Nick Timmins: Learning from the central role of counseling in vaccine success

The experience of the pandemic has transformed the relationship between local government and the NHS, writes the King’s Fund senior researcher.

The Covid years – and an unwelcome second anniversary fast approaching – have been unprecedented for local government. Not least for their directors of public health, who – the Salisbury Novichok poisonings aside – have faced the greatest test of their professional lives.

Nicholas Timmins, Senior Researcher, King’s Fund and Institute for Government

Many of their achievements during the pandemic seemed to have been achieved in spite of the central government rather than with its support. For many months, the government ignored their expertise in contact tracing, instead relying on a fully privatized approach to test and trace. When some local authorities took the advice of their directors of public health to close schools at the start of Christmas 2020, then education secretary Gavin Williamson threatened to sue them.

The experience of rolling out the vaccine, however, has been very different. Directors of public health and local government more generally have played a central role in a program that has been one of the few almost unqualified successes of the government’s response to the pandemic. From the start, once it was clear that effective vaccines would be available, NHS England, whose ultimate responsibility was deployment, was clear that local authorities had a crucial role to play.

The crucial role of advice

A new King’s Fund study of vaccine program trials, tribulations and successes concludes that a wide range of interrelated factors have played a role in the successes to date. IT and logistics – getting the vaccine and huge quantities of associated kits to vaccination sites – worked well. The NHS has never used so much data so quickly and therefore so powerfully to manage not only logistics, but also to determine who had been vaccinated and where, and therefore the places where either confidence in the vaccine needed to be built or more sites were needed to make obtaining as easy as possible.

Public health directors and local authorities more generally helped find what many called “community champions” to help raise awareness of the vaccine and tackle vaccine hesitancy.

The military played a crucial role, particularly at the center, helping to organize the initial deployment. The many thousands of volunteers who helped run the vaccination sites, some becoming vaccinators themselves, also played a crucial role.

But so does local government. Public health directors and local authorities more generally have helped find what many have called “community champions” to help spread awareness about the vaccine and tackle vaccine hesitancy. Part of the reason they were able to do this is because they worked earlier in the pandemic.

As one public health director put it: ‘We had developed our outreach work throughout Covid. So in terms of the vaccine, we could, in pretty much no time, get 200 community leaders of all kinds together in a webinar, from people who run playgroups and community centers to religious leaders, and tell them “this is what we know about the vaccine, this is how it was developed and why it was done so quickly” and debunk myths while encouraging them to use their networks to spread the vaccine message and building trust and that kind of infrastructure that the NHS doesn’t really have.

Understand your citizens

Local authorities have also played a key role in vaccination sites, from seemingly small sites such as lifting parking restrictions around them, to locating additional sites themselves while using their local knowledge to identify where pop-up sites and mobile vans were likely to have the most effect.

As one regional commissioning manager put it, where there has been real traction “is through very strong leadership from local government and public health directors, and a real understanding of your citizens. What the NHS brings is breadth of supply. But the interface with the citizen and the community is where the local government and the directors of public health really come into play. We couldn’t have done it without working together.

It must be said that it is unlikely that it worked perfectly everywhere. And there are conditions for the success of the deployment. Adoption remains lower among many ethnic minority groups. It is weaker in deprived areas and – antivaxxers aside – it has proven less easy to persuade some of the younger generations that the vaccine is in the interests of others as well as theirs. But it is undeniable that the deployment would have been less successful without the central role played by local authorities.

Best luck in a generation

The open question is how much of this experience can be bottled up and reused for other NHS services? After all, he took the vaccine to places the NHS doesn’t normally go – to mosques, gurdwaras, churches and a wide variety of community places. And some of those who have offered their sites are among those who argue that they can and should be used for other programs – improving uptake of childhood vaccinations, cancer and diabetes screening, high blood pressure and other conditions.

In other words, enabling the NHS to not only offer universal service, but to provide more equitable access to it – using the power of the kinds of data that have been harnessed for the vaccine to identify where the usage is low, then taking these services to the hardest to reach. Important, not least because this type of highly localised, ‘place-based’ work between the NHS and local government is key to the success of integrated care systems.

Some are optimistic. As one public health director put it, the wider experience of the pandemic, not just the vaccination programme, “has been transformational” in terms of the collaboration between the NHS and local government, adding: “We have to create partnerships within our integrated care system, and the people who look after that know each other personally now. We’ve had fights together and we’ve done a lot of good things together. So it’s evolved dramatically, and we probably have the best chance in a generation of making it work.

Nicholas Timmins is Senior Fellow at the King’s Fund and author of The Covid-19 vaccination program: trials, tribulations and successes.

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