Supporting the COVID-19 vaccine programme

The army of volunteers that emerged almost overnight was astonishing: furloughed, multi-lingual airline staff with a tradition of excellent customer service (especially when dealing with nervous people); furloughed staff from a local hotel with a very similar skill set; medical and dental students, happy to be able to contribute; and army cadets from the local barracks who were well disciplined and seemingly impervious to the cold when working ‘bare below the elbows’ in a marquee in the middle of winter. They blended into a single, highly functional and adaptable team, and worked long shifts of 12 hours or more without complaining. Those from outside the NHS commented on the pleasure of working in such a supportive atmosphere, and noted that occasionally, when things didn’t go quite as they should, it was the process that was reviewed rather than a finger being pointed at any individual – for some this was a novel experience. And the army cadets learned that in the NHS it is OK to question someone who is more senior.

We have learned a lot from the people who have come for vaccination too. In the early, dark days of last winter they were mostly elderly, often frail and very stoic. Some had not left their home for months as they had been shielding, or too afraid to go out. Some had been bereaved, and were lonely and very isolated. One told me that I was the first person she had spoken to for several weeks and many were patiently waiting for repeatedly postponed operations or investigations. They dressed up for their first trip out – to a vaccination centre - often thinking ahead and wearing short sleeved tops (even when it was snowing) so that they wouldn’t waste a moment of our time when it came to being vaccinated.

As the months went by, and vaccines became available to younger people, there have been more questions, and more hesitancy, about vaccinations. The publicity about the very slightly increased risk of blood clots following an Astra Zeneca vaccine had a huge impact, particularly on people who had relatives abroad, who were being given different advice about the age group for which AZ was suitable. It was very hard to get the risk into perspective for those who were worried, and to persuade them that the risk of being seriously ill, or dying, with COVID-19 was much greater than the risk of having a vaccine. One woman said ‘I don’t want to be responsible for killing myself by agreeing to a vaccine’. Somehow the risk of becoming infected was perceived as a more passive, and therefore uncontrollable, possibility.

The role of social media in promoting vaccine hesitancy cannot be over-emphasised. Frustratingly for a medic, some people are more inclined to believe what they read on a screen than what they are told by a clinician. We heard many of the myths: that vaccination would reduce fertility, that it was a ruse to facilitate world domination by some remote evil organisation, that it would reduce immunity to other pathogens, and that vaccines could not have been tested properly when they were produced so quickly. The initial uncertainty about the safety of vaccines in pregnant women led many to decline vaccination, and sadly that caution has persisted, even though we now know that they are safe. Unfortunately, unvaccinated pregnant women are at increased risk of severe infection and very sadly some have died. The higher incidence of severe COVID-19 infection in non-white ethnic groups has been well publicised and has many causes, including social factors (more likely to live in multi-generational and sometimes crowded housing, and to work in people-facing occupations), as well as genetic susceptibility. Some ethnic groups also demonstrate more hesitancy about vaccines: I have heard people raise concerns that if COVID-19 can be more severe in some ethnic groups then maybe the side effects could be more severe in them too. Others have mentioned the historical abuses of past unethical experimentation such as the Tuskegee syphilis study in Alabama from 1932-1972, in which infected black men were deliberately left untreated in order to observe the natural history of the disease.

In challenging times, trust is a particularly valuable commodity – hard to earn and easily lost. Some people attending to discuss vaccination were hesitant, because fundamentally they do not trust the Government. Why should they do as they were told when Ministers and MPs did not always follow the rules themselves, or even believe they were necessary? One of the most powerful incentives for vaccination turned out to be the freedom to travel again that this enabled. Many people, especially younger adults, knew that their own risks of having severe COVID-19 were small, but they wanted to protect their elderly relatives or more vulnerable friends. Surprisingly small incentives, such as a free hot drink, also helped.

It seems we still have a long way to go and, despite the rhetoric, have not always learned from past experience. The forthcoming change in the law, to make vaccination for people working in health and social care mandatory, may seem to those working outside an obvious way to increase participation in the vaccination programme, but some NHS staff who are hesitant about vaccination have told me that it has made them angry and actually increased their resistance. In my experience, providing opportunities for people to talk, express their concerns and have their questions answered is a much more effective way of encouraging those who are resistant to get vaccinated than coercion. People do not like to be bullied into doing things, especially by people who do not follow the rules themselves. Allowing people to make a choice is empowering; considering their questions and concerns demonstrates respect. For those who are needle phobic, treatment can be offered.

None of us working in vaccination centres knows for how long we will continue to be needed. The prospect of COVID-19 vaccination becoming an annual event is daunting, but the NHS already delivers an annual flu vaccination programme and the COVID-19 vaccination programme is slick and works well; I am sure it will cope. It is frustrating that some people will never accept vaccination, and they will remain at higher risk of becoming seriously ill and dying. We are motivated by a hope that vaccinating as many people as possible will enable life for everyone to return to something more like normal, but the timescales are far longer than most of us imagined a year ago. While some volunteers from other sectors have returned to their old jobs, others have successfully applied for substantive NHS posts or are training to be nurses and they enrich our workforce; one benefit from an otherwise extremely challenging year.

Professor Frances Flinter, Council Member