Policy paper

UK COVID-19 vaccine uptake plan

Published 13 February 2021

Foreword

Foreword from Secretary of State for Health and Social Care and Minister for COVID-19 Vaccine Deployment

Only a few months ago, there were doubts that an effective COVID-19 vaccine would ever be developed – now 5 companies have published positive phase 3 results, 3 vaccines have been authorised for use and over 13 million people across the UK have received the first dose of a vaccine.

Vaccination is the way out of this pandemic, and we are grateful to everyone who has played a part in the vaccine effort, from the scientists and trial volunteers to NHS and care sector staff to volunteer stewards at vaccination sites, for their hard work and dedication to overcoming this virus.

The UK COVID-19 vaccines delivery plan published on 11 January provided details about vaccine investment and supply, as well as how vaccination sites will be operated and staffed across the country.

It is fantastic progress that over 13 million people across the UK have already taken up the offer of a vaccine and uptake across cohorts has been strong. We had assumed uptake would be around 75% based on previous vaccination programmes but in fact, so far, over 90% of care home residents and over-75-year-olds in England have chosen to receive their first dose of the vaccine. But we must not be complacent; we know that there is variation in the level of uptake across different geographies and communities and we will not rest until everyone who is eligible is protected.

We need to ensure that everyone feels that the vaccine is for them. For some groups of the population the intention to be vaccinated is lower than others. To make sure all our communities are protected, this Vaccine Uptake Plan sets out our approach to making sure that as many people as possible take up the offer of vaccination. The vaccinations are extremely safe and provide protection both to you and your community.

We urge everyone to take the vaccine when you are invited to receive one. This will save thousands of lives. Thank you for everything you are doing to help us beat coronavirus.

Introduction

The COVID-19 vaccine is the best way to protect us from coronavirus and will save thousands of lives. Three COVID-19 vaccines have now been authorised for use in the UK by the medicines regulator, the Medicines and Healthcare products Regulatory Agency, after meeting strict standards of safety and effectiveness. The vaccines are very safe, very effective and having a vaccination when it is your turn will protect you, your friends, your family and your community.

Vaccine deployment started on 8 December, in the order of priority set by the independent Joint Committee for Vaccination and Immunisation (JCVI). Starting with those who are aged 80 years and older, care home residents and staff, as well as frontline health and social care workers, we are now vaccinating those who are 70 years of age and over and clinically extremely vulnerable individuals. Thanks to the brilliant work of the NHS and its partners, as of 11 February over 13.5 million people across the UK have received their first dose. By 15 February, we will aim to have offered at least a first dose to everyone currently identified in the top four JCVI priority groups, who together account for around 88% of the deaths attributable to COVID-19.

As we continue to offer vaccination in line with the JCVI priority groups, we need to ensure that everyone in each group has the opportunity to get vaccinated, the information they need to make an informed decision, and that no-one is left behind. We have assumed a benchmark uptake rate of 75%, based on comparable programmes. So far, we have exceeded our own expectations, seeing over 90% uptake in those over 75 years of age and our aim is to achieve as high uptake as possible in all other groups.

We need a collective effort to save as many lives as possible and a relentless focus on ensuring our approach is fair to individuals and communities across the country. This plan provides an overview of how we are doing this at a national and local level and how we will intensify and focus our efforts to work in partnership with our communities to increase vaccine uptake and ensure equity of access.

Our approach

Our collective aim is to improve vaccine uptake across all communities. The approach is underpinned by four enablers at national, regional and local level. These are:

• working in partnership
• removing barriers to access
• data and information
• conversations and engagement

Working in partnership

To ensure as many people as possible take up the offer of a vaccine when it is their turn, we need to work in partnership at every level and at every step of the way. This plan takes a local, community-led approach, and support will be provided from government, NHS England and NHS Improvement (NHSEI) and local authorities to coordinate and enable action.

At a local level

To vaccinate as many people as possible, as quickly as possible, the NHS, local authorities and voluntary, community and faith sectors continue to work together to ensure vaccination services can operate in their communities. We are already seeing thousands of individuals and organisations across the country working together to help and encourage people to get vaccinated when it is their turn, and we want to foster this level of community engagement in every corner of the UK.

Local directors of public health are crucial to the national vaccination effort. They and their teams bring deep experience of immunisation and screening programmes and can play a critical role in understanding the whole population of an area, empowered through two-way communication at national and local level. Core to the role of local directors of public health is a statutory responsibility to advocate for an emphasis on reducing health inequalities and improving access in underserved groups.

Health and Wellbeing Boards support decision-making as the key leaders from the local health and care system in each area. Integrated Care System/Sustainability and Transformation Partnerships offer local-level support and understanding of where the vaccine needs to be taken to ensure diverse communities and unvaccinated groups are reached.

Starting with 60 hospitals in early December, there are now more than 2,700 different locations across the UK offering vaccinations in local communities. These range from GP surgeries and high street pharmacies, to larger sites in bigger urban areas that can vaccinate a lot of people, safely and quickly. For those who are housebound or residents of care homes, GPs and their teams are taking the vaccine to them.

As the programme expands and more people are offered the vaccine, more centres will open their doors to offer local vaccination services, for example in places of worship, taking the vaccine to communities. In Lancashire, local engagement and consultation with the community helped decide where their local vaccination centre should be. In Birmingham, the Al-Abbas Islamic Centre in Balsall Heath worked with local NHS leaders to establish a vaccination centre in the mosque and GPs working with leaders of the Shree Swaminarayan Mandir temple in Kingsbury wanted to send an unequivocal message to the Hindu and wider South Asian community that the vaccine is safe and religiously permitted.

At a national level

The Department of Health and Social Care (DHSC), Ministry for Housing, Communities and Local Government (MHCLG) and other government departments are working together with NHSEI, Public Health England (PHE) and others to deliver a coordinated uptake plan. There is a role for all parts of government to play to drive vaccine uptake, from the Department for Business, Energy and Industrial Strategy encouraging people to take up the offer of vaccination through employers, to the important work of the Department for Digital, Culture, Media and Sport (DCMS) on tackling misinformation.

A new Vaccination Equalities Committee, led by NHSEI, brings together government departments with national representatives from the Association of Directors of Public Health, Local Authorities, Fire and Police services and third sector organisations to advise and guide the vaccine deployment programme on addressing inequalities. It plays a key role in contributing to the development of the overall vaccine deployment strategy, drawing on the expertise and experience of its members. There is also an important role for the education sector, through schools, colleges and universities as, for many families, these are trusted sources of information and support.

Over £23 million funding has been allocated through the Community Champions scheme to 60 councils and voluntary groups across England to expand work to support those most at risk from COVID-19 and boost vaccine take up. This is part of over £7.9 billion government funding provided to councils to help them support their communities during the pandemic. The Community Champions Scheme will enable councils and voluntary groups to expand local schemes that support those most at risk from COVID-19 and boost vaccine uptake. The funding supports local engagement with groups including older people, disabled people, people from areas of deprivation as well as people from ethnic minority backgrounds who are disproportionately impacted by COVID-19.

Case study 1

Slough: working with community champions

Slough suffers from a lower uptake of immunisations across a range of vaccines including Influenza, Measles, Mumps and Rubella (MMR) and Human Papillomavirus (HPV). Research suggests that vaccine myths remain prevalent in Slough. For some parts of the community, cultural reasons present a challenge to vaccination uptake.

In September 2020, the OneSlough partnership, led by Slough Borough Council, the Slough CVS (Council for Voluntary Services) and the East Berkshire CCG established a network of 'Community Champions'. Their role is to support the Covid response in communities that have been disproportionately hit by the virus. By the end of 2020, there were 600 community champions.

At the beginning of December 2020, the champions' role developed to become 'vaccine champions' to ensure as many residents as possible are vaccinated, whilst at the same time helping dispel any vaccine myths and disinformation.

Since then, the partnership has provided training and information sessions to the champions on how to talk about the vaccine and mitigate the impact of disinformation, produced tailored social media resources and created a bespoke local FAQ guide on the vaccine (which is given to everyone receiving a rapid Covid test in the borough).

The partnership has also trained some champions as volunteers at vaccination centres themselves to support logistics and community engagement on the ground. Virtual information supported by champions and delivered by public health and CCG experts, for example with the University of the Third Age cover vaccine hesitancy. Sessions like this are being offered to all local community groups.

Removing barriers to access

According to recent polls, the overwhelming majority of adults reported they would be very likely or fairly likely to have the COVID-19 vaccine if offered. However, we know that there are multiple factors which contribute to vaccination uptake rates and impact on different communities in different ways.

Some communities may require more support and we are working with partners across health and social care, local government, and the voluntary sector to support meaningful engagement and action such as that in case study 2.

Case study 2

Bradford Metropolitan District Council

Bradford Council and the Race Equality Network work closely with community centres including the Karmand Centre and The Laisterdyke Hub to encourage vaccine uptake in different ethnic minority communities. The areas covered by these community centres include some of the worst deprivation in the district and the country.

The council built on established sessions and events, such as the daily online women's exercise classes. They used these forums to share messages about vaccines and gave people in the community the opportunity to ask questions. These sessions provide the chance to celebrate together when anyone is invited for or receives their vaccination.

WhatsApp groups have been very successful in sharing messages from trusted community voices including local Imams and GPs. These messages are presented in a range of formats – such as film, audio clips and social media tiles – as well as clear, accessible text.

The Befriender Service and Youth Service proactively engage people in conversations to offer the chance to answer questions, provide information and encourage vaccine take up. These conversations take place over the phone or at the door.

Facebook Live events have been extremely well-received. Trusted professionals and community leaders answered questions and cleared up myths, and doctors working on COVID-19 at local hospitals talk about the risks of catching the virus.

The more people get vaccinated and the more normalised vaccinations become, the easier the conversations are.

Building trust

The most trusted voices are clinicians and vaccine and immunisation experts, recognisable frontline health workers such as GPs and nurses, community and faith groups/organisations as well as trusted stakeholder groups. To continue to build trust, we must work at a national and local level to prioritise:

• giving people information in formats that connect with them
• information sharing from relatable leaders who understand people's specific circumstances (see case study 3). Sometimes this is also wider than GPs, clinicians or faith leaders but will be local community champions or local community links.
• understanding the power of individual choice and that choice should not be judged, for example seeking to understand fears and concerns, and then providing answers and evidence-based reasons to alleviate the fears
• ensuring appropriate, tailored outreach and engagement from familiar authorities are available where mistrust exists between individuals and healthcare professionals

For example, NHSEI and PHE have been working with Rethink Mental Illness to understand barriers, and common causes of concern faced by people living with severe mental illnesses. They are using these insights to develop and promote targeted communications materials to help respond and reassure these communities. Top tips for vaccinators have been developed to support people living with learning disabilities and autism to access vaccination when it is their turn.

The adult social care workforce has a higher percentage of women and people from ethnically diverse communities than the general population of England, and evidence shows that people in these groups are more likely to be hesitant about taking the COVID-19 vaccine. Reasons for health and social care workers being hesitant include lack of knowledge about the vaccine, misinformation and mistrust of government and perceptions of equality and discrimination in health and public services.

Uptake is even more critical for those caring for patients and others in the population who are at a greater risk of serious outcomes from COVID-19. There are ongoing initiatives at the national and local level to encourage vaccine uptake among the adult social care workforce. DHSC is developing communications materials to encourage vaccine uptake, which are being shared with social care stakeholders to use in conversations with members of the workforce who are recognised as clinically vulnerable.

DHSC, NHSEI and DCMS are also developing products and messaging aimed at tackling misinformation, a proportion of which is targeted to ethnic minority and hard to reach audiences.

Case study 3

Home care manager inspires COVID-19 vaccine confidence in her staff

Gbemisola Akinyemi, Registered Branch Manager of MiHomecare, works closely with care workers who support vulnerable adults in their homes. Gbemisola noticed many of her staff were initially hesitant to take the COVID-19 vaccine. Through open communication and sharing her own vaccine experience, she has inspired more staff to get vaccinated themselves.

"Initially only one or two of our frontline care workers who deliver direct personal care to the most vulnerable were interested in getting vaccinated. I was certain that education would help improve confidence. I did my own research to share information and help encourage staff to make informed decisions about the vaccine."

"Still, I knew this wouldn't be enough. So, we posted a video of me being vaccinated on our workplace social media and WhatsApp group so that our care workers can see that it is simple and safe and can be encouraged by my experience. Since posting the video, the number of staff taking the vaccine has increased and more care workers are showing interest daily. Our Local Authority even noticed that our uptake has been very encouraging compared to other providers."

"Care workers are now realising that they need the vaccine to reduce the risk to those they provide care to and therefore to continue doing their important work."

"I would urge care managers to find credible information about the vaccine, attend webinars and read official guidance so that they can be well informed when they discuss the vaccine with care workers and can empower them to make their own decision to take the vaccine."

Watch Gbemisola have her vaccine: Home care manager Gbemisola Akinyemi receives her COVID-19 vaccine

Being invited for an appointment

Not everyone is registered with a GP. This includes those experiencing homelessness, people who may not live in a fixed location, refugees and those seeking asylum or simply because an individual chooses not to. NHSEI, working with partners such as Groundswell and Friends, Families, and Travellers have launched the 'Everyone is welcome in general practice' initiative, which encourages and supports people to register with a GP. Vaccination can be offered without an NHS number. We have also asked councils to ensure that all those sleeping rough are registered with a GP, and that targeted support is built into local area vaccination plans. This means that when such individuals are due to be vaccinated in line with JCVI priority groups, they can be contacted.

Booking an appointment

For those who choose to book an appointment at a vaccination centre or community pharmacy, we are ensuring booking an appointment is as accessible as possible. The National Booking System provides written translations of letters and patient information including Braille, easy read, large print and audio versions. All of these services are also available over the phone if people choose to call and book an appointment. GP led vaccination services will offer appointments through telephone, text, letter and online.

GPs use the National Immunisation Management System database to identify those who have not yet been vaccinated and follow up with invitations and reminders to help make it easier for people to attend an appointment (an approach known as call and recall).

Choosing a vaccination offer

The NHS is offering vaccinations to communities using three main models: GP and community led local vaccination services, hospital hubs and vaccination centres. For those who are housebound or residents of care homes, GPs and their teams are taking the vaccine to them. The NHS is supporting this through a £10 payment to general practice for every COVID-19 vaccination they deliver to someone who is housebound, in line with JCVI prioritisation.

Over 97% of the population live within 10 miles of our current vaccination sites. Over the coming weeks the NHS, working together with local authorities, will continue to set up more vaccination sites and increasingly offer these in community settings, including places of worship.

The pandemic may also impact on an individual's ability to attend a vaccination, for instance due to the cost of transport or having to miss work. We are piloting different ways to improve access for those most affected, for example working with local taxi and bus companies whose normal work has reduced because of the pandemic to help with transport, as well as large retailers and others with access to free parking. See case study 4 for an example of this.

Case study 4

Crawley 'vaccine bus' from the Alliance for Better Care

The Mobile Vaccination Service (MVS) is a new way of breaking down barriers to accessing the COVID-19 vaccine. It uses the flexibility of the Oxford University/AstraZeneca vaccine to bring the vaccine to parts of the community which might otherwise be harder to reach, including those who have been shielding or would struggle to get to a vaccination site.

Launched by theGP Federation Alliance for Better Care (ABC), the MVS uses a 'vaccine bus', staffed by the ABC Community Vaccination Team, providing a clean space with one way flow and easy disabled access. Vaccine doses are taken from a registered site on the day of use, and appointments for the mobile unit are by invitation only and are booked by the local GP practices.

Potential locations for the MVS are agreed with health and care leaders at a local level, in partnership with local authority Community Development teams, charities like Citizens Advice and other community and voluntary organisations. Locations which could host the MVS need to be accessible, Covid-secure, and have nearby amenities such as toilet and handwashing facilities.

MVS can be especially helpful for individuals who are at greater risk from COVID-19, such as those who are clinically extremely vulnerable and advised to shieldwhen transmission rates are high. Where the MVS is being used to provide vaccinations to people who are shielding, a text message explains that they will soon be able to choose where to go for their vaccination, giving them options they wouldn't otherwise have had.

Getting your vaccination

At a local level, vaccination services have also put in place adjustments to ensure people with seen – and unseen – disabilities can access a vaccine safely and easily when it is their turn to do so. Guidance has also been issued to the NHS that makes it clear that sites need to be accessible and provide appropriate support including British Sign Language interpreters, disabled accessibility, equality and diversity training, psychological first aid training and have suitably private spaces to complete consent and capability assessments.

Across the country, the NHS has set up vaccination sites in gurdwaras, mosques and temples, and local teams have been supported to take vaccine into local communities to maximise uptake.

Data and information

Data and evidence are crucial to understanding where we need to focus particular effort. It is important to act on what we know from previous vaccination programmes and attitudinal surveys. Uptake data is important for assuring whether enough is being done, but waiting for uptake data to act, risks interventions coming too late to ensure everyone accepts their vaccination offer when their turn comes. We know from previous vaccination programmes that uptake is likely to be lower among minority ethnic groups and survey data is starting to confirm that. Attitude surveys for COVID-19 vaccines confirm this trend is continuing, and local Healthwatch surveys provide a local perspective.

We are also collecting and monitoring uptake data to drive and improve the national deployment plan, as well as sharing data to support local uptake action and decision-making. A recent cohort study covering 40% of GP practices in the UK, confirms divergence in actual uptake between different ethnic groups and between more and less deprived groups. Case study 5 explains how partners in Blackburn with Darwen have used data and analysis to support local communities who are more hesitant about receiving the vaccine.

At a national level, the NHS publishes daily data on the number of first and second doses administered, now broken down by region. Weekly publications share data on the number of first and second doses broken down by age category, ethnicity and STP/ICS. Local authority directors of public health receive daily updates on vaccine uptake in their areas, broken down to small areas (MSOAs) and by ethnicity.

Locally, teams addressing inequalities in their area should consider gathering local intelligence and bespoke data when setting priorities and planning interventions, understanding their populations and also using PHE's template local action plan to set out an approach. This tool helps to comply with The Health and Social Care Act 2012 legal duties on health inequalities and will also help when considering the requirements of the Equality Act 2010.

Information

DHSC is working with MHCLG, PHE and the NHS to ensure local authorities, faith groups and organisations, including those in the voluntary sector representing communities, have all the advice and information they need about COVID-19 vaccines. Our communications work includes targeted information and advice via TV, radio, social media, and printed materials. DHSC and NHS social media channels are producing advice and information videos every day to answer questions about the COVID-19 vaccines and provide the latest details about the vaccination programme.

DHSC and DCMS are also working closely with social media platforms to identify and act against incorrect claims about the virus and anti-vaccination messages which could endanger people's health.

Case study 5

Blackburn with Darwen

Data shows that Blackburn with Darwen has a high case rate compared to many other parts of the UK. Together with East Lancashire Hospital Trust, which serves many people from ethnic minority backgrounds across Lancashire, it has a much higher percentage of younger people from ethnic minority backgrounds compared to the UK population overall.

There are indications that some people who identify as being from an ethnic minority background in the community are more likely to be hesitant about taking the vaccine than in white communities. For some people, the worry is that being given the vaccine will make them ill, or that it could affect their fertility. Others want to see people around them take the vaccine before they do themselves.

To respond to these emerging concerns, local leaders have taken steps to reassure residents and build on pre-existing initiatives. The Lancashire Local Resilience Forum, supported strongly by the Local Authorities, established a BAME/Inequalities Cell in Spring 2020, which is chaired by the Director of Public Health from Blackburn with Darwen.

Blackburn with Darwen BAME Engagement Programme has commissioned a number of voluntary sector groups with a hundred thousand pounds worth of engagement activity. Providing education about vaccines is one of three core themes of the Programme and includes common vaccine myths, criteria for vaccination and information about the safety of the vaccine. We are using local insights, combined with local and national data, to help inform targeted engagement with communities, groups and individuals on key public health messages and to support those most affected by COVID-19.

Conversations and engagement

Success in driving vaccine uptake and ensuring equity of access is found in communities. Local, community-based conversations and engagement are already happening up and down the country.

We are providing advice and information at every possible opportunity for all those who have questions about COVID-19 vaccines. Senior clinicians at DHSC, PHE and the NHS are devoting time to media interviews and audience Q&A to keep answering whatever questions people have about the COVID-19 vaccines. Government ministers and senior clinicians work closely with faith and community groups across the country including through regular roundtables with ministers and faith groups to provide advice to help them support their own communities to access the COVID-19 vaccination programme. We are also working closely with local authorities and the voluntary sector to provide support, information packs and access to experts so they can convene their own events to provide advice to local communities. We are sponsoring content in local and national newspapers as well as community newspapers, radio and television in multiple languages.

We also need to leverage wider role modelling and peer education, utilising role models and champions across our society

Nationally, our role is to collect and share these examples, encourage systems and communities to 'pinch with pride' the ideas and innovation that works and ensure that all systems are working together to address inequalities in access and uptake. We must ensure there is simple messaging that all can identify with and recognise despite their final choice.

We will do this by drawing on the experience and expertise of our existing networks and communities of practice and will establish a Vaccine Equality Hub to share best practice, host a library of resources and provide a forum for the exchange of ideas, innovation and challenges.

A series of 'Connect & Exchange' conversations - open to all - will support our approach by providing a live and interactive space for people to share their ideas, ask for help or advice, and connect with others from across the country. These regular ongoing conversations will ensure connections are maintained, help identify problems early and enable us to celebrate successes. Case study 6 provides an example of the type of ways such engagement can help reduce barriers.

Case study 6

Using short films to provide accessible information about vaccines for people with a learning disability and autistic people

Feedback from stakeholders and individuals revealed that there was some confusion around vaccines amongst people with a learning disability and autistic people.

To address any concerns that people might have when they are called for vaccination, NHSEI’s Learning Disability and Autism Programme produced a short film with clear, accessible information about: what a vaccine is, how vaccines are made, why individuals should get a vaccine, whether a vaccine makes you ill and how to decide whether to have a vaccination.

The film was coproduced with colleagues with lived experience and PHE.

In the film, NHSEI’s Learning Disability and Autism Network Manager, Katie Matthews, speaks with the National Clinical Director for Learning Disability and Autism, Dr Roger Banks. They discuss a series of frequently asked questions about vaccinations.

Given it is three and a half minutes long, the Communications Team at NHSEI also produced 5 shorter social media clips with highlights from the film. This means that the most important messages can be easily shared within communities and social networks.

The film has been well received by stakeholders and the system and shared extensively across all networks.

Watch the film: Information about the covid vaccine for people with a learning disability and autistic people

The NHSEI team are also about to publish a covid vaccination film produced in collaboration with Learning Disability England, Skills for People and colleagues with lived experience for use ahead of their call to vaccination in the relevant JCVI grouping.

Conclusion

High vaccine uptake is vital to the success of the vaccine programme in helping us defeat COVID-19. Without high uptake across our communities, our lives, and those of our loved ones, will remain at high risk from this devastating virus.

This plan sets out key enablers for action and describes the collaborative approach already being taken to support people to receive their vaccine. We have highlighted a range of barriers to uptake and some of the work taking place across government and with partners, and at a local level, to minimise the impact of these barriers. We need to work together to ensure our approach is fair to individuals and communities across the country and save as many lives as possible.

As well as taking the vaccine when it is your turn to do so, the 3 best ways to play a part in the national vaccination programme are:

• help – support those eligible for vaccination in a COVID-19 secure way by helping friends, family and loved ones with their appointments, as well as volunteering to help those in the community
• join up – sign up to clinical trials for COVID-19 vaccines and treatments
• stay informed – keep up to date with accurate and trusted NHS advice and make sure to share facts and information with friends and family from trusted sources such as the NHS, PHE, your local GP or director of public health