Stark variations in Covid vaccine uptake between richer and poorer areas of England, together with “stubbornly high” coronavirus rates in some deprived communities, pose serious questions about the measures needed for restrictions to be safely eased.
Experts fear Covid could become a disease of the poor, with wealthy communities protected through vaccination and having lower exposure to the virus, while more deprived communities are left at greater risk as a result of lower jab uptake, greater prevalence of underlying health conditions and greater exposure to the virus through factors such overcrowded housing and public-facing jobs.
“It is likely that as the country opens up, there will be pockets of the virus that get less attention and publicity, and the government will basically allow this to happen,” said Prof John Drury of the University of Sussex, a member of both the SPI-B advisory sub-group of Sage and the Independent Sage group of experts.
Not only could such a situation be devastating for communities, but experts say it could lead to social division.
Prof Stephen Reicher of the University of St Andrews, and a member of SPI-B and Independent Sage, said particular communities could end up being “blamed” for the virus continuing to circulate, and for restrictions, while the use of vaccine passports – under discussion in the UK – could lead to a “social apartheid” with certain groups excluded from public spaces, potentially leading to clashes with the police.vaccines.
But the question remains how to unlock the country without either Covid, or Covid restrictions, having a disproportionate impact on particular groups.
According experts such as Reicher, the key is to drive down infection rates across the country so outbreaks can be contained by a functional test, trace and isolate system – something he and others argue has yet to be put in place.
But Reicher also stressed the need to change the way communities with low vaccine uptake and high infection rates are viewed, with a concerted effort needed to build trust, provide suitable information, make workplaces safe and offer practical help with vaccination and testing, contact-tracing and isolation.
“It is not that these are … difficult communities,” he told the Guardian. “The problem lies not with them but with us.”
Prof Andrew Hayward, director of the UCL Institute of Epidemiology and Health Care, also emphasised the need to boost resources for disadvantaged areas, including placing vaccination centres at their heart, employing community groups to share information and dispel vaccine myths, shifting test and trace to local teams and offering greater financial support for isolation.
“We need to do everything possible to ensure our poorest communities can benefit from testing and vaccination and are not further disadvantaged when they are asked to self-isolate,” he said. “Otherwise, we will soon be in a situation where the poorest areas of the UK will be forced back into lockdown due to unacceptable death and hospitalisation rates.”
But while some efforts towards such goals are under way – such as the bus-turned-mobile jab unit in Crawley – hurdles remain. Data released last month revealed the majority of those who have applied for self-isolation support in England were turned down.
Fears that Covid could become endemic in deprived communities is not new. The question is whether the government’s approach to tackle it will be.