‘No One Is Safe Until Everyone Is Safe’ – Vaccine Rollout Misses Key People

Homeless people, migrants, refugees, asylum seekers, and some people from Black, Asian and minority ethnic backgrounds are among those struggling to get a coronavirus jab even when they’re entitled to one.

The UK’s coronavirus vaccination rollout is being hailed as a rare pandemic success with the NHS on target to hit its goal of immunising 15m of the most vulnerable people by next week.

But people are falling through the gaps because they face barriers to accessing healthcare.

Experts say many of the people being missed out in the vaccine rollout are already at greater risk of health inequalities and have cautioned that until all communities in the population are reached with the vaccine, coronavirus cases will “keep creeping back”.

Charities and campaigners say the easiest route for people to be called for a coronavirus vaccine is by being called for one by their GP.

But those with an unstable immigration status are often too terrified of registering with a GP or seeking medical care as they fear they might get reported to the Home Office and deported.

And some homeless people are struggling to register with a GP practice even though they shouldn’t need a fixed address or proof of ID, according to Jenny McAteer, who leads the national #HealthNow campaign promoting health equality for Groundswell.

Groundswell, a charity that works to tackle homelessness and inequality, has produced “My Right To Healthcare” cards to help people get registered with a doctor and spread the word that being denied access is not acceptable.

“We have been concerned from the outset of this pandemic that people suffering from homelessness already suffer from grave health inequalities and have a lower life expectancy,” she said.

“They either live on the streets or in temporary accommodation and are at increased transmission risk and are often at an increased risk of death as they have long-term health conditions which have often not been picked up.”

Homeless Link, the membership charity for frontline homelessness agencies, has written to vaccines minister Nadhim Zahawi urging for homeless people to be treated as a priority for coronavirus vaccination “as a matter of urgency”.

“Many people who are homeless should already be in a priority group as they are clinically vulnerable,” said McAteer. “But the problem is, they are not going to be picked up if they are not registered with a GP as the system does not know where they are.

“Homeless people are much more likely to transmit the virus to each other and end up in hospital services with Covid-19 and die of the virus so it makes absolute sense to make this group a priority for the vaccine.”

Some homeless people are reluctant to access health services due to the discrimination and treatment they have experienced in the past.

“We hear stories such as one homeless person who went into a GP waiting area and was sprayed with air freshener,” McAteer told HuffPost UK.

“One of the reasons homeless people don’t access health services is because many of them have been traumatised by the stigma and discrimination they have encountered.”

Although homeless people are not currently a priority group for coronavirus vaccines, the Joint Committee on Vaccination and Immunisation (JCVI) does allow for some flexibility at a local level, which some local authorities are using to vaccinate homeless people.

But even when the hurdle of getting those experiencing homelessness to register with a GP is overcome, they still need support. “They might not have a phone or might need help filling in a form or face digital barriers, especially when a lot of things to do with the vaccine are online,” said McAteer.

She added: “The coronavirus system itself is designed as a universal offer, but some people have extra needs and might have less access to that right.”

Alex Bax, chief executive of homeless healthcare charity Pathway, says viruses and diseases often correlate with poverty. “One of the characteristics of homelessness is being poor,” he said. “So the risk is the virus will find its home in you.”

One of the risks for people in homeless settings is relatively young people mixing with people who are clinically vulnerable. “These homeless environments are not the best places for those who have to shield,” he said.

“We need to get vaccine coverage in every population. If we do not protect our whole population, then coronavirus will keep creeping back.

Dr Andrew Haywood, co-director for the UCL collaborative centre for inclusion health, told HuffPost UK there is “no real way of checking who has not been invited in the first place” for a vaccine.

He added that it is important to reach out to socially excluded and marginalised people such as refugees and asylum seekers and those with no recourse to public funds as one of the things they often have in common is poor access to health.

Haywood said more homeless people were contracting Covid-19 during the second wave, likely due partly to the government’s failure to repeat the lifesaving Everyone In scheme that saw homeless people put up in hotels during the first wave – and partly to the fact there is now increased transmissibility of the virus.

“A lot of the time, people are living in homeless hostels which are overcrowded so Covid is more easily transmitted,” he said. “They may also have high levels of chronic disease which might not be recorded on their medical records.

“The best way to reach these people would be to [send] vaccines to homeless centres and vaccinate everybody.”

Those living in the UK illegally have been reassured by the government that they won’t be risking deportation by coming forward for a coronavirus vaccine.

But many organisations fighting for migrants say the damage that has already been done by the government will take a long time to heal.

“The government has a very poor record of building trust with migrant, refugee and BAME communities,” said Satbir Singh, chief executive of the Joint Council for the Welfare of Immigrants (JCWI).

“There are a whole range of policies which have been put in place over the last decade creating a hostile environment which makes life unliveable in cruel ways for people who do not have a secure immigration status.”

While some of these were outright exclusions such as people not being able to access medical care without paying upfront, other measures such as mass data sharing and surveillance have made people too scared to use services even when they legally can.

“It’s good that the government is finally making an effort to tell some of the most marginalised and at-risk groups in our communities that they should come forward for the Covid-19 vaccine,” he said.

“Everyone has always been able to go to a GP regardless of their immigration status so this is not a new policy.

“But people are too frightened to go to the doctor because of the data sharing agreement between the NHS and the Home Office.

“There will be people who might have symptoms of coronavirus who are too scared to go to the doctor whether that is to get tested, treated or get the vaccine.”

Singh added that the government is now “panicking” as it is realising the policies put in place are now “creating obstacles to getting out of this pandemic”.

“They are trying to row back as quickly as possible – but that can’t just be done with a press release.

“The hostile environment must be immediately scrapped and the government needs to put in place clear commitment to keeping people’s data safe and show they can be trusted.”

The hostile environment, which included policies such as charging migrants for NHS care, has damaged the relationship between the NHS and BAME and migrant communities, creating a situation where patients don’t trust nurses and doctors and avoid healthcare services, Anna Miller, head of policy and advocacy for Doctors of the World UK, told HuffPost UK.

“We know of at least one NHS trust that has sent letters to patients eligible for early phases of the vaccine requesting ID or a utility bill at vaccination appointments and suggesting some patients may be subject to charging and immigration status checks,” she said.

“This is a surefire way to ensure patients don’t receive the vaccine and to spread more fear among these communities which could ultimately undermine the UK’s vaccination programme and cost lives.”

Miller added: “We are facing the greatest public health challenge in recent history and putting everything into getting the whole population vaccinated, but at the same time patients are being scared away because NHS staff are being used as border guards.

“If we want everyone living in the UK to access NHS Covid-19 services and engage with public health initiatives then the NHS needs to completely distance itself from the Home Office and its hostile environment agenda and stop carrying out immigration checks.

“This means scrapping the NHS charging regime and launching a multilingual public information campaign to send a clear message to migrant communities that the vaccine is free for everyone, regardless of immigration status or ability to provide documentation.”

But it’s not just migrant communities who are facing barriers to getting the coronavirus vaccine as many people from BAME backgrounds are hesitant about taking it up.

Mistrust of the vaccine exists due to historic medical racism and inequalities and this needs to be tackled to change that say campaigners.

Elizabeth Harding, humanitarian representative for Doctors Without Borders UK (Medecins Sans Frontieres) told HuffPost UK that they have seen for decades the impact of unequal access to healthcare, including treatments and vaccines, on vulnerable people.

“In the UK, the homeless community are among the most marginalised, as are the people forced to live in cramped, squalid conditions such as the hundreds of asylum seekers currently held in unused barracks,” she said.

“These communities must not be forgotten as the vaccine rollout continues across the UK.

“We will not overcome this outbreak unless the most vulnerable communities in the UK and across the world are able to access the vaccine.”

A spokesperson for the NHS told HuffPost UK: “The government has been clear that people in the four highest priority groups, independently set by the JCVI, are currently being prioritised for vaccination, and this includes people in these cohorts who are homeless.

“To ensure this happens, GPs are being encouraged to take action to help register people with a GP and practices should not be turning away anyone trying to register who doesn’t have proof of ID, address or immigration status.”

The spokesperson said the NHS has also been vaccinating some people in non-health locations including community centres and religious sites such as temple and mosques and was supporting some people through roving vaccinations, such as taxis and bus services taking people to be vaccinated.