In Wakefield the council and local NHS have set up a roving vaccination team to work with communities at risk of low uptake.
The team has helped vaccinate hundreds of asylum seekers, homeless people, those with drug and alcohol problems and sex workers as well as people with learning disabilities and mental health problems.
Taking jabs into the community
Wakefield Council set up a vaccine inequalities working group right at the start of the programme. The group identified several health groups at risk of low uptake including but not limited to asylum seekers, people who inject drugs, people experiencing homelessness, and Gypsy Roma Traveller communities.
As the vaccine programme got under way, a roving team involving public health staff, NHS vaccinators and trusted message-givers - staff or volunteers - was established to work alongside these communities. They started doing outreach work in March.
They run clinics in the settings these groups use. For example, asylum seekers at the borough’s two main hostels are visited every month, while a homeless hostel and drop-in service which is already well-used is used to vaccinate that group. The team has also delivered vaccinations at in a needle exchange services, and at Gypsy Roma Traveller sites. Bespoke clinics have been run for people with learning disabilities and serious mental illness with the roving team.
The clinics have been a huge success. Among asylum seeker population uptake has risen to 75 to 80 per cent of the eligible people in one of our accommodation settings.
COVID Response Manager for Vulnerability and Health Inequality Pat McCusker, who is part of the roving team, said:
Going to the location that people already visit is essential because you are working in a place and with people they trust.
“Some of the long-stay residents in the asylum seeker accommodation actually became ambassadors for us, promoting the benefits of vaccination to their peers. That is very powerful.”
Vaccine hesitancy training
Another key step has been providing training to people who work with these groups in how to tackle vaccine hesitancy. Around 500 people have taken part in the online training, which covers both basic information about the vaccines, such as how they have been made and the safety checks they have been through, as well as some tips on behavioural change techniques.
Mr McCusker, who has helped run the training, said: “We wanted to equip people on the frontline with the skills and knowledge to talk about vaccines. There is a big emphasis on asking open questions and discussing vaccination in a non-pressured way.
“It is about communicating rather than persuading. We have found that many of the groups we have worked do have genuine questions about the vaccine and so having lots of people being able to answer them is really important.”
Among the groups they have worked with, Mr McCusker said the most challenging in terms of increasing uptake has been the Gypsy Roma Traveller community. “We have been to Traveller sites and have started making some progress with the older members of the community, but less so with the younger members. We hope in time they will come forward – for some groups it is a very gradual progress.”
The worked aimed at sex workers did not work out as planned either, but for very different reasons. “We found that they actually had good uptake as they had no problem using the core vaccination services. Knowing that is still really important,” added Mr McCusker.
‘Having flexibility is key’
Public Health Manager Kerry Murphy, who chairs the council’s vaccine inequalities working group, which has overseen the work, said a key strength of the team has been its flexibility.
“While we have a core team we do draw in on the expertise of the people and services we are working with. Thanks to the training that has been done, there are now a lot of people on the frontline that are both knowledgeable and really committed to improving uptake, who already have the trust of the people we are offering vaccine to.
“So when the vaccinators go in they help organise the clinics and work alongside them – there is almost a mini-team around each group. Being able to draw on their expertise is invaluable.
“It has meant the roving team has been able to be really responsive. For example, the staff working in the homeless service have rung up the core team when they have new clients in willing to get vaccinated and got them to drop past on their way back from another clinic. That’s only three people – but it is three people who may not have been vaccinated if not.”
Ms Murphy said the tapping into communities has also been essential. “We have a COVID-19 Community Champions Network which have provided really important intelligence. We have done regular Zoom calls with them and they have helped to inform us of some of the myths and concerns that are circulating – that has helped us frame our communications around vaccination.
“Local communities have also played a big role in promoting the vaccination clinics the roving team has done. We have found WhatsApp to be a very powerful tool. There are some WhatsApp groups with thousands of people in so we have produced digital leaflets that have been circulated in these groups. They are reaching people who would not normally engage with the official council communications. You have to be prepared to work differently when it comes to this.”
Kerry Murphy, Public Health Manager, Wakefield Council:
Pat McCusker, COVID Response Manager – Vulnerability and Health Inequality, Wakefield Council: