inequalities cell was created bringing together public health teams and community leaders. It helped gather data and coordinate the responses to tackle the increased risks these communities faced.

“There has been real trust and collaboration throughout. The community trusts me to fight their corner and tell them the truth and I trust them to act on it and do what is needed. When we started getting the data about cases I was sharing it with them and we were working together to try to keep communities safe.”

That relationship will no doubt be important in the coming weeks and months to combat the rise of the Omicron variant. “I think we are going to get a very big surge locally and nationally. We have had outbreaks in care settings, places that have very good infection control measures in place, and it is remarkable just how much it has spread. I think we are going to be in for a very big wave of infections, probably between Christmas and the end of January.

“It does seem to be causing milder illness and hopefully that will continue, but even so there is still the risk of unsustainable pressure on the health service if infections climb really high. But even if that doesn’t happen we are going to have so many people isolating that I think we could have real business continuity problems across whole sectors – not just the NHS but food, transport and energy. The Plan B measures will help slow the spread, but we may need to do more.”

The long-term challenge

But regardless of what happens with Omicron, Professor Harrison believes this winter will see one of the highest levels of excess deaths for many years.  “We are already seeing big increases in non-COVID-19 illness. People who have been on the waiting list for a long time are getting ill and needing emergency treatment.

“Then we have COVID-19 on top. I think what this variant has shown is that we have to adapt the way we live. We are going to have to think about what steps we can take to control spread while keeping our freedoms – the regular testing, better hygiene and infection control will have a role to play.

“We have gone from virtually no controls to emergency response four times since the start of the pandemic - we are going to need a different approach to virus transmission risks in the future.”

But Professor Harrison is also aware of the need to address the knock-on impacts of the pandemic. He said there is a real danger COVID-19 is going to exacerbate existing health inequalities further in the coming years.

To try to get ahead of this, the NHS and councils across Lancashire and South Cumbria have commissioned Sir Michael Marmot to carry out a review into the issue. His commission is due to report early next year. 

“I am very worried about what is going to happen. Life expectancy at birth in Blackburn with Darwen and many other northern local authority areas is falling further behind the England average as a result of the pandemic. The most recent data shows our local life expectancy at birth for 2020 has now fallen to the level of life expectancy that England achieved 20 years ago. We have many people of working age with long-term conditions and that has an impact on employment and economic productivity.

“With 70 per cent of hospital admissions for preventable disease, prevention needs to be a much greater priority for NHS investment. We are going to be dealing with the increased health inequality impacts of this pandemic for years to come.