There is growing evidence that in some specific communities there is significant reluctance to take up the potentially life-saving coronavirus vaccination. So, the role of local government will play an integral part in closing these gaps and in working with the NHS to build a positive message regarding the COVID-19 vaccine.
Directors of public health are only just starting to get access to data on ethnicity and medium super output area level data on vaccine uptake, so we are now gaining intelligence of our true position. The anecdotes of reluctance and hesitancy from frontline primary care are common and repeat the same themes of worse uptake in some ethnic communities and some deprived communities.
Hesitancy seems more common, at least in the clinical anecdotes, in African and Caribbean communities. In discussions with local faith leaders from these communities, their shared history of institutional racism and abuse is underpinning a much higher level of mistrust fanned through extremist views and myths being circulated on social media.
The disproportionate impact of the first wave on ethnic minority communities, especially those in African and Caribbean communities, created a culture of mistrust where the communities saw people dying but the ‘system’ was unable to identify rapid trends or analyse ethnic data fast enough to respond.
These factors, combined with a limited cultural competency in messaging and a lack of translated and accessible information, all created layers upon layers of mistrust which are now playing out in vaccine hesitancy. Further to this, there is some suspicion that far right extremists are generating some of this material specifically with the intent to manipulate these communities into vaccine refusal and drive up death rates – a truly sickening twist.
Underpinning this is the fundamental issue of the systemic disconnect between minority communities and the public sector, a fracture in the social civic contract that has been growing over the last three decades.
Addressing this lack of trust cannot be done overnight but acknowledging it exists is an important start. Building back trust is something that requires many parallel actions working with elected members, community leaders, faith leaders, and citizens themselves. In Birmingham, we have invested heavily in community engagement since the start of the pandemic.
We have held weekly meetings with faith leaders since March 2020 to hear their concerns, answer their questions and work with them to influence their congregations. This has been an essential line of communication to inform our approach which since late autumn the NHS has utilised to start to address vaccine concerns. Several of our faith leaders have organised specific faith seminars on vaccine understanding to improve uptake and several have consented to be vaccinated on camera to help increase confidence in their congregations.
Building on the best practice from Newham, we now have more than 590 COVID Community Champions, volunteers from across the city who meet with us weekly in live Q&A sessions and receive information to flow out through their personal networks. Working with the local NHS we have launched a three-part ‘Understanding Vaccines’ programme which helps to explain what vaccines are, how they are developed, the specifics of the COVID vaccines, and answer some of the common questions people are asking.
But community engagement should be about investing in communities as well. If we are truly going to improve relationships then we need to help build the community infrastructure that has been decimated through repeated cuts to local government funding.
Through an open tender process we have commissioned 19 community engagement partner organisations to work with 35 different targeted communities of identity and interest. These are community organisations working with local people and local networks to provide two-way communication about COVID and now about vaccination.
The vectors of communication vary from text message and audio clip cascades to translated live Q&A on Zoom or Instagram Lives, with community influencers answering questions as they scroll up the screen.
We have committed to taking the experts to where communities can interact with them and ask questions directly to build confidence and trust.
We have also invested in local community radio and TV, working with stations such as New Style Radio, Unity FM, Switch FM, Sikh TV, and others, to disseminate information into homes on the stations they listen to and trust.
Working with these stations and local politicians has been a key part of our strategy to explore every angle to give all our communities the knowledge to protect themselves.
Elected members have a pivotal role alongside specialist officers in building confidence and trust and this network should not be underestimated by the NHS.
Locally we have seen ward members bring together local leaders and community influencers rapidly to mobilise responses when case rates have spiked in specific areas and been successful at cutting through to different segments within their communities.
Over the last year, we have learned a lot from these relationships. Engaging in honest and open two-way dialogue hasn’t been easy or comfortable but it has been essential. What we have built to engage on COVID risk reduction is now being fully utilised to build confidence and trust in the COVID vaccination programme.
There is no time to reinvent the wheel and these relationships are anchors in communities that need to be nurtured and reinforced to address the challenges of vaccine hesitancy if we are to achieve a brighter future living in a COVID world.
Dr Justin Varney is director of public health at Birmingham City Council
@DrJV75