Hundreds of thousands of people in England without access to a car will struggle to reach their nearest Covid-19 vaccination centre, according to an analysis by the Financial Times that will deepen concerns of a postcode lottery in the UK’s ambitious immunisation programme.
Even as the UK is lauded for running the most effective drive in Europe — more than 4m have already received their first dose — the findings suggest the vaccine rollout risks exacerbating income, ethnic and geographic divides, condemning some to impracticably long journeys to receive the protection of a jab.
The uneven distribution of vaccine centres, particularly in rural areas, points to how the government’s ability to meet its target of vaccinating about 15m of the most vulnerable people in the UK by the middle of February may rely to a significant extent on volunteers ferrying those without vehicles to the locations providing the jabs.
Meanwhile, doctors and campaigners say the decision to focus on age as a criterion for receiving the vaccine has disadvantaged those living in low-income areas where poor health can set in 20 years earlier than in richer populations.
The Joint Committee on Vaccination and Immunisation, which advises government, has set out nine categories of people to be prioritised for the vaccine, with care home residents and staff, over-80s and health and care workers at the top.
The NHS has rapidly expanded the number of vaccination sites since the first inoculations were delivered on December 8, and a total of 1,220 GP surgeries, hospitals and mass vaccination centres are now giving jabs to those considered to be the most vulnerable to the disease in England. The government’s vaccine delivery plan has a target to establish more than 2,700 sites across the UK.
However, FT analysis of data from mapping company TravelTime shows about 5.5m people in England live more than one hour’s travel on public transport from their nearest vaccination centre, of whom 336,000 are estimated not to have access to a car. A total of 1.3m of that group are aged 65 and above, of whom 166,000 are unable to use a car.
Data on car ownership suggest these “vaccine deserts” may also disproportionately affect members of black and minority ethnic populations, and the lowest-earning 10 per cent, who are far less likely to have the use of a car than wealthier white peers.
The addition of more than 200 local sites since the start of the year has reduced the number of people more than an hour away on public transport by only 16 per cent — while halving the number of people more than half an hour away by car. That disparity suggests poorly connected rural areas remain a tricky issue to solve.
The FT’s findings also demonstrate the particular difficulties for older Britons for whom walking even relatively short distances may be a challenge. If “within reasonable reach” is interpreted as a place within one hour of someone’s home on public transport with a maximum of 10 minutes’ unbroken walking time, 341,000 elderly people — one in 30 — will be unable to reach a vaccination site under their own steam.
Significant regional differences are evident in the official data now published daily by the government. The North East and Yorkshire have had the highest vaccination rates while London appears to be a laggard. However, the capital’s relatively low numbers look rosier when considered as a percentage of the number of over-80s in a city from which many choose to move as they age.
Calculated as a percentage of older residents, it is the East of England rather than London that has had the slowest rollout. The region also has among the country’s most limited public transport networks.
The UK’s notoriously wide income-related gulf in healthy life expectancy is also threatening to handicap some of the neediest Britons in the race to secure vaccination.
Rebecca Fisher, a fellow at the Health Foundation think-tank who practises as a GP in a deprived urban area, said her practice had very few patients over 80 “because poor people don’t live as long”. Pointing to a 10-year gap in male life expectancy between the most and least deprived areas, she said: “Someone of 60 in my practice is as likely to have multiple health conditions as someone of 85 in another area.”
Dr Fisher welcomed the recent announcement by the prime minister that practices that had completed immunisations of over-80s could move to those in their 70s but said areas with unvaccinated people in the older age group were still being prioritised for supplies. “So it means vaccine is literally going to richer areas where people live for longer. We need to make sure that deprivation is factored in to the equation for which areas get vaccine supplies,” she added.
Ruthe Isden, head of health at Age UK, the older people’s charity, described the dearth of people in their 80s and 90s in some areas as “a sad indictment of health inequalities more widely”.
She was cautious of interpreting variable coverage of over-80s as a postcode lottery, “because the demographics of the population are going to be quite different in different areas”.
Ms Isden added: “I wouldn’t want to start saying ‘there are some 90-year-olds who haven’t heard anything and in this area they’re vaccinating 75-year-olds’ because that might be the right thing to do — they may be the most high risk people they’ve got.”
Richard Vautrey, a GP in Leeds in the north of England who represents family doctors for the British Medical Association, said the ability to set up vaccination sites had in some cases been “limited by geography”, with rural areas in particular finding it harder to find suitable locations.
But he insisted the key issue holding back the programme remained supply. “We want to be able to plan ahead so we know in nine weeks’ time we’ll have vaccine so we can book people in. We’re not there yet because the NHS isn’t providing us with long-term projections around vaccine availability. We’re working from hand to mouth at the moment,” Dr Vautrey said.
Health officials said sites were being added at community pharmacies, GP networks and surgeries, as well as larger vaccination centres and care homes across the country.
The NHS said: “Hardworking NHS staff have already stood up more than 1,200 vaccination sites, meaning the vast majority of people live within 10 miles of a centre and hundreds more, including more than 200 high street pharmacies, are due to come on online over weeks, as the NHS accelerates rollout to ensure as many people as possible get vaccinated.”
To calculate access to vaccination sites, the Financial Times used data from TravelTime to map the area around each of England’s 1,220 vaccination sites that is accessible using different forms of transport and different timeframes. The resulting areas were then cross-referenced against each of England’s 32,844 lower super output areas — neighbourhoods of around 1,600 residents each — to determine the numbers of people within reasonable reach of a vaccination site. This was then combined with census data on car availability by age to produce the numbers of people likely to be reliant on public transport or volunteer assistance.
The new nationwide lockdown rules in England
The main restriction is a firm stay-at-home message
People are only allowed to leave their home to go to work if they cannot reasonably do so from home, to shop for essential food, medicines and other necessities and to exercise with their household or one other person — once a day and locally
The most clinically vulnerable will be asked to shield
All colleges and primary and secondary schools will be closed until a review at half-term in mid-February. Vulnerable children and children of critical workers will still be able to attend while nursery provision will remain available
University students will have to study from home until at least mid-February
Hospitality and non-essential retail will be closed. Takeaway services will be available but not for the sale of alcohol
Entertainment venues and animal attractions such as zoos will close. Playgrounds can remain open
Places of worship can also stay open but one may attend only with one’s household
Indoor and outdoor sports facilities, including courts, gyms, golf courses, swimming pools and riding arenas, will close. Elite sport including the English Premier League will be able to continue
Overseas travel will be allowed for “essential” business only
Full details are available on the government’s official website.
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