Sabrina Daley, 40, stands outside New Tings, the Brixton Caribbean restaurant where she works as a chef, listing the reasons she’s not bothered about having the Covid jab. “I’m not saying never, but I don’t rave and I haven’t left the UK in 20 years, so to me, having a vaccine passport doesn’t make a difference,” she says.
The Jamaican-born mother-of-four had Covid, “terribly”, in November (“the only place I didn’t have pain was my hair”) and lost close friends to the virus at the start of the pandemic, but she doesn’t regret not having the vaccine. Despite having an appointment booked two days before catching Covid, and widely-publicised figures showing that nine in ten ICU patients are unvaccinated, she chose not to go. “I’ve heard of people who’ve taken the vaccine and still got sick with Covid...” she says. “So what’s the point?”
It’s been four weeks since the street where Daley works, Acre Lane, recorded the highest coronavirus rate in the country, with one in ten residents recording positive cases during the second week of last month – six times the UK average. At the time, health experts put much of this figure down to the area’s low vaccination rate, with 34.2 per cent of residents in the area not having had the jab, putting it in the bottom 15 council areas in the country for vaccine uptake, alongside the likes of Westminster where four in ten residents are completely unvaccinated.
Their views are wide-ranging, from account manager Alice Read, 24, who’s had the jab herself (”for my grandparents”) but knows young creatives in their twenties who’ve refused it because “they don’t want to be told what to do”, to new mother Amelia Williams, 33, whose best friend hasn’t been vaccinated because of concerns around the side effects.
Daley and her friends might not be worried about low vaccination rates in the area, but on the other side of the river in Westminster, concern is building. This week the government indicated plans to scrap Plan B rules as soon as this month - but will the city’s low vaccination levels get in the way of their planned return to ‘normal’? Already, unvaccinated members of the public are becoming a major problem across the NHS, with recent data from the UK Health Security Agency showing that people who have not been vaccinated are up to eight times more likely to be hospitalised with the virus, adding extra pressure on hospitals that are already close to breaking-point.
Chris Whitty recently said he was “saddened” by the proportion of unvaccinated Covid patients in intensive care (roughly nine in ten) and Dr Steve Mowle, a GP running a vaccine clinic in the Acre Lane area, has called the misinformation that leads to these figures “frustrating”, with those as young as 30 often left fighting for their lives. “We’ve heard tragic stories from those working on the frontline that intensive care units are full of patients who wish they could go back in time and get vaccinated, but that it’s sadly too late,” health secretary Sajid Javid said earlier this month.
The implications are being seen outside of the NHS. With many industries asking their employees to be vaccinated before coming to work, low vaccination rates are leading to staff shortages across sectors from social care to transport, with many leaders calling for greater pressure to be put on unvaccinated people so society can return to something closer to normality. “I really want to piss them off,” French President Emmanuel Macron said in a (now heavily-criticised) statement about unvaccinated people earlier this month.
Daley shrugs – she’s not surprised by her area’s low vaccination figures. Only one person she knows has had the Covid vaccine and anti-vaxx rhetoric in the area is – literally – clear to see. Just 50 metres down the road outside a Tesco superstore, a graffitied clothing-collection bin displays some of the wide-ranging anti-vaccine arguments amongst people in the area. “Poison jab!!!” reads a line scrawled in angry black capitals – a nod to concerns about side effects and certain false news stories about what the vaccine contains. Another line of graffiti points to a baseless but sinister conspiracy theory that the pandemic was planned by a shadowy cabal of elites as a method of ethnic cleansing or “depopulation”, while other conspiracy theories include the belief that vaccination is a method of microchipping the population.
We’ve heard tragic stories that intensive care units are full of patients who wish they could go back in time and get vaccinated
Other graffitied phrases point to less extreme views. “It’s the flu FFS,” one line on the bin reads, suggesting - as many locals believe - that the government’s Covid response is an overreaction to a flu-like virus. A passing mother and her teenage son confirm this. “I don’t even take the flu jab – I just let my natural immune system cope with it and I find that’s the best thing for me,” Julie Obalola, 51, the wife of a bus driver, tells me on her walk home from the shops.
She points to Brixton’s Universal Pentecostal Church next door and says she’ll continue to pray to God that the pandemic ends soon. “I live my life by the word of God – so far it’s protected me from the virus,” an 80-year-old pastor at the same church said last month. “There’s no need for me to have the vaccine.”
Acre Lane might have been singled out as the country’s Covid hotspot in the run up to Christmas – rates there remain among the highest in the country – but its low vaccine uptake is far from an anomaly. London currently holds 14 out of the country’s 15 least vaccinated postcodes, with a third of Londoners still yet to have a single jab, compared to 11 per cent across the whole of the UK. In certain boroughs that figure is even higher - in Westminster, four in ten residents are completely unvaccinated. So why has London become the country’s unvaccinated hotspot? And what are people’s reasons for choosing not to have a vaccine that could protect themselves and others from the virus?
First, London has a more “transient” population than the rest of the country so the figures might not entirely reflect the truth, says Dr Pauline Paterson, co-director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine. But it’s not all dodgy data – the capital does indeed have a higher proportion of vaccine sceptics and refuseniks than the rest of the country, and it’s important to note the complex and personal reasons behind this.
As Whitty pointed out this month, the majority of unvaccinated ICU patients are not conspiracy theorists with “weird views”, but ordinary people who have fallen for “deliberate online misinformation”. A stroll along Acre Lane reveals everyone from laundry workers who haven’t found the time or energy to book an appointment, to members of minority ethnic communities who fear being shunned by younger family members if they take the jab.
Reasons are wide-ranging, but Paterson believes there are two factors at the heart of London’s low vaccination figures: first, its relatively young population, who are more likely to feel less at risk from Covid than older members of the community. Roughly 42 per cent of the capital’s 18 to 24 year-olds are yet to be vaccinated (although people in the capital have lower vaccination rates in every age group).
Secondly, there’s the diversity of London’s population. According to the British Medical Journal, people from black and minority ethnic backgrounds and lower income households tend to be more mistrustful of the government and its institutions. “I feel black people have been through too much to have the almost child-like faith in authority that some of our white counterparts have. We lose that innocence when we are stopped and searched, excluded from school or turned down for a job,” Jasmine*, a black British management consultant told Gal-dem magazine last year. According to research quoted on the UK government website in October 2020, black people make up less than half a per cent on the NHS Vaccine Registry – just 1,200 of the 270,000 who signed up to participate in the clinical trials were from the black community.
Paterson says individuals from minority communities are more likely to be vaccine hesitant for a myriad of reasons, including concerns around a lack of research, a wider distrust of the government and its handling of the pandemic, and longer-term historical reasons. Evidence quoted by Savid Javid last year also found structural racism can lead to patients from ethnic minority communities suffering poorer health outcomes in the NHS.
In many cases, this has translated into an often cult-like rejection of the vaccine among ethnic minority communities. “We’ve had examples of elderly couples [from BAME communities] coming in and saying ‘Please don’t tell our children that we’re being vaccinated’ because their younger family don’t approve of it,” says Dr Steve Mowle, a member of the Royal College of GPs who runs a vaccine clinic in the Acre Lane area and has seen patients shunned by their communities for being jabbed.
We’ve had elderly couples say ‘Please don’t tell our children that we’re being vaccinated’ because their younger family don’t approve of it
Age and ethnicity clearly play a role in people’s vaccination decisions, but a poll of Brixton’s residents quickly proves that the reality is far more complex than binaries such as young and old, black and white or religious and non-religious. Even within the vaccinated camp, reasons for having the jab are wide-ranging, with views stretching from more mainstream vaccine-takers like cab driver Fuzum Habte, 54, and bike shop manager Evandro Lopes, 52, who never hesitated about having the jab and think their friends are “mad” for refusing it, to more reluctant vaccine-takers, who only accepted the jab to make their lives easier.
“The only reason I had [the vaccine] is because the government made me,” says Cornel Brown, a 72-year-old retiree who needed his vaccine passport to make his annual trip to see family in Jamaica. “I did it because couldn’t be bothered to take a lateral flow test every time I go anywhere,” says Natalie Turner, 30, a nearby shop assistant from Bromley who wants to keep going out with friends.
For friends of hers who haven’t had the vaccine, it’s mostly down to apathy – they can’t be bothered because the rules aren’t strict enough for a lack of vaccine passport to restrict their lives.
Turner’s friends aren’t the only vaccine-apathists I hear about on Acre Lane. Mowle says many practices he knows regularly have at least 100 no-shows for every 600 vaccine appointments. “I worry about [Covid], but not as much as other things - I’ve got other things on my mind,” says Rudolf Balasievic, 34, a Slovakian laundry operator from Tooting, when I ask why he hasn’t had the jab despite his mother recently being on a ventilator with Covid. “I know eventually I’ll have to get it [to go abroad], but I haven’t bothered.”
If a vaccine could be brought to him right now on the street, would he take it? Balasievic laughs, turning away, but he doesn’t say no – a suggestion that perhaps the vaccine isn’t as accessible as it’s widely believed to be, says Paterson. Her research has highlighted other groups who might struggle with access: busy working parents with no spare time or childcare options (a number of companies do not provide sick pay, even if someone is isolating with Covid), and ethnic minorities who might not feel comfortable standing in a vaccine queue for fear of being judged, as is the case for some of Mowle’s patients.
For others, the decision not to be vaccinated is based more on principle: they don’t like to be told what to do. A survey among health and social care workers by Paterson and her colleagues at LSHTM recently found that those who had pressure from their employer to take the vaccine were actually more likely to decline it – so does enforcement actually hinder vaccine uptake? In some cases, it would seem so, says Read. She has several friends – mostly young creatives in their twenties – who’ve refused the jab for freedom reasons: “They don’t want to be told what to do.”
Other passers-by say they prefer to take health decisions into their own hands. Obalola was vomiting for three weeks when she had Covid last autumn, but chose to take natural remedies, drink green smoothies and ride it out, like she would any virus. A passing 30-something says he hasn’t had any form of medication in 20 years, not even paracetamol (“so why would I have the vaccine?”). Meanwhile estate agent Josh*, 28, tells me he’s had both jabs (“of course”) but has no intention of having the booster because there’s “no need” - despite contradictory government advice that booster vaccines give “significant increased protection” against the virus.
Josh’s 50/50 position on the vaccine is reminder that there are more than two camps in London’s vaccination debate, says Paterson. Just like the flu jab, someone might choose to have it once, but that doesn’t mean they want to go and have it every three months, especially when some people suffer worse symptoms from the vaccine than they do the actual virus. “Part of the reason that cases are so high is the lack of that third dose,” she says. “The majority of people in London have had two doses... it’s that third dose that’s catching up.”
Paterson’s note about the vaccine’s side effects points to a final reason many members of the public are skeptical or fearful of the vaccine: they are concerned about the short- and long-term impacts on their health. New mother Amelia Williams, 33, tells me she didn’t take the vaccine until the final trimester of her pregnancy because of the “mixed messages” surrounding the jab’s impact on pregnant women and their babies.
Half her antenatal group still haven’t had it, despite latest urgent calls for pregnant women to get fully vaccinated before their third trimester of pregnancy following new research from Scotland showing that the mortality rate for women who gave birth within 28 days of a Covid diagnosis was four times higher than normal, and that severe complications from Covid in pregnancy were “significantly” more common in unvaccinated women. Williams’ best friend hasn’t had the vaccine because she’s worried about the side effects more widely, not just for pregnant women.
Several doors down, an unemployed father-of-two from Trinidad agrees. “It’s Russian roulette – it’s not been researched enough,” says Kalvin St Louis, 44. He refuses to tell me whether he’s had the vaccine or not, but it quickly transpires that his mistrust runs beyond the science. “It’s a form of ethnic cleansing... How do we know that what [Boris Johnson] was injected with on TV is what the masses are actually taking?” he asks me 30 minutes later, quoting the “plandemic” conspiracy theory - one of several harmful anti-vax theories being shared on social media by figures including a former Miss Great Britain, a reality TV star and a former GP.
What influenced St Louis’ beliefs? The Trinidadian says he doesn’t use social media, watch TV or read the news, but later admits he does watch YouTube. Is he one of the thousands if not millions of people in the capital believed to have fallen down that widening rabbit hole of pandemic-related misinformation?
Instead of stigmatising, we need to tackle misinformation at its root and make it easier for people to get vaccinated
At his bike shop down the road, Lopes says the friends who’ve fallen for “fake news” about the virus are mostly builders and delivery drivers being forwarded content on WhatsApp or YouTube, and an investigation by the Mail on Sunday recently found that a concerning six million people follow UK anti-vax accounts on Facebook, Instagram, YouTube, Twitter and TikTok.
St Louis’ views might lie at the extreme end of vaccine refusal, but his sense of alienation from the government and institutions like the NHS is widely shared, particularly amongst some of the capital’s more marginalised communities. So what can be done to dispel this misinformation and close London’s widening vaccine chasm? Paterson says Macron’s suggestion of making people’s lives harder if they don’t get vaccinated misses the point - she’s “furious” with the French leader for suggesting it because it only widens the mistrust gap and addresses a small part of the issue.
For Paterson, closing the vaccination divide shouldn’t be about assuming it’s people’s level of education that determines vaccine uptake. Rather, it’s about tackling the problem at its root: addressing existing inequalities in society; improving vaccine access (being able to sign up without an NHS number and not stand in a queue, for example), and dispelling disinformation, whether it’s within communities or on social media.
Educating faith leaders and supporting groups like UN initiative Team Halo – a team of scientists and health professionals putting out vaccine myth-busting videos on TikTok – are two effective examples of this, and Paterson hopes more will follow.
“Rather than stigmatising, we need better access to healthcare, we need to make it easier for people to take time off work to go and get vaccinated, we need to allow people to get vaccinated without having an NHS number...,” she explains.
Tackling inequalities that have existed for decades might sound daunting - but it could be a legacy in the long-term, Paterson continues. The government’s current vaccine drive has already helped to break down barriers - there have been collaborations with faith leaders and organisations giving vaccines to the homeless, for example. If these kinds of partnerships continue, “hopefully this vaccine programme can help us to tackle inequalities straight away, rather than wait and see that there are more inequalities,” she says. “It could be an amazing opportunity.”
