Overview

The BMA continues to ensure that doctors’ experiences during the pandemic are heard and learnt from. We are actively contributing to the UK Covid Inquiry to ensure that crucial lessons are learned and implemented. This is our opening statement for module 4 of the UK Covid Inquiry. 

1. The BMA views the COVID-19 vaccination programme as one of the biggest successes of the pandemic response in large part due to the immense efforts of doctors, particularly GPs and their practice teams, the wider healthcare workforce and volunteers.
 
2. The unprecedented scale of the vaccination programme saved millions of lives globally. A study by the World Health Organization (WHO) of 54 countries in the European region found that those countries that implemented vaccination programmes early – such as the UK – saw the greatest benefit in terms of number of lives saved overall through vaccination. And the authors of the report estimate that COVID-19 vaccinations in the UK reduced mortality by 70% in adults aged 25 and over, which is among the best outcomes across the European region.

3. Vaccination also changed the context of the pandemic and allowed governments to move towards reopening society as COVID-19 became less of a risk for most of the population.

4. The BMA proactively made the case in England that the COVID-19 vaccination should be delivered by GP practices, given their expertise in delivering vaccinations, such as the annual flu vaccination programme; their proximity to local populations; and their ability to respond to any concerns regarding vaccination.

5. By the end of October 2021, 71% of vaccines in England had been administered by GPs and their teams and community pharmacies, compared with 21% by vaccination centres and the remaining 8% in hospitals or other settings. And this significant contribution (which was well above planning assumptions) was made alongside the delivery of COVID and non-COVID care.

6. GPs also made significant contributions in the devolved nations. As of Spring 2024, 47% of vaccines in Northern Ireland had been delivered by GP practices. In Wales, health boards were responsible for delivery of the vaccination programme, and by July 2021, COVID vaccinations were being delivered at 51 GP practices. And in Scotland, where over two thirds of all vaccine doses administered were delivered using either mass or community vaccination centres, general practice administered the second largest proportion of doses (at approximately 13%).

7. GPs were also involved in efforts to increase vaccine uptake amongst their patients, and some GPs contacted individual patients from many of the at-risk groups personally to encourage uptake.

8. However, despite its success, the vaccination rollout was not without its challenges.

9. The pre-pandemic understaffing of health services, as well as the pressures of the pandemic, and insufficient consideration given to workforce planning in connection with the vaccination programme, meant that GPs and their teams were required to work even longer hours, while already overstretched, to deliver the vaccination programme while also maintain non-COVID and COVID care.

10. These pressures resulted in medical professionals reporting stress, burnout and fatigue, for example, a GP from Northern Ireland who reported, “We have been stretched so thin covering COVID centres and also delivering vaccine programmes, this has had a huge impact on our staff”.

11. Issues with the vaccine supply chain also presented a challenge for vaccination delivery. Calls for improvements to the vaccine supply chain were made at various stages of the vaccine programme, and the BMA raised concerns that the approach to delivery and availability of vaccines had created uncertainty amongst GPs and healthcare teams regarding what they could provide to their communities, and when.

12. The BMA’s view was that those most at risk of illness or death from a COVID-19 infection and frontline healthcare workers should be prioritised for vaccination. Frontline health and social care workers had a far greater risk of exposure to infection, due to their work caring directly and intimately for patients with COVID-19. Because health services were already operating with severe workforce shortages, it was imperative that doctors and other frontline staff be protected so they could continue to provide services. The BMA was therefore pleased to see health and social care workers prioritised for vaccination.

13. However, there were differing experiences across the medical profession during the rollout, and groups that reported particular difficulties included resident doctors, GP locums, and doctors working in private practice. 

14. There were also indications of vaccine hesitancy amongst some healthcare staff. And in July 2021, research published by UK-REACH found that healthcare workers from ethnic minority groups were more likely to be vaccine hesitant than their White British colleagues. The research also found that healthcare workers were more likely to be vaccine hesitant if they were younger, female, pregnant, or had already experienced an infection.

15. The BMA strongly urged doctors and frontline healthcare workers to be vaccinated, and uptake was high among doctors. For example, results from a February 2021 BMA survey found that – at the time – 93% of respondents had received the first dose of the vaccine. However, the BMA voiced concerns about policies put in place in England that made vaccination a condition of deployment among staff in older adult care homes, and its proposed expansion to the health and wider social care sector, which policy led to the loss of significant numbers of care home sector staff, and exacerbated the existing workforce crisis.

16. The BMA’s view was that vaccination should be voluntary based on the principle of informed consent, being respectful of individual rights and liberties and that any move away from the existing voluntary model would need to be properly justified and proportionate. The BMA’s priority was to support doctors and other healthcare workers getting vaccinated while listening to and addressing any concerns staff may have, emphasising that vaccinations are safe and effective in protecting against the disease.

17. In the general population, while the overall uptake of the vaccine programme was high, the BMA expressed concern that progress was not equal across the UK, and that an overall high rate masked significant disparities in vaccine uptake, particularly along the lines of deprivation and ethnicity. 

18. Lower rates of COVID-19 vaccine uptake amongst some ethnic minority groups were seen across the UK, and throughout the different stages of the vaccination programme, again with vaccine uptake highest among those from a White ethnic background.

19. Disparities in vaccine uptake were also seen along deprivation lines, as referenced in the BMA’s 5th COVID-19 Review report, data from 2022 showed that across England, Scotland and Wales, vaccine uptake was higher in areas of greater affluence and gradually decreased along deprivation lines.

20. Pregnant women were another group which had needs that were not sufficiently met in relation to the COVID-19 vaccines. Changing government advice led to confusion amongst those who were pregnant, or those who were considering pregnancy, about whether they should be taking the vaccine. The confusion should have been avoided, as pregnant women were at higher risk of severe disease from COVID-19. This also impacted women trying to become pregnant, among whom uptake of the vaccine was lower, also fueled by myths about the vaccine impacting fertility.

21. The BMA believes that more could have been done to identify the needs of vulnerable and minority groups ahead of the vaccine programme’s delivery, particularly in light of the well-known pre-existing health inequalities and knowledge that vaccine uptake was lower in marginalized and minority groups, not least because of a history of structural racism. This significant disparity in uptake cannot be ignored, and the barriers to vaccination must be addressed if the UK is to be prepared for any future pandemic.

22. In the BMA’s view there were several key barriers to uptake of the COVID-19 vaccine:

• There were physical barriers to accessing vaccination sites, such as difficulties reaching the sites. For example, some mass vaccination centres were a considerable distance from people’s homes or workplaces and could not be accessed via public transport routes. The cost of transport, as well as having to take time out of work to travel were also issues, especially for those on lower incomes.  Accessing the vaccine was also challenging for those who were unable to leave home easily, such as elderly or disabled people. And for those who were clinically vulnerable, many had a fear about leaving home and catching COVID-19.
• Not having an NHS number became a barrier to vaccine uptake for many people in the homeless population, as well as for vulnerable migrants. Despite there being no need for a fixed address to access the vaccine, there were reports that some people still faced this barrier.
• Communication barriers also existed for people who could not understand or access all the relevant information about having the vaccine, for example, in a linguistically or culturally appropriate way.
• A significant cultural barrier to accessing the COVID-19 vaccine has also been the lack of trust in health services and, by extension, the vaccine amongst some ethnic minority communities. People from ethnic minorities and deprived communities also had worse health outcomes before the pandemic, and with this in mind, there should have been greater consideration of these groups in planning the vaccine rollout.
• Misinformation about COVID-19 vaccinations and anti-vaccination messaging in the press and on social media also likely added to vaccine hesitancy, and the BMA called on the UK Government to take more action to tackle misinformation online.  

23. Finally, a discrete issue that the BMA wishes to address within this opening statement is to rebut the criticism that it sought to take commercial advantage of the vaccination scheme by seeking payment for vaccination services.

24. This offensive and unfounded criticism is based on a mistaken view that GPs had sufficient spare capacity within existing workloads to deliver the largest and most complex vaccination programme in the country’s history, in the middle of a national health crisis.

25. Whereas, in fact, the vaccination programme was additional work that general practice, already stretched to breaking point, was required to deliver, and which necessitated existing staff working significant numbers of additional hours, often at weekends, and the engagement of additional staff, all of which needed to be paid for.

26.  And despite these challenges, vaccinations administered by GPs were delivered at significantly lower cost than the planning assumptions, and at significantly better value than at vaccination centres. 

27. The challenges faced by General Practice at this time were made clear by the BMA in a letter to government in September 2021, in which the BMA called for public transparency, stating, “…there are simply too few GPs and practice staff in under resourced premises to meet the huge surge in demand that practices are currently experiencing, which will be exacerbated by the Covid vaccination booster programme…it will be GPs and their practice teams who will be leading this additional work. Given the magnitude of delivering millions of vaccines over the coming months, together with increased patient demand during the winter, it is vital that the public are made fully aware of just how much strain practices are under...”

28. In conclusion, and as outlined in this statement, while the vaccine rollout was an undoubted success, due to the unwavering commitment of healthcare staff and GPs in particular, it was not without caveats for improvement. The BMA invites the Inquiry to consider the inefficiencies within the supply and delivery of vaccines around the country; to reflect the strain that the vaccination programme placed on general practice and the healthcare workforce; to acknowledge the detrimental impact on the workforce of vaccination as a condition of deployment; and to make recommendations that address the disparities in vaccine uptake and access to healthcare more broadly, which the BMA says requires urgent improvement by governments across the UK.