Normal public health messaging does not get through to minority communities when it comes to driving up vaccination rates, says Mohammed Hussain…

Last year the NHS, including community pharmacy teams, responded to the urgent call to action to vaccinate the nation. We also recognised that Covid exacerbated existing health inequalities, with those from minority communities experiencing the worst outcomes.

Vaccine hesitancy was highest among black people followed by those of Bangladeshi and Pakistani heritage. The factors contributing to vaccine hesitancy include perceptions of risk, spread of misinformation, lack of community engagement and access options.

It was in response to this that the NHS positively engaged with addressing these inequalities through a multi-pronged approach. This was effective in driving up vaccination rates across all communities, and especially in marginalised groups.

As a community pharmacist working in vaccine clinics based in various local wards, I have seen a change in the take-up of vaccines by different groups over the past 18 months. Last year, we had excellent take-up in all wards and among all groups, although this needed different approaches to engage with different communities.

This year, the NHS has reverted to normal public health messaging and more routine vaccine recalls. I believe this more routine approach, without the extra targeted messaging for minority groups, has led to a more standard outcome.

There is a growing disparity in the take-up of Covid boosters between white groups in England and other minority groups, even when taking into account the overall reduction in vaccines at a population level.

The vaccine clinics we are running in pharmacies in two distinct wards highlight the issue. The first pharmacy is in a majority white ward. The clinics are full every day and oversubscribed.

The other pharmacy runs a clinic in a majority Pakistani ward and here there has been a significant reduction on the vaccine take-up - both year on year, and in comparison to the other wards. We have had to reduce number of days the clinic operates, and we still do not get full appointment lists.

Health inequalities are multifaceted and complex. Last year showed us that where the NHS recognises this and actively tailors its approach, it can address disparities and achieve better outcomes.

A return to more standard approaches this year has highlighted the difference that can be made, and how we are failing to earn the lessons of community engagement that arose out of the pandemic.

The Scientific Advisory Group for Emergencies (SAGE) identified that to overcome these barriers, the NHS needed multilingual, (yes, languages again!), non-stigmatising communications from trusted sources across different religious and cultural practices. It stated that communication should consider the “whole communication journey” for vaccine roll-out.

Community pharmacies are perfect vaccine clinics. They are at the heart of their communities, staffed by people from the local neighbourhood, often speaking the same languages and able to address vaccine hesitancy.

However, community engagement needs national leadership and resources to provide a cohesive approach.

Individual pharmacies cannot address this deficit on their own. I look at all the talk of inclusive healthcare and the inclusive pharmacy programme and I then look at my vaccine clinic and see that rhetoric alone does not bring minorities through the door for their vaccinations.

We know what works because we did it last year, and yet we have failed to repeat it this year. Where are the champions of inclusive pharmacy practice this year to sustain the desired levels of vaccine uptake?

They are likely too busy celebrating their successes from last year even as we fail this year.

Mohammed Hussain is an independent contractor and non-executive director of Bradford Teaching Hospitals Foundation Trust.