Why blaming vaccine 'hesitancy' for outbreaks lets politicians off the hook

Or you could tell the public it is up to them to exert “common sense” judgements, urge them against (but not ban) holidays in amber list countries, and pass the buck for outbreaks of 'Indian' and other variants to “vaccine hesitancy” among deprived neighbourhoods and ethnic minorities.

People queue for vaccine in Glasgow as call made for those who missed first vaccine appointment to come forward

Unsurprisingly, the UK Government opted for the latter this week, and has faced something of a backlash.

In Scotland too, some politicians and public health leaders have been drawing attention to lower vaccine uptakes in some groups to explain why Covid case rates have soared in parts of Glasgow and left the city in level three limbo.

Scotland’s national clinical director Jason Leitch said that up to 15 per cent of Glasgow’s vulnerable population might have missed their first appointment.

READ MORE: Watchdog orders release of Covid care home deaths figures withheld for months

The situation is not entirely clear cut, however.

Firstly – yes – there is objective evidence that people from poorer areas or ethnic minorities are less likely to be vaccinated.

The most recent data from Public Health Scotland shows that in all the age groups from 50 up, white people were consistently the most likely to have been inoculated.

In the 60-64 age group, as of April 21, white people were 26% more likely to have been vaccinated than African people living in Scotland, while 50-54-year-old whites were 21% more likely to have been vaccinated than people of Black/Caribbean ethnicity.

Source: Public Health Scotland

Similar patterns are to be found for deprivation with the very highest uptakes among “decile nine” groups living in the second most affluent tenth of postcodes (curiously, those in the most affluent areas of all tend to be slightly more anti-vax, as seen with the MMR jag).

The very lowest uptakes are consistently found in decile one communities, however, where around 10% fewer people aged 50-54 have had a first dose compared to their decile nine counterparts (80% versus 89.7%).

Source: Public Health Scotland

Surely this smacks of “hesitancy” then?

Well, maybe in some cases – but the reality is more complex.

A report in April by the Deep End group of GPs who work in Scotland’s most deprived communities highlighted their concerns about the risk of “marginalised groups” being missed.

They warned that a failure to be more proactive in vaccinating these individuals “risks a resurgence in Covid cases in our most deprived areas as lockdown eases”.

The fact that “mass vaccination centres are not always well matched to postcode” can throw up obstacles for those with mobility problems who are faced with getting there and back on public transport.

READ MORE: Fewer than one in five applications for self-isolation support payments granted in Scotland

People with “severe and enduring” mental health difficulties were also at risk of low vaccine uptake, and the report cautioned that some shielders with long-term conditions “are now very fearful of leaving home, never mind getting public transport and attending mass vaccination centres”.

Such chronic physical and mental health conditions are, notably, more common in deprived areas, and deprived areas are also disproportionately non-white.

The report called on health boards to accommodate a bigger role for GPs, for example allowing them to “mop up those missed in the initial rollout”.

A second issue is to what extent lower vaccination uptake can actually be said to be causing a surge in cases.

First and second vaccine dose uptake in Bolton (in red and orange bar charts) against the average uptake for each age group across England (Source: Independent SAGE)

Both Bolton and Bedford, the hot spots for the so-called Indian variant in England, have vaccination coverage in line with the average across England, although UK Health Secretary Matt Hancock said that in Bolton “the majority of people in hospital with coronavirus were eligible for the jab but have chosen not yet to have the jab”.

In Blackburn and Darwen, though, six of the nine patients in hospital had been vaccinated (most probably becoming infected before or shortly after their first dose).

Labour MP for Bolton South East, Yasmin Qureshi, noted that her constituency also had “a significant number of intergenerational households as well as high levels of deprivation and unemployment”.

In such communities people are more likely to live in accommodation without space to isolate from other family members, or to work in occupations that cannot be done from home or where self-isolating due to virus symptoms or potential exposure is unaffordable, increasing the risk that infections spread.

“Factor into this that 30% of households do not have access to a car, it all creates a perfect storm for additional barriers to the vaccine,” added Ms Qureshi, echoing the warnings of the Deep End GPs.

Cases and hospitalisations in most recently available seven-day period in Scotland (Graphs by @TravellingTabby)

In Scotland, however, more than 81% of the 2,134 cases in the past seven days have been in people aged 44 or younger who are unlikely to have been offered a first vaccine yet or who will have had their first dose too recently to have developed immunity.

There were also 515 infections in children under 15 who are not even eligible for vaccination.

Similarly in the week to May 12, half of those admitted to hospital with Covid in Scotland – 34 from a total of 67 – were patients under 45.

READ MORE: Glasgow's Indian variant outbreak is the price we pay for UK's 'leaky' border controls

Failures of England’s Test and Trace system have also been implicated in the spread of the B1.617.2 variant, however.

A leaked report this week revealed that eight local authorities in England did not have access to full data on positive cases in their area over a period of three weeks in April and May, when infections were on the rise. The number of missing cases was highest in the Blackburn area.

“This is not a vaccine hesitancy issue,” said Dr Zubaida Haque, a member of the independent SAGE expert group.

“This is about the fact that the government have left open the border... with no virus suppression strategy to stop the Indian variant spreading across the country.”