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We have a golden opportunity to tackle health inequalities with the vaccine roll out – let’s not waste it

By Sidney, former Birmingham outreach lead, Doctors of the World UK (DOTW).

It has been just over 1 year since the UK first went into lockdown, and COVID-19 has changed all our lives in more ways than we could ever have imagined. This pandemic has been no respecter of persons, borders, wealth, or social class. People from all walks of life have lost loved ones; many have been robbed of their livelihoods, and economies have been paralysed the world over.

Leaving great misery in its wake, the pandemic has also shone a light on the deep inequalities that exist in society. Although it has affected us all in one way or another, those from less privileged backgrounds, on lower incomes, and from ethnic minorities have experienced worse outcomes in terms of prognosis, number of deaths, loss of jobs and academic achievement.

But as with every dark cloud, bright green shoots of hope are beginning to appear. With over 41 million people in the UK having now had their first vaccine dose (as of 15 June 2021) and restrictions slowly easing, there is genuine hope that we finally have a way out of this ordeal.

Vaccines have saved millions of lives and helped bring previous pandemics to an end. For vaccines to work, a big portion of the population needs to get them. Thankfully, many in the UK have embraced them so far, and even better, studies on the efficacy of both the Pfizer/BioNTech and AstraZeneca/Oxford vaccines have been thoroughly encouraging. For most people, getting vaccinated has only required a notification from their GP that they are eligible for the vaccine and where to get it.

For many others, however, getting a COVID-19 vaccine is unlikely to be such a straightforward journey. One such group is undocumented migrants, a group that I work with and understand very well. The fear of deportation often trumps the need for medical attention; people go for years without seeing a doctor until their ailments are no longer bearable, or their very lives are at stake.

It should come as no surprise that communities that have often felt ignored and marginalised are finding it hard to engage with the vaccine roll out. As a migrant and person of colour, I am very aware of the reasons why my community might find it very hard to embrace a well-meaning public health message. After all, you do not have to look far to see the glaring health inequalities: maternal deaths among Black women in the UK four times higher than those in their White counterparts; higher rates of HIV/AIDS among Black, Asian and minority ethnic communities; the first 11 doctors to die from COVID-19 in the UK were of Black, Asian and minority ethnic background, and the list goes on and on.

This precarious situation is not helped by GP surgeries that refuse to register people due to lack of documentation, contravening the NHS England guidelines which state that neither proof of address nor immigration status are necessary for GP registration. I led Doctors of the World’s pilot project in Birmingham, a city that has a large, established migrant community, with over 22% of the population born overseas and more than 40% of residents belonging to Black, Asian and minority ethnic groups. In my role I received calls from undocumented migrants who were clinically vulnerable and should have been eligible for early phases of the vaccine, but who were too scared to see a doctor or had been previously refused GP registration.

With scientists and public health officials warning that leaving sections of the population unvaccinated risks derailing our quest for herd immunity and leaves room for new strains to mutate, it was no wonder that the British government announced a vaccine amnesty for all undocumented migrants. This has more likely happened as a result of relentless advocacy from healthcare supporters rather than as a thoughtful gesture of compassion and altruism from the government and, contrary to some media reports, this was no policy change – migrants have always been able to register with a GP and receive vaccinations free of charge. Similarly, COVID-19 services have been exempted from charges and status checks since the start of the pandemic.

Despite the government’s reassurance that there will be no legal repercussions for undocumented migrants who come forward for COVID-19 vaccination, engagement from this excluded community is still very low. Some suggestions are that this might be due to lack of confidence in COVID-19 vaccines within Black, Asian and minority ethnic communities – a section of the population that includes most undocumented migrants.

There are several reasons as to why people might be reluctant to get vaccinated. For some it is about longstanding mistrust due to historical injustices. For others it is concern about the speed at which the vaccines have been developed. But for the many that I saw at DOTW, it sometimes is simply due to fear and mistrust that a government, which has prided itself in creating a hostile environment for migrants, is suddenly being charitable and extending kindness to them. And since undocumented migrants are the most adversely affected by the hostile environment, who can blame them!

To find a way forward, it is important to engage these communities rather than dismiss their concerns and legitimate mistrust. It is unrealistic to expect people who have been made to feel like they do not matter to suddenly believe that they have an important role to play in the national crisis. The government needs to try and understand the reasons as to why certain sections of society are not engaging with the vaccine roll out and find ways of mitigating these. A good start would be to end the hostile environment in the NHS by stopping harmful and unjust practices such as NHS charging and sharing patient data with the Home Office and ensuring vaccines for all.

Healthcare professionals, especially those from Black, Asian and minority ethnic communities like myself, need to counter misinformation by giving correct and up-to-date information about the vaccines and COVID-19. Nearly a year on since DOTW raised concerns about the lack of translated coronavirus guidance, there remains an urgent and ongoing need for public health information to be made available in a wide range of languages to cater to the UK’s multilingual population. DOTW, in partnership with the British Red Cross, continues to try to fill that gap by, for example, launching COVID-19 vaccine guidance, which is now available in 31 languages. But a broader public information campaign is needed to ensure that communities impacted by the hostile environment are aware of their right to healthcare and the vaccine, and can access this vital information in their language.

As we all look ahead, pondering over what a post-pandemic world will look like, I hope that society will be forced to reflect on the fact that any inequalities anywhere ultimately affect us all. The pandemic has shown that even when these inequalities do not expressly manifest in our daily lives, we are all one virus away from a hospital stay and one pandemic away from having our lives turned upside down. I also hope that the government comes to the stark realisation that leaving swathes of the population marginalised and excluded from health services only ever serves to compromise public health, eventually leaving even the non-marginalised at risk.

About the author

Sidney was the outreach lead for Doctors of the World UK (DOTW) services that were piloted in Birmingham and the surrounding areas between September 2020 and April 2021. Sidney came to the UK to claim asylum for fear of persecution in his home country and was eventually granted refugee status. As a person of colour with lived experience of migration and healthcare exclusion, Sidney is now dedicated to helping others overcome barriers to accessing healthcare.