Councils have a crucial role in local communications, planning and support to deliver mass vaccination effectively – particularly for those groups with low trust in national institutions and / or low take up of the vaccine.
1. Councils are playing a crucial role in the successful roll-out of mass vaccination for COVID-19. We want to build on this as we plan for the future and develop plans to live with COVID-19 in the medium to long term. We are likely to need a continuation of this national effort and potentially regular mass vaccinations of the whole population, and urgently need to tackle vaccine hesitancy and to ensure full take up by all groups in the population. Councils have a crucial role in local communications, planning and support to deliver mass vaccination effectively – particularly for those groups with low trust in national institutions and / or low take up of the vaccine.
2. The purpose of this briefing is to articulate what additional support councils need in fulfilling their role in driving vaccine uptake in disproportionately impacted groups.
3. Set out a clear single view of expected local authority roles in relation to vaccination, testing, tracing and isolation built into the revised framework for Local Outbreak Management Plans and related local governance. This should be specific on the local authority role after cohort 1 though to 9 of the JCVI priority list have been vaccinated.
4. Review NICE guidance for improving flu vaccine uptake and implement those recommendations applicable to COVID-19 Vaccination.
5. Share high quality detailed data and analysis to monitor vaccine uptake and identify unwarranted variation – to identify where vaccine uptake is poorest in communities and inform our outreach efforts.
6. Allow local flexibility to use supplies to maximise take up of the vaccine. Prioritise administration by trusted health practitioners in familiar and convenient locations such as primary care rather than mass vaccination sites.
7. Share insights and understanding of public attitudes towards vaccination and how it varies.
8. Share confidence levels on supply of the vaccine a local area can expect as far ahead as possible. This will help Councils to plan confidently in rolling out the vaccine in their local areas.
9. Sustainable funding for extensive engagement at local level to enable use of local credible advocates to work with key communities; engagement with trusted sources such as healthcare workers, GPs, and scientists from within the target community to respond to concerns about vaccine safety and efficacy. Additional work with community organisations to address forthcoming potential implications of Ramadan.
10. Share multilingual, non-stigmatising communications including vaccine offers and endorsements from trusted sources to increase awareness and understanding and to address different religious and cultural concerns.
11. Place-based priorities should be considered for delivery of vaccine in the second phase to reach groups who may not be registered with primary care.
Feedback from councils
12. Greater flexibility is needed in delivery channels and guarantees of vaccine supply to help maximise take up of the vaccine. This should include being able prioritise vaccination deployment to communities with higher infection levels including vaccinating adults in multi-generational households/cohorts and the opportunity to establish very local or mobile clinics.
13. Developing a roving approach could include pop up facilities in community venues, roving vaccination teams delivering into specific areas and settings as well as vaccination buses equipped with dedicated vaccine teams.
14. Concerns have been raised that there has been too much of a focus on the mass vaccination sites compared with Primary Care Network delivery and that focusing on this disproportionality will impair the success of the vaccine roll out.
15. Regular reporting of progress on the vaccination offer, uptake and coverage by time, place and person (including by minority ethnic group) will help to facilitate local planning.
16. Concerns have been raised that as the Vaccine roll-out moves into cohorts 5-9 and the financial incentives for GPs may combine to remove the more granular, less efficient but essential outreach work.
17. Some suggestions have been made that community pharmacies may need to be taken off the national booking system in some localities - so that contact centre staff can use the full range of local facilities to focus on serving the more reluctant cohorts they are able to persuade.
18. From some councils we have heard concerns that communities won’t always benefit from new drives to vaccinate carers (for example people from South Asian backgrounds with caring responsibilities less likely to identify as a carer), and prioritise people with comorbidities (people in deprived areas less likely to have their conditions diagnosed.)
19. Ensuring socially excluded population groups are offered a vaccine in an accessible way through commissioned services will be crucial.
20. Peer to peer conversations will be crucial in encouraging take up of the vaccine. We need to work with small and large businesses to take on this important role.
21. In rolling out the vaccine the link between Public Health and Primary Care Network teams will be of particular importance. These relationships will be especially important in low IMD areas.
22. Producing accessible, culturally sensitive, multilingual, easy to read information and communications can reduce confusion and increase awareness.
23. Need to ensure positive vaccine uptake rates are promoted. Shift the language to talking about being “vaccine confident” rather than vaccine hesitant.24.
24. Governance systems should be established and used to ensure that all organisations delivering messages to the public on the vaccination programme are consistent and do not share mixed or conflicting messages. According to the Contain Framework Local Outbreak Control Boards provide public engagement and community leadership, including comprehensive and timely communications to the public and a link to ministers. Their role in helping drive vaccine uptake in disproportionately impacted groups and providing governance for this should be considered.
25. Access to testing data enables local authorities to identify local issues, act swiftly in an emerging outbreak and target our communication and engagement measures. The paucity of information regarding the uptake by particular groups needs to be available at a granular level. Councils would really value being able to do the same in terms of vaccine take up, in particular where social workers are now able to book their own vaccinations and we are currently unable to track takeup.
26. Ethnicity data on healthcare systems is often poor, leading to issues in identifying gaps in uptake, and is a barrier to identification of cohorts. The JCVI have identified this as a factor that should be considered when deciding priority groups. Annex A: COVID-19 vaccine and health inequalities: considerations for prioritisation and implementation (Updated 6 January 2021)
27. There is some overlap between those who are clinically extremely vulnerable and those with a disability or learning disability, however not all people with a disability will be CEV or in priority group 6.
28. Practical support to ensure no financial disadvantage is incurred, e.g. loss of earnings due to travel or waiting time to obtain vaccine, transportation costs etc.
29. Training for all healthcare staff, community leaders and community champions as these individuals are recognised for their role as a trusted source of health information for groups. Training should include strategies to initiate discussions about vaccinations and how to tailor conversations to address vaccine beliefs. This will support more meaningful dialogue and provide vaccine facts from a reliable source. There should be a focus on embedding sustainable networks and champion programmes to deliver long term contribution to addressing inequalities as the vaccine roll-out progresses.
30. Develop a training pack for third sector and community volunteers to increase confidence in answering questions regarding the COVID-19 vaccine out in the community.
31. A platform to collate and evaluate what works in increasing vaccine uptake to share this best practice across local systems and across the country to improve performance.
32. In terms of assurance and accountability there is a role for Local Authorities to hold the NHS to account for equity in the programme; and supporting uptake though local communications and our reach into communities. SOLACE raised that this is working well in Rotherham as an example. MHCLG gaining assurance from the NHS that data is being shared and the conversations officers are able to have with the LGA and others are standard practice would benefit other places.
33. A big issue that is still unresolved is the vaccine allocation process:
33.1 Government should seek to move away from the ‘push’ model to enable local teams to better plan their vaccine delivery – this is all tied up in vaccine supply, but that is improving and the current model hampers ability to plan expansion of delivery
33.2 Vaccine allocation is not equitable. Lots of concern on this both in terms of north/south and regional variations in supply, and in terms of allocation at PCN level. Some areas are seeing inequity in vaccine supply to PCNs with more deprived populations at.
34. Solutions to the above would be more transparency in terms of the allocation model with reassurance that need and equity are accounted for in the approach and the ability to make local decisions at ICS level on allocation rather than national direct to practice
35. We must widen access to vaccination and expand delivery capacity once vaccine supply is no longer the rate limiting factor). We would be keen to see vaccine delivery in community pharmacy pushed harder to widen access and also to enable General Practice to return to looking after those with long term conditions and delivering preventative work like health checks and CVD screening.
Barriers to vaccine uptake
36. Recent representative survey data from the UK Household Longitudinal study shows overall high levels of willingness (82 per cent) to take up the COVID-19 vaccine. However, marked differences existed by ethnicity.
37. Barriers to vaccine uptake include:
- 37.1 Perception of risk
- 37.2 Low confidence in the vaccine
- 37.3 Distrust
- 37.8 Access barriers
- 37.5 Inconvenience
- 37.6 Socio-demographic context and lack of endorsement
- 37.7 Lack of vaccine offer or lack of communication from trusted providers and community leaders.
38. There are a wide range of barriers facing people living in deprived communities, including, access, health literacy, engagement with healthcare services.
39. Concerns around fertility have been widely reported by health and social care staff, and these concerns may continue as younger cohorts begin to be offered vaccinated. RCOG guidance states: "There is no biologically plausible mechanism by which current vaccines would cause any impact on women's fertility. Evidence has not been presented that women who have been vaccinated have gone on to have fertility problems.”
40. Carers not formally employed may be hard to identify and call for vaccination. Unpaid carers fall into priority group 6, despite formal paid carers falling into priority group one, and vulnerable patients may be put at risk if their carer falls ill with COVID-19. Communications plans need to include this group to ensure awareness of eligibility. Stockport carers organisation have proposed a method to ensure unpaid carers are appropriately recognised and called for:
- 40.1 Patient contacts practice requesting coding as carer
- 40.2 Practice provides Signpost information to patient for them to contact and register
- 40.3 Signpost issues Carers Card, if caring role warrants this
- 40.4 Signpost securely (password protected) emails confirmation of patient carer registration to practice, including Signpost registration number if required.
Adviser – Test, Trace and Contain