Covid boosters: “apathy” blamed for low vaccination rates in Lancashire, as NHS asks what it can do to make it easier to get a jab

Data shared with the Local Democracy Reporting Service (LDRS) shows that the middle aged, some ethnic minority communities and even younger people deemed at high risk from the virus are all coming forward for the jab in far lower numbers than during previous phases of the campaign.

There has also been a particularly slow take-up amongst health and social care staff in the county - with little more than a third of the workforce so far registered as having received the most recently offered dose.

Across all sections of the Lancashire and South Cumbria population for whom an autumn booster is available as part of the national programme - broadly, the over-50s and the most clinically vulnerable and those who care for them - only 51.8 percent of residents had opted to have the shot by late November.

Jane Scattergood, the senior responsible officer for the Covid vaccination service in the region, told the LDRS that the circumstances in which jabs are sometimes recorded means that the figures within individual cohorts are likely to be higher than the official stats suggest.

She also says that some health and social care workers who have recently been infected with Covid are planning to maximise the benefit from their jabs by getting them in the new year - in recognition of the fact that they will currently still have some “natural immunity”, something which she says is “probably a very wise move”.

However, the vaccine boss acknowledges the stark contrast between the public clamour she faced in her role when the first generation of vaccines were being rolled out exactly two years ago and the very different challenge confronting her today.

“In that December and January (of 2020/21), we had unmanageable queues of the elderly in the snow. My problem was keeping [them] warm while they queued up - and making our services ran faster.

“[Whereas] now…overall, we’ve absolutely got vaccine apathy - or a view that Covid is over - in the entire population,” Jane explains.

Lancashire and South Cumbria is by no means alone when it comes to an apparent loss of collective concern over Covid - and its autumn booster rate is actually higher than the North West average of 49.3 percent.

Uptake amongst those older age groups who queued in the cold for their first jabs two winters ago remains strong - at above 80 percent in the over-80s and in excess of 75 percent for 70-79-year-olds.

However, within the over-70 age range, there is a significant disparity in uptake between people from different backgrounds. Just over 80 percent of those classified as White British are known to have had an autumn booster, compared to 55 percent of people of Asian heritage and 53 percent from the Black community. The figure is higher - at 64 percent - for those of mixed heritage.

There is also a marked decrease in the rate amongst younger demographics - with fewer than 1 in 3 50-54-year-olds from all communities having been boosted this autumn.

Jane Scattergood hopes that the NHS has done everything that it can to remove any practical barriers to vaccination for all Lancashire and South Cumbria residents, regardless of their personal circumstances.

Vaccines have been available at over 170 sites in the region this autumn, including at more than 80 “pop-up” facilities. Until last week, there was even an option to have a dose delivered in your own home.

However, Jane is nevertheless keen to hear from anyone who feels that their particular needs have not been met by the service that has been on offer.

“If they need something different from us…we’ll bend over backwards to make it so,” she pledged.

Yet the inescapable conclusion from the autumn booster statistics appears to be that it is not just the vaccine itself which wanes over time - but public demand for the protection it continues to offer most people from the worst Covid outcomes.

Jane says that prevailing attitudes towards the virus are “undermining” the impetus for eligible people to grab a jab - no matter how convenient it may be to do so - because of a narrative that suggests Covid is now “only mild [or] like a cold”.

“[Some people also think], ‘I’ve had Covid this summer, the vaccine didn't stop me getting [it], so why would I bother coming forward?’”

Jane says that the Covid “threat perception” has changed with regard to the virus, but adds that there is no “guarantee” that any virus will evolve to become milder - even if they tend to do so.

The role of vaccine boosters in reducing the threat from the constantly-mutating Omicron variant was reflected during a devastating outbreak in Hong Kong earlier this year. That saw the nation register one of the highest Covid mortality rates in the world - and a study later linked the death toll to low vaccine coverage, especially in the over-60s

Across the whole population, only five percent of those eligible had been boosted, while less than half of people aged 60 and above had received even their two primary vaccine doses.

Meanwhile, the LDRS has seen a Lancashire and South Cumbria NHS internal presentation slide which notes that there has been a “significant reduction in the focus on Covid-19 [from] central government” during the autumn booster period, which “has not helped to champion the ongoing vaccination programme”.

While Jane stresses that that comment was an “observation” and not the official position of the area’s integrated care board, she says that Covid appears to have fallen off the national agenda to a degree, amid messaging that suggests: “There’s nothing to see here”.

Yet Covid continues, typically, to contribute to the deaths of dozens of people a day in England. It was mentioned on the death certificates of 221 individuals in the week to 25th November.

During the four Omicron waves seen this year, hospitalisations of patients with Covid have tended to be for reasons other than the virus itself. That was estimated to be the case for around two thirds of Covid-positive patients being treated at LTH during a spike in infections in July.

However, any exposure to the virus risks not only Long Covid - the persistence of symptoms such as extreme fatigue and shortness of breath more than 12 weeks after infection - but also, studies are now showing, other serious health threats. That includes increased risk of heart attack, heart failure and stroke for up to a year after infection.

Jane Scattergood also warns that it could necessarily be decades before there is a full understanding of what Covid “will do to you in 10, 15, 20 years’ time”.

She says that enthusiasm for vaccines amongst older sections of the population is likely to be a function not just of concern about their increased risk from Covid - but their long memories.

“There are, thankfully, two or three generations of people that don't remember horrible vaccine-preventable diseases [like smallpox and polio]. It Is our elders who remember how awful that they were and [so] they are vaccine believers.

“[They recall] their best mate at school who’s now got a short and twisted leg because of polio and [that’s] why everybody accepted their polio drops - because it was the solution, like everybody accepted Covid vaccine [was] in the first phases…to a perceived threat.”

However, irrespective of vaccine hesitancy or apathy, Jane says that regular Covid jabs are likely to become a permanent feature of the NHS schedule - possibly twice a year for the over-70s - and potentially in a combined shot with a flu vaccine. She is also confident that there will be investment in the effort to improve the effectiveness of Covid vaccines.

“I would like to see such a level of immunity that…it does have a demonstrable impact on transmission, so we can really box Covid into a corner.”

The Department for Health and Social Care did not respond to a request for comment on some of the issues raised in this article.

‘ROLLING BACK RESISTANCE’

The NHS in Lancashire and South Cumbria established four groups dedicated to increasing the uptake of the Covid autumn booster in sections of the population amongst whom it was likely to be low - the deprived and isolated, homeless people and asylum seekers, pregnant women and some ethnic minority communities.

Jane Scattergood, who leads the Covid vaccination programme in the region, says “some mistrust” of officialdom within certain communities has often combined with the Covid apathy now being seen across wider society to reduce the take-up rate.

However, she believes that the “labour intensive” investment in highly targeted, hyper-local intervention has paid off - and notes that older age groups are more likely to accept a vaccine irrespective of background.

“We work with local community leaders, council engagement officers and faith leaders and we [visit]...streets where we think uptake is poor. Those guys go out and do myth-busting, education and have dialogue with the citizen, say, on the Monday and then on the Wednesday, a couple of nurses with a cold box of vaccines revisit those addresses, with translators [and] community leaders, and make a direct offer [of a jab],” Jane explains.

Although the vaccine-at-home service has now ended, very localised pop-up vaccine facilities remain - and Jane says that she hopes that the engagement done with local communities has a “ripple effect” of encouraging others to take up the offer of a jab when it is presented to them, when they might not otherwise have done.

She also told the LDRS that she would welcome comments from any community which feels that the NHS could be making things easier still to access vaccines.

“We’re very happy to hear critical feedback. [Say to us], ‘Yes, you've done all these things, but you haven't done this - and if you only did this, we might see a better uptake.’”

Lancashire and South Cumbria’s Covid vaccine programme was handed the Health and Equity Campaign accolade for its vaccination outreach work at the Caribbean and African Health Network awards in October.

Jane says that the only downside to the service that has been offered is the likely undercounting of vaccines actually delivered to ethnic minority groups - and the resultant lowering of official statistics - because of a lack of internet access in the places they are being administered and the need to capture accurate demographic information first on paper and then input it into a computer later.

Jane adds that similar vagaries connected to data recording could partially account for apparently low uptake amongst health and social care staff - because if an employee receives the jab somewhere other than their workplace, they have to remember to advise their employer, who, in turn, has to register that fact.

WHO CAN HAVE A COVID AUTUMN BOOSTER?

You must be:

***aged 50 or over

***aged five and over and at high risk because of a health condition

***aged five and over and at high risk because of a weakened immune system

***aged five and over and lives with someone who has a weakened immune system

***aged 16 and over and is a carer

***pregnant

***a frontline health and social care worker

It must be at least 91 days since your last dose before you can have a booster shot. Find out where you can book a booster – or any Covid jab – on the NHS website.

BOOSTER BREAKDOWN

Across Lancashire and South Cumbria up to 27th November:

All eligible groups - 51.8 percent

Care home residents - 84.5 percent

Over-80s - 81.0 percent

75-79-year-olds - 80.8 percent

70-74-year-olds - 77.8 percent

65-69-year-olds - 70.5 percent

60-64-year-olds - 54.2 percent

55-59-year-olds - 41.0 percent

50-54-year-olds - 29.4 percent

Health and social care workers - 34.8 percent

At-risk 16-64-year-olds - 33.5 percent

Within the over-70 group:

White British - 80.2 percent

White Irish / other white - 76.3 percent

Mixed White Black Caribbean; Mixed White Black African; Mixed white Asian; ‘any other mixed background’ - 64.3 percent

All Asian backgrounds -55.6 percent

All Black backgrounds - 53.4 percent

Chinese - 62.4 percent

All other ethnicities - 59.1 percent

Source: Lancashire and South Cumbria Integrated Care Board