In March 2021, UCLPartners started working with the NHS London region as the learning partner on their Vaccine Impact Programme. We have run a Learning Health Systems approach, gathering and analysing data from a range of sources and feeding it back into the system in rapid cycles to help them learn from the evidence and implement changes. This is helping us to understand the activities and approaches that support good uptake across different populations and cohorts.
Through this work, we’ve seen consistent themes emerge: around demand for the vaccine and how to increase vaccine uptake; around access and how to make it easier for people to get the vaccine where and when they want it; and finally on the learning for future immunisation programmes and other health and care work.
Understand who you are trying to reach and use people they trust to engage them
There were consistent messages from the panel about the need to take time to think about who they were trying to engage, how to engage them and to allow space for conversations. Raj Gil, a Physician Associate Partner in Camden and lead for the Bloomsbury COVID vaccination hub, talked about recruiting a team of people who were representative of the diverse population they were serving. When residents were contacted by people who spoke their language and understood their community, this helped to inspire confidence and meant they were more likely to engage with the clinicians.
Vanessa Apea, a consultant at Barts and health services researcher at QMUL who has been leading the hospital staff vaccination programme, talked about recognising the decision to take the vaccine was difficult for many staff members. By acknowledging and confronting issues around mistrust in societal structures and embedded inequalities from the outset, and providing a safe space with trusted peers, staff felt more able to convey and express their concerns and have open conversations with colleagues about their decision.
Binta Sultan echoed these points when she talked about her work with people experiencing homelessness, who had concerns that taking the vaccine would mean they were no longer considered ‘at risk’ and so would lose access to emergency accommodation. The outreach model they developed as part of the Find & Treat team with UCLH included the use of trained peer vaccinators, people with lived experience of homelessness who could understand the anxieties and concerns of this population group, helping to put them at ease with the process.
The role of the media and communications has been instrumental in getting the message about the vaccine out…
The role of the media and communications has been instrumental in getting the message about the vaccine out, though this has been hit by powerful misinformation campaigns that led to increased concerns about having the vaccine. Dr Ammara Hughes, a GP working in Camden leading the Bloomsbury hub with Raj, talked about the importance of engaging the media early and using a variety of methods to get the message out, such as local and national press, radio, TV, social media and blogs. An appearance on Bangladeshi TV may well have contributed to their Bangladeshi community having the highest uptake in their Primary Care Network. The learning here is to think about where people go to get their information and make sure that’s where you are targeting.
Bring the vaccine to people and to the places they go
The majority of vaccination services are set up around the idea that people will go to them rather than the other way around. Flipping this so that services are brought to the people who need them can make a huge difference.
As we heard from Steven Platts, Chief Executive of the charity Groundswell, which works with people experiencing homelessness, not everyone has a GP. Traditional ways of accessing health, including vaccines, are out of reach for many, so instead they developed an outreach model, taking the vaccines to shelters and hostels, which significantly boosted uptake. This outreach approach was also used in the Bloomsbury hub, where they recognised that simply offering the vaccine in GP surgeries would act as a barrier for some members of their communities. They identified the places that would work well for their populations, such as the Living Centre in Somers Town, which was already well-used by members of some of the most deprived communities to access healthcare, foodbanks, children’s services and other community activities. This flexible approach to providing services feels to me to be key, ensuring they are provided in places people already regularly access rather than expecting everyone will come to you.
“If you actively and intentionally see everyone, you then make systems for everyone”
Vanessa Apea, a consultant at Barts and health services researcher at QMUL
The Vaxi Taxi project, led by Dr Sharon Raymond, provided a black cab to transport people back and forth to the pop-up vaccination clinics, helping those who otherwise struggle to access services. It can also provide an opportunity to ‘make every contact count’. Sharon told us how her bespoke pop-ups offer the vaccine alongside a range of other services, such as health checks/screening, physiotherapy, or podiatry. This took the pressure off people feeling they needed to make a decision about the vaccine and could instead get other health needs seen to, while having a conversation about their concerns.
I was interested to hear what the panel thought about the increasing use of surge vaccination events on a large scale, such as across London sporting venues. The consensus was very much that while these events have a place in terms of raising awareness and opportunistic vaccinating, they are much less successful at targeting specific populations or communities. Ammara was clear that targeted call and recall was a much more successful approach for her population and that a range of activities, recognising the different needs of different communities, need to be offered.
Use this opportunity to address embedded inequalities
The COVID-19 pandemic and now the vaccine programme have put the spotlight on inequalities of access across the health and care system, some of which were known, but some that have emerged as the programme has continued. I wanted to hear what the panel thought were the key lessons from the vaccination programme that we can apply to future work and long-term planning, to ensure that we address these inequalities and avoid excluding sections of the population in the future. They all agreed that we need to have inclusion at the forefront as we develop and design new systems and programmes, to ensure they are accessible and designed for the people who most need them. Provision of holistic services, much like the pop-ups Sharon offers, that provide a range of health services in addition to vaccination, were felt to be a good way of addressing this.
A key factor is also going to be improving the way that different sectors and organisations communicate and collaborate, so that each understands what they all offer and how they can work together.
We can also celebrate that the vaccine programme has done a huge amount to demonstrates that these problems are not insurmountable; they need thought and planning, but we can make a difference. As Vanessa said, “If you actively and intentionally see everyone, you then make systems for everyone”.
Join our Vaccine Impact Programme learning community
Working with NHS England and NHS Improvement, we have established a virtual learning space on Hexitime, the online collaboration platform. This is a space for people to share ideas, experiences and resources and work together to achieve the best possible uptake of the COVID-19 vaccine. It’s free to join and all are welcome: https://hexitime.com/campaign/Covid-19-Vaccine-Impact-Programme
As Network Development Lead, Sophie supports people working in our region to connect, share learning and support each other in their improvement work. She leads the Improvement Fellows and Aspiring Improvers programmes and develops events and activities for the wider network.