Inspiring confidence: Liverpool GPs tackle the vaccine race gap

GPs in the Central Liverpool primary care network had been vaccinating for about a month when they realised they had a major problem. About 29% of their 106,000 patients are from a black, Asian or minority ethnic (BAME) background and yet 90% of patients who had turned up for a Covid jab were white.

As of Thursday, 8,650 white patients had been vaccinated, compared with just 984 of BAME heritage. Of those, 210 were from Asian backgrounds. Only 281 black patients had received their first dose, along with 177 from Chinese backgrounds.

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With people from black and south Asian communities disproportionately at risk from Covid-19, the GPs realised they had to act fast. On Wednesday, they opened a pop-up clinic at the Pal Centre, a community hall in Toxteth, one of the most deprived neighbourhoods in the UK, offering vaccines to anyone in the four priority groups.

One of the first visitors was Sheikh Abdul Kareem, the imam from al-Rahma mosque next door, along with the man who does the azaan, the call to prayer. Both were filmed and photographed being vaccinated, with the footage uploaded to local social media sites to counter the misinformation putting many congregants off the jab.

Dr Cait Taylor, a GP who is joint clinical director of the Central Liverpool primary care network, decided she and other white medics would not be giving the inoculations. Instead, they put a call out for medical students from BAME backgrounds, offering £10.21 an hour for Urdu and Arabic speakers. “We wanted to inspire confidence,” said Taylor.

One of those to heed the call was Areej Shams-Khan, a fourth-year medical student who speaks Urdu. She thought moving the clinic to a popular community centre was a smart move. People felt more comfortable there than at a GP surgery, she said, “where you might be met with a white receptionist, or a white vaccinator, or a doctor who doesn’t explain things to you properly, or doesn’t know your language”.

Mohammed Ali, a fifth-year medical student, agreed that people felt more at ease in the community centre, “rather than somewhere cold, white and clinical”. Aarzoo Bhatia, another Urdu speaker, said she was happy to be of service, reassuring patients that the vaccine did not contain pork and would not affect fertility: “It’s nice to feel useful for once.”

The session was set up with the help of Rahima Farah, a community volunteer of Somali background, who mobilised local WhatsApp groups and social media networks to spread the word. “The BAME community are not hard to reach if you bring the services into the community,” she said. Taylor agreed: “The message we’ve got loud and clear from local communities is: come to us and we’d love to take the vaccine, thank you very much.”

Rachel Stead, the network manager, said the ad hoc way in which vaccines were distributed exacerbated racial inequalities. Last week, she received 3,500 more Pfizer doses than she was expecting, which had to all be administered within three and a half days, prompting a panic not to waste a drop.

“You have got to just get rid of them quickly. So actually, what you end up doing is vaccinating the people that are easiest to get into your vaccination centre, people who are likely to be able to receive a text message and respond to that online,” she said, saying that those people were disproportionately likely to be white and affluent. “That automatically increases health inequality because the people that we need, we need to take time to get them in. We need to take time to educate and find out where they want us to vaccinate them. Right. So it’s only now that we’ve got the Oxford vaccine that we can do that, because it has a much longer shelf-life of six months and is much easier to move.”

For the first month of the vaccine rollout, NHS England made it very difficult to move vaccines from the big clinics to smaller community settings, said Taylor. At the start, all vaccine clinics had to be open from 8am to 8pm seven days a week, which counted out most multipurpose venues such as the Pal Centre.

In her GP network, the first clinic to open was in Vauxhall, the whitest part of central Liverpool, where only 6.8% of patients are from BAME backgrounds. That is a 45-minute bus ride away for patients in places such as Toxteth, who sometimes lacked not only the confidence to leave their neighbourhood but also the bus fare, said Taylor. At her clinic, in nearby Dingle, many patients were “women who are based in the home, who don’t venture out much”, she said.

Nehla Akram, a driving instructor who cares for elderly relatives at home, was one of the 40 patients vaccinated at the Pal Centre on Wednesday, along with her husband, Ijaz, a civil engineer.

Misinformation about the vaccine was rife, they said, particularly among the older community who received all of their information via word of mouth – or WhatsApp – rather than mainstream news outlets. “I’ve got a pharmacist in my family who is saying: ‘I’m not having it,’” said Ijaz. “People don’t believe in Covid and they don’t believe in the vaccine,” said Nehla.

Ijaz nodded: “They don’t think that these vaccines have been around for so long, and you’ve got rid of typhoid, and all the other diseases. Why not this one?”

Nehla said she would now spread the word among her community. “I’ll be saying how important it is that we get ourselves protected otherwise we can’t get back to normal.”