Governments and institutions in developed countries continue to prioritise their own populations, and perversely, the profits of northern-based pharmaceutical firms over the imperative of ensuring life-saving COVID-19 vaccine access to everyone everywhere. This is not only a matter of gross injustice and tragedy for individual lives, families, communities and entire nations, but it is also a major stumbling block to ending this pandemic for all.

That said, even where vaccines are plentiful, equity and justice is not guaranteed. Here too, there are profoundly social, political and economic challenges to contend with. Challenges with long histories and ongoing legacies, linked to issues of trust, confidence, social processes and accessibility. Racism, economic inequality and precarity, austerity, hostile migration policies, and more, have implications for COVID-19 vaccine equity today.

Learning from Ealing in London

We have drilled down into the context of Ealing – a richly vibrant and diverse borough in North West London – to understand how vaccine (in)equity has played out on the ground. We mined the literature to build a picture of Ealing, its social, political and economic history, and the experiences of its diverse residents which might have implications for vaccine equity.

In Ealing, like many places across the UK, vaccine uptake rates are lower among more deprived residents, and among people from ethnic minority backgrounds who have been historically marginalised and excluded. We also spoke to people involved in local vaccine rollout, as well as within community groups, to get a sense of what the challenges have been, what strategies and approaches have been more successful, and what they thought still needed to happen.

What emerged were lessons not just for vaccine equity, but for health equity more broadly. The pandemic emerged into a context in Ealing – like elsewhere – which was already characterised by inequalities in health and wellbeing. Many of these along racial and ethnic lines.

What are the considerations for those working on the vaccine rollout?

There is need to take differentiated, and sometimes more intensive strategy to reach and engage different social groups. Importantly, we need to prioritise those who are vulnerable rather than assuming a one-size-fits-all approach is sufficient. It’s critical for responders to understand the perceptions, perspectives, concerns and lived experiences of different groups, and what they need to feel more confident in, and have greater access to vaccines, or other critical services.

More joined up approaches to working between and within teams in the council, health system and community are also essential. Indeed, many we spoke to felt that the collaborative approach was behind local successes in narrowing vaccine uptake gaps. Another critical point is the need to support revitalised civil society and community groups – including smaller and more informal ones – to enable their independent organising, and to support their engagement in local decision-making and co-production processes. Often, many trusted and active community-based actors are not those who authorities and outsiders might assume them to . While it is important to engage traditional community leaders such as faith leaders, others including shopkeepers, sports coaches or hairdressers may also or even more readily have the trust of their communities in some cases.