Coronavirus vaccine: Transport staff and teachers should be prioritised

Nicola Sturgeon this week set out the Scottish Government’s plan to vaccinate 4.4million Scots over the age of 18. There are hopes that around 1million people could receive the jag before the end of January.

Frontline health and social care staff, care home residents and staff and all those aged 80 and over will be the first to receive the vaccine.

Those under 65 who are at an additional clinical risk will follow, before it is extended to the wider population.

But a recent study published in The Lancet last month was critical that the guidance being followed by the UK and Scottish governments does not take into account occupations or socioeconomic factors.

It suggested that ‘high risk’ jobs such such as transport should also be considered when deciding on priority groups.

READ MORE: Poor and wealthier Scots dying earlier due to decade of austerity cuts, first study of its kind warns

Data published earlier this year found that men working as social carers, factory workers, security guards and cab drivers had more than double the risk of death as men in the general population.

For women, carers and sales assistants were more likely to die than other women in the population.

John McKendrick, a Professor of Social Justice at Glasgow Caledonian University, said he believes those living in deprived areas should be ‘higher up’ in the chain including those in key worker jobs, while teaching union the EIS has suggested school staff should also be prioritised.

Research has already shown people living in areas with the highest levels of poverty and lowest levels of educational attainment have the highest rates of hospitalisation and are 1.9 times more likely to die from Covid-19.

Physical crowding, homelessness, poor air quality, and smoke exposure are also associated with poorer outcomes and there is a disproportionate impact on minority ethnic groups.

READ MORE: Coronavirus: School teacher absence rates double in Tier 4 areas

Many of the areas placed under the strictest Tier 4 measures on Friday have a high density of deprivation, including North Lanarkshire and Glasgow.

“You can’t change the drivers in a pandemic," said Prof McKendrick. "What you can do is make sure that resources are skewed towards those who are most vulnerable.

“You would like to think that people who are more vulnerable are likely to get access (to a vaccine) quicker. More deprived areas should be higher up there.

“It will be interesting to see if that becomes a bit of a bun fight because everyone wants that vaccine yesterday.”

Concerns have already been raised that changes in the way the flu jag has been administered in some health board areas including Glasgow during the pandemic has adversely affected those from deprived areas, many of whom are having to travel further distances on public transport, which has cost and virus risk implications.

Public Health expert, Professor Linda Bauld said it had been “crystal clear” that higher cases of Covid in the North of England were linked to deprivation but suggested that non-compliance with restrictions in those areas might also be at play.

She said: “There probably is lower compliance just because people are disenfranchised in these communities anyway - they don’t trust government, why would they? - so you can see that it’s these urban-deprived areas that are worst hit. “That’s the case across the UK.”

In contrast, Prof McKendrick said there was “absolutely no evidence” to suggest that people from poorer areas are less likely to be compliant with restrictions and suggested the reverse might even be true.

He said: “I would be very uncomfortable about asserting that.

“There is no indication of it.  I can think of no good reason why people from deprived areas would be less likely to be compliant.

“In fact there is a logic to the reverse. A lot of the non-compliance is understood to have been in younger populations, early 20s. If you look at the distributions, they are probably less likely to be in deprived areas just by virtue of life stage.

“I think it is more likely to be related to job occupations where you are more out and about. “There is a reliance on public transport, which is really important to acknowledge.

“It’s fine for that guidance to be given to myself who can travel in a private car but it’s simply not an option for a lot of people from deprived areas.

“You’ve got denser environments and you’ve got occupations that don’t allow home working.

“ If you put all these factors together, it’s entirely logical that you would be expect there to be higher instance in more deprived areas.

“I don’t think it’s a behavioural non-compliance issue. Again, I don’t have the data to prove it but all the indications are that it’s to do with structural problems rather than decisions made by individuals.”

Ruth Dundas, of Glasgow University’s Social and Public Health Sciences Unit, was involved in research by Public Health Scotland comparing the impact on life expectancy of Covid and inequality-related factors such as drugs, alcohol or suicide.

The study found that over 10 years the impact of inequalities on life expectancy would be the equivalent to nine unmitigated Covid-19 pandemics.

She said: “We were told immediately that if the government didn’t do any work around Covid, there would be 500,000 deaths in the UK.

“So we then had all the mitigation and it was modelled again at 20,000. Everything happened very quickly.

“In terms of health inequalities, we’ve known about this for 40 years and there has been limited policy changes. It’s not that nothing has happened but very little has happened.

“Unmitigated Covid deaths per year were modelled to be about 42,000 and inequality related deaths is about 17,000 but they are coming round every year.

“Our argument is that the hope is that Covid is a one-off thing - whether it will be completely gone is another matter - but once it’s gone it’s one thing, whereas deaths from inequalities are happening all the time, year after year.

“It could be that we might catch Covid if we go on public transport but we are not going to catch the diseases of poverty.

“People are catching those diseases but not the people who are making policy.

“What Covid has shown is that population health does matter to the public and to the government and it shows it can respond when necessary.”