In Ealing, the roll out of the COVID-19 vaccination programme was led by the NHS and supported by the local council. Initially, vaccination delivery was across two mass vaccination sites and a small number of GP surgeries. As the pandemic progressed Ealing Council’s COVID-19 Vaccine Working Group (VWG) became more agile in its decision making and activities.
The group analysed data on vaccine uptake across the borough and anecdotal feedback from vaccinators, health colleagues and the community which was then used to plan and adapt activities. Group members valued this collaborative working and credited it with improving response rates over time.
As the programme progressed it became apparent that people from low socio-economic groups and some ethnic minority backgrounds, (particularly people from our black and mixed ethnic background communities) had lower rates of vaccine uptake.
Strategies were developed to engage different communities including interactive public webinars such as an online event with a Somali group with a Somali Islamic scholar. There was some reluctance within the VWG to support the approach due to the relatively small number of individuals it would engage but the value of these events was later recognised.
A key lesson learned was that it may often be necessary to spend a greater proportion of resources on reaching smaller numbers of particularly disadvantaged and/or sceptical or hesitant people and groups. VWG members emphasised that this should be recognised as necessary and critical for equity and an overall effective vaccination response, as well as being relevant for addressing other public health priorities.
Community engagement was undertaken with residents, community groups, faith leaders and others with existing relationships to the council’s established community engagement team. Visits were also made to vaccination sites to speak to various groups. Although often ad hoc, these engagements gave VWG members a greater sense of community perceptions and needs. Transportation services to vaccination sites were also set up to support people who faced travel-related challenges.
A regional level weekly ‘huddle’ to improve vaccine equity hosted by the Northwest London Health and Care Partnership was also established, where learning across boroughs could be shared between council, NHS and community representatives.
Challenging narratives emerged. The question ‘why now?’ was posed by a young Afro-Caribbean woman who described the scepticism amongst some members of her community and other disadvantaged groups in the region. Many in these groups may feel reasonably suspicious of authorities’ sudden interest in their uptake of a vaccine when they may have otherwise felt their wellbeing has at best been ignored, and at worst, actively undermined by authorities.
To make vaccination more accessible, comfortable, and convenient, pop-up sites in various locations including faith centres, schools, and supermarket parking lots were established. Initial reluctance to this was overcome as significantly greater numbers of people arrived for vaccination at the first site than originally anticipated.
Clearer communications were developed to reassure people they would not have to give their personal details to get vaccinated. Consequently, many unregistered people, including undocumented migrants were vaccinated. Information was also translated into relevant languages in the borough through mobilisation of various community-based networks.
Overall, action for improving vaccine equity was undertaken through collaboration between the council, NHS and community partners. Each played key roles and learned lessons over time. This led to narrowing gaps in vaccine uptake between different social groups. Such gaps remain however, meaning that trust must be built with these communities.
Recently, the council has been awarded funding to set up a Community Champions programme to facilitate further community engagement, including closer working with residents and trusted community organisations to support vaccine uptake, and to address other issues of health inequity – many of which, are affected by similar issues of structural disadvantage and limited trust.