New data on the UK’s vaccine rollout has shown some striking disparities in protection between places, with cities falling behind. Across the eight English Core Cities and London, the average first dose coverage of adults is 50.1%, compared to 71.9% in England as a whole.[1]
This puts cities a long way from achieving herd immunity through vaccination. Herd immunity is where individual immunity has reached high enough levels to stop the virus from spreading, and threatening unprotected persons. Estimates of herd immunity for Covid-19 vary depending on the transmissibility of the variant in question, but many experts expect that the threshold will be between 70% and 90% immunity, leaving areas further from this threshold at greater risk of uncontrolled spread. [2] While the initial aim of the vaccination programme, protecting the most vulnerable age groups with two doses, has been achieved, continued community transmission puts those groups in certain places at risk. And continued spread might hold back the economic recovery through a reduction in consumer confidence, with health anxiety linked to local Covid-19 prevalence. [3]
While there has been a lot of talk about vaccine hesitancy, most of this gap is a consequence of rigid age prioritisation in England, with vaccination availability determined by age. Looking at the graph below, we can see that total vaccine uptake is strongly correlated with the median age of a place. The specific demographic structure of cities combined with tight age priority has resulted in substantially lower levels of protection through vaccines for city residents, with larger cities a long way off hitting herd immunity thresholds. Outliers from the trend, like London with lower coverage even when accounting for their relatively young populations, and with lower takeup in priority age groups,[4] suggest a smaller but still significant role for vaccine hesitancy.
Figure 1. First does coverage in UK local authorities by median age
Source: Median age - ONS (2019), and Dose coverage - UK Covid Dashboard: 25/05/2021
Other countries have taken a different approach to the UK’s strict focus on vaccinating in descending age order, and are seeing different outcomes. In the United States, lower overall vaccine takeup has resulted in rapid opening of vaccine availability, and now younger cities and states are pulling ahead. Kaiser Health estimates that vaccination rates are 3.6% higher in urban metro-area counties than their rural and town equivalents.
UK vaccine policy has focused on protecting vulnerable individuals based on personal characteristics, such as age and health. However, our work has shown that place is also an important factor in Covid-19 cases. As outlined in a report Metro Dynamics recently carried out with the Key and Core Cities, deprivation and Covid-19 case rates are closely correlated. Overcrowding, existing poor health and a lower likelihood of being able to work from home contribute to Covid-19 risk in more deprived neighbourhoods, which are disproportionately found in cities. A vulnerable person will be more at risk living in an area with low vaccine coverage, and even more so in a more deprived area, as vaccines are not 100% effective
Figure 2. Correlation between deprivation and Covid-19 cases in the Key and Core Cities (to March 2021)
Source: Metro Dynamics Analysis of English IMD (2019), UK Covid Dashboard (2021)
If the vaccine rollout continues at current speed, the first dose gap will be resolved over the next month, as under 35s are called up. The second disparity, in second doses, follows the same pattern and will likely take longer to even out. Given initial reports suggesting reduced efficacy for single doses with the growing Indian variant, this is a concern. [5] This might have implications for economic recovery, if urban centres already impacted by “Zoomshock” see higher case rates than their surroundings, and residents feel uncomfortable travelling in to spend and work.
Figure 3. Second does coverage in UK local authorities, by median age
Source: (ONS, 2019), (UK Covid Dashboard: 25/05/2021)
Vaccination isn’t the only measure of current protection; prior infections also provide a level of immunity. The Institute for Global Change has analysed vaccine rollout combined with projections of infection rates to deliver an overall estimate of protection against Covid-19. On this measure, cities like Manchester and Liverpool, with high prior infection rates see relatively higher protection, while other cities like Cambridge, Exeter, Brighton and parts of inner London see lower gains. However, there are still substantial spatial disparities, and a need to refocus vaccines towards areas falling behind.
Changes for flexibility in vaccination are already underway. The recent surge in cases of the Indian variant has seen flexibility introduced in urban areas with higher cases. Surge vaccines have been rolled out in Blackburn with Darwen and Bolton, while in Manchester, residents in vulnerable city centre wards are being moved to the front of the queue.
The place-blind approach which has been taken to date in vaccinations both ignores the fact that disease spread has a highly spatial pattern (between individuals in close proximity) and that populations vary between different types of places, meaning there are unintended spatial consequences. As we move from a focus on directly protecting the vulnerable to a focus on preventing community transmission, a much more spatial lens should be applied to vaccinations, targeting future supply at the places furthest from herd immunity.
[1] Metro Dynamics analysis of UK Covid Dashboard Data, (25.05.2021)
[2] John Hopkins University, What is Herd Immunity, (2021): Link
[3] Deloitte. What’s weighing on consumer’s minds? (2020): Link
[4] NHS, Covid-19 Vaccinations 8th December 2020 – 23rd May 2021 (2021): Link
[5] The Financial Times, Vaccines work well against variant found in India, (2021): Link