Covid-19 Vaccine: Take-up Rates in London

Indeed, the success of the programme nationally, whereby I think we are at 22 million first doses and about 1 million second doses, is, again, an achievement. Obviously—I do not wish to state this in any adverse way—we are going to talk about the problems today. We are going to take for granted the successes and talk about the problems, because that is our job.

About one third of the population has had a first dose, and a very small percentage—less than 2%—has had a second dose. That is a matter of political and scientific choice, which most people would agree with, although it is not how some other countries have dealt with it. Nevertheless, it shows the size of the achievement and also the task ahead. If we have done a third, which might include some young people who are not getting the vaccine in the near future, there are two thirds to go—even my maths tells me that—and then there is the second dose as well. There is still a mountain to climb, but what gives me confidence is the fact that the NHS’s data and operation are better placed than perhaps any health service could be to deal with the problem. However, let us not gloss over the fact that this is taking the individual effort of millions of people across the country.

I shall go through some problems, but on another positive note, I had a very uplifting conversation with my local director of covid-19 response and recovery last night. She told me that the expectation, which I hope the Minister will be able to confirm, is that, first, from next week there will be a substantial increase in the amount of vaccine available nationally and locally. I think we are going from some 2 million doses a week to 4 million. I do not know whether that is true, so perhaps the Minister will be able to confirm that.

Secondly, that will allow the centres that are dispensing the vaccine to expand. One problem so far has been a lack of vaccine at some of the GP-run primary care network centres, with major centres in many places not opening at all. I hope that the Minister, if his information is this granular, will be able to confirm that the Hammersmith mass vaccination centre based at the Novotel hotel in the centre of Hammersmith, which was due to open on 8 February, will open next week and that other centres will open this month in north-west London.

My third point, which relates to a local initiative, is on the issue of vaccine hesitancy. Next Monday we start a local programme to contact every person who we know has either declined or not been contacted and is in one of the priority groups. We will go through the process of contact, persuasion or whatever else is necessary to ensure that we catch up on what are not terribly good figures at the moment. I will come back to that at the end, because one thing we are looking for there is perhaps support from the Government in carrying out that programme, which is a really good programme. I have been told all about it, and I compliment the local council on setting that up and using the Hammersmith and Fulham community aid network—H&F CAN—which has been helping people shield and helping people in need over the past year.

We have been asking for data for many weeks. I can see the Minister’s dilemma, because if he gives us national data, we ask for regional; if he gives us regional, we ask for integrated care systems; if we get ICS, we ask for clinical commissioning group; if we get CCG, we ask for Medical Science Liaison Association; if he gives us medical support officer, we ask for postcode—so he might think it is a slippery slope. In a darker moment, he might have concluded that it is better to give us nothing at all. I will contradict that view by saying that it is better to say, “There is a story to tell here.” I do not think that anybody will take a view other than one that will help the process go ahead. It is important to have more granular data, at least down to ward level, so that we can see what is happening in our constituencies and we can take action to deal with it.

On the issue of supply, it appears that—I say “appears” because I spend a lot of time on this and it is difficult to do the sleuthing work—in the initial roll-out at the beginning of the year, London was being left behind, and then there was a correction and more vaccines came into London, and in the past few weeks we have had something of a dearth—a drought—of vaccines nationally. If one looks at the daily figures, one sees that by the end of last year they were at around 600,000 doses a day. For the past week or so they have been between 200,000 to 400,000 a day, which is a significant change. I hope that we will see the figures go up again.

In a way, there is a bit of “bald men arguing over a comb” here, because colleagues in other regions will say, “Hang on, you are not taking our vaccines to London, are you?” I do not know whether they are saying that in your part of the world, Sir Christopher, but I have heard it said. The reality is that we all need to vaccinate all our populations. The question is one of overall supply. It would have helped had we known the situation more clearly at an earlier stage.

There is also the push and pull factor. Some privileged institutions, such as the hospital hubs, are able to order from what supplies there are and obtain those. There may be some logic to that, in the sense that they are principally—not exclusively—vaccinating NHS staff, who clearly are a priority, but it does mean that the local GP-run PCN hubs are reliant simply on what is delivered to them; they have very little control over that. They may have very little notice of what is being delivered. It got to the state last week where, between Monday and Friday, not one of the five dispensing outlets in my constituency had any vaccine delivered. Unless there was some left over still within its shelf life, no vaccination was going on.

That was an extreme example, but if I look at those GP hubs, during the course of this year, the best of them—where I had my jab—has operated for about 25 days, so less than half the time. When I say “operated”, I mean at a significant level of, say, more than 400 vaccinations a day, and that was for only 25 days. But for the other two hubs in the borough, including the one at White City, which is the most deprived area in my constituency and the one where vaccination rates are giving us most concern, the number of days has been in single figures since the beginning of the year. In that area, significant vaccination has been going on for fewer than 10 days. That is of great concern.

That may be corrected by the sheer volume that is coming through. It is essential that we get enough vaccine for the PCNs, the major centres, and for the pharmacy and hospital centres if they are to continue to operate. I hope that the Minister will be able to confirm what I think is the strategy now, which is that the major centres—in my case, say, 1,500 doses a day, which is very significant—will be dealing with the new cohorts, so the younger people coming into the system now and also possibly some second doses. That is what we think is going to happen.

There is a certain sense in that, because the process of going to a major centre involves getting a letter and making an appointment, and it may involve some travel. It is more suitable for people who are more mobile and may have a car or something of that nature to get them where they are going.

The PCNs are going to give some of the second doses, but I suspect they are going to scale down a little, because GPs obviously have other work to do—I am going to ask the Minister about this. The problem is that we are neglecting an important group of people in groups 1 to 4 who missed out on the vaccine and who now need to be the target for ensuring that we get our vaccination rates up. It is pretty clear that the PCNs are the best vehicle for delivering that.

I do not want to go on for too long as I know many colleagues want to get in, but the last and most important point for us at the moment is how we deal with the issue that is variously called vaccine resistance or vaccine hesitancy, but is simply a problem for the NHS, the Government and all of us working to resolve it. We need local solutions as well as national resources. There has been a lack of data in relation to these matters. The evidence for that is the reliance that so many colleagues have placed on Sky News’s analysis of the data on the NHS website. I am not sure that is where we should be going as our first port of call, although they did a good job, because for the first time, over a week ago, we were able to see figures by ward. Knowing the different characteristics of our wards, we were able to see how things were going within the constituency.

In my constituency—I feel the pattern is true across the rest of London—the more prosperous areas, the less ethnically diverse areas and the less deprived areas were already at 100% for the older cohort of the population. Poorer areas, such as those in Shepherd’s Bush, White City and West Kensington, were below 75%. That is a very significant difference. It is replicated across London, and north-west London is one of the most difficult areas. As of last Friday, it was the only integrated care system area in England that was below 80% for those over the age of 65. All the London ICSs are down at the bottom, but north-west London is slightly further down.

We talk about 80% and 75% as worrying and significant, but when one adds in deprivation, by looking at the most deprived 10% of the population, and ethnicity, because certain ethnic groups are being vaccinated at a much lower rate, often below 50%, then that should be ringing alarm bells in Whitehall. It is certainly ringing them locally. We have not cracked this nut. I seek a response from the Minister on that point.

We know what is needed: time, money and personnel to ensure that those contacts are made. The problem is that phone calls are made that are not answered once, twice or three times, or someone may express a reservation about the question, and either there is not time to deal with it, as that is not the way the system is set up, or the caller is not expert enough to deal with it. A lot of it is about trusted people—that is very important— and places, and places that are accessible.

All of those are important, but so is having people who can answer the questions that are asked. If they cannot answer questions such as, “How do you know that the vaccine will be safe in 5 years’ time?” or, “How will it protect someone with my medical condition?”, or dispel fears and rumours such as, “I have heard this about the vaccine from somebody I trust,” it is almost worse than not having made the approach at all, because they end up reinforcing the problem.

We think we have cracked that. I have been looking at the hesitancy programme that Hammersmith has set up, and I think it is good. I pay tribute to the staff doing it. It will be labour-intensive and will cost money. The Minister knows my beef on that. When the £23 million of so-called community champions money was made available at the end of January, quite rightly, and handed out to some 60 local authority areas across the country, those that had the lowest take-up rates at that time essentially did not get any money—Westminster, Kensington and Chelsea, Hammersmith, and Newham. Some did, but it seemed to be a bit of a lottery. I think seven London boroughs got sums ranging between £40,000 and £750,000. I do not think we need help in knowing what to do, but we do need some resource of that kind. I understand that there is a little resource coming in through the NHS: £100,000 per ICS. However, that really only goes down to £10,000 per CCG. Looking at areas we have the most data on, where there are particular problems, it would be useful to add to that resource now.

I think I have gone on long enough—you are probably not the man to ask, Sir Christopher—but I think I have had enough questions for the Minister to be able to remember and answer them all. This is special pleading for London, in a way, because London has suffered. We can conjecture the reasons for that. They are complicated. We have talked about deprivation, we have talked about ethnicity, but there are other factors in London we all know about. We know about them through canvassing and elections; we know about them through electoral registration; we will know about them this month through trying to fill in census forms.

London has a disproportionate number of people who are isolated, for all sorts of reasons. They may not have financial resources, or they may not have a mobile phone, or have credit on their mobile phone. They may live in a room in a multi-occupancy house which has no doorbell or other means of reaching them. They may have mental health problems. They may simply live alone and have become isolated from the community around them.

We are actually very good at contacting those people if we have the time and the money to do so; we do it through electoral registration, and we are also doing it with the census. However, we do need that prioritisation and I hope that the Minister will understand that, and will be able to respond in kind.

I have yet to see the information that is provided to the directors of public health. As of this point, the middle of March, nearly three months into the vaccination programme, it has not yet been shared with me. The fact that it has not been shared with me by my local authority reflects its concerns that the data is not accurate. The Minister will have heard, no doubt, from many other people, that there is a concern that building up from the basis of the local data to a larger picture and then expanding it out to a national picture will give different results, and people will start looking at variations in that data and asking questions about it. I understand that point and can see that it is indeed difficult to get those statistics all squared off. On the other hand, I am absolutely clear that unless we understand the difference between what is in happening in, for example, the Mozart estate area in the Queens Park ward, and Belgravia and Knightsbridge, we will not get a proper understanding of where the priorities should be.

My local authority has told me that part of its anxiety is that there is a variance between the use of the Office for National Statistics data and the national immunisation management system data, which has led to a significant national population variant of, I believe, as high as 5 million. As my hon. Friend outlined, there is good reason to believe that the percentage variance will be greater in central London than anywhere else in the country. We have seen that in terms of the census and the population figures. I had a debate on the 2001 census because of my concerns about accurate recording of population. However, it is unclear to me, from discussions with people working in the local health service, what population denominators are being used locally. It is unclear who is using what data, and as a consequence it is unclear whether such local data as exists is even remotely accurate.

The question is: does that matter? I would say that it does, because if we are spending time trying to find people who are simply not present, to raise the vaccination rate, for good reasons, we are wasting time and effort on them, whereas at the same time—both phenomena are, I think, true simultaneously—there are wards, estates and communities in my constituency, as there will be in others, where we are failing to make contact with people who need to be contacted, because they are extremely hard-to-reach populations. My hon. Friend outlined some of the reasons for that. There is a high relative proportion of single people who will not necessarily have ties to communities, and links so that we can use the normal channels of communication. There is a high proportion of people with mental health problems, again, often living singly. There is the largest private rented sector in the country, with a high degree of population churn, which means that when talking to someone it is often unclear whether they are the same person who was living there six months before. Unless and until we can be sure of the granular data and understand the baseline population statistics on which it is based, we have a problem.

A secondary data problem concerns ethnicity and understanding some of the issues around both the take-up of the vaccine and vaccine reluctance, which are different components. The issue is that, in central London, we have the largest Arabic-speaking populations, a very diverse set of communities, but these are being recorded under “ethnic—other”, and therefore it is difficult for us to be able to focus in on those communities, which are important, in terms of delivery.

I have written to the Minister with some of these questions, but even since I wrote to him there has been new information from the local authority and from the clinical commissioning groups that raises questions for me about the data. We need to know whether the population that we are chasing is there, whether we are chasing hard-to-reach people or whether we need to focus in on people who have vaccine reluctance. I was told last week—

The supply problems are really serious. To give the Minister an example—I hope he will be able to answer this—the capacity at each of our vaccination centres is roughly 860 doses a day, yet this week, our centres will only receive 400 doses. That is less than half a day’s work, so the lack of supply is holding us back from achieving even faster vaccination rates.

The real problem that emanates from that is that we are having particular difficulties in contacting younger people who have underlying health conditions. They are among the most reluctant to come forward, because of the myths and legends about what the vaccine does to people’s bodies. I am pleased that we now have a myth-buster to combat this unfortunate propaganda, which is spreading very widely among different communities. An excellent video has also been put together by different community leaders, coming together irrespective of race, religion, colour or creed to say why it is important that people have the vaccination, to encourage people to do so, and to try to combat some of this insidious propaganda.

Also on the issue of vaccine supply, my centres complain that they get notified only a day in advance of the vaccine arriving, which of course means that it is very difficult to schedule people in to get their vaccinations. Can we have a better plan for supply of vaccine, which is vitally important? Equally, allowing flexibility to GPs undertaking vaccinations at GP surgeries would help considerably. It would reach those harder-to-reach groups, because people trust their GPs in the way that they do not necessarily trust going to a large vaccination centre.

I will end my remarks by saying that in Harrow, certainly, we have achieved remarkably well, but we can do better provided that we get the supply, that we have better notice, and that the facilities continue to arrive. At the end of April, two of our mass vaccination centres will close, and there will be the potential for complete chaos when we come to the second doses, because everyone will be invited to attend one centre in Harrow to get their second dose. I predict that is going to be quite chaotic, so I would ask that we look at potentially keeping those centres open for a further period to ensure that every adult gets their opportunity for at least the first dose by the end of July, as per the plan that the Minister has.

Thank you, Sir Christopher, and I look forward to listening to what other colleagues have to say.

As a whole, London—our nation’s capital—sometimes seems to have experienced this over-promising, and this moonshot rhetoric. Not that long ago, we were promised 24-hour vaccinations in the capital. That was being said in January. The experience of our centres last week was far from that.

We are waiting for the second dose and hopefully there will be a big surge, but it concerns me that there seems to be a bit of anti-London rhetoric from the Government at times. That stretches to the fact that we have a towns fund with new bungs bringing in prosperity and opportunity—but not in London, which has been completely excluded in favour of red wall locations. I would caution the Government not to let that apply to vaccination supply. London is not immune from deprivation, poor housing and overcrowding: I have those in my wards in Acton. Localised need should drive allocation, not centralised supply.

The wards in my constituency with the highest covid rates and poor primary care provision do not have vaccine centres nearby. The nearest vaccine centre for constituents in those wards is two bus rides away, which is just not acceptable. Where the need is greatest, the provision is low. In the most affluent areas of my constituency, where there is good primary care provision and many vaccine centres, the uptake is more than 80%, and 40-year-olds are now being called for their vaccines.

Finally, 16,000 people across Enfield—predominantly in the eastern part—are not registered with a GP. There is no clarity on how those constituents will access vaccines. I would be really grateful if the Minister set out the plan for people who are not registered with a GP. Will the Minister also clarify what is meant by the term “hesitancy”, as there is real confusion on that? Does it mean people who reject the vaccine outright, saying, “I do not want this,” or does it mean people with whom no contact has been made after three contact attempts? It is really important that we get some clarity on that.