Understanding, not judgment, should shape our response to those who remain unjabbed

The start of the coming year will be defined by the UK’s vaccination gap, but the issue is more complex than you think

Amid rocketing Covid infection rates, rising hospitalisation numbers and test shortages, the opening weeks of 2022 are going to be defined by the UK’s vaccine gap.

According to the latest official figures, 91% of people aged over 18 in the UK have had at least one Covid jab, 88% have received two and 64% have had their third. But the 9% who have yet to be vaccinated at all accounts for about five million people, whose preponderance among those now being hospitalised is clearly a huge problem.

Precise figures are a matter of debate: some senior NHS staff put the share of unvaccinated people on their wards at up to 90%, although the most recent estimates show the share of people needing critical care who are unvaccinated running at just over 60%. What cannot be doubted is that if more people were vaccinated, the latest phase of the Covid crisis would be much more manageable, and the people in charge might not be faced with such a difficultset of options.

If the NHS is soon overwhelmed, tightening across-the-board restrictions might become inevitable, but it would highlight the unfairness of disrupting the lives of the vaccinated majority to protect those who are still unjabbed. Coercing people into getting vaccinated using stringent Covid passports – let alone introducing compulsory inoculation – would infuriate the Tory backbenches, make Boris Johnson’s future all but impossible, and even to many of us outside Conservative circles mark a worrying extension to the state’s reach, not least under a government as illiberal as this one. There are, in fact, no clear and easy choices, beyond retaining a vague hope that the sudden urgency of the pandemic’s latest phase might convince more people to pitch up at a vaccination centre, and keeping faith in the grassroots organisations currently doing their best to change minds.

To some people, though, the issues are completely straightforward. Ten days before he was made a Knight Companion of the Most Noble Order of the Garter, Tony Blair issued a characteristically sweeping verdict: “If you’re not vaccinated and you’re eligible … you’re not just irresponsible, you’re an idiot”. He later expressed regret about his choice of words, but by then it was rather too late: he had already triggered a wave of judgment on social media, suggesting that most unvaccinated people were either reckless fools, or the unhinged disciples of those online cults that put the past two years of human history down to a quest to tighten the grip of the secret world government.

Inevitably, the facts of the vaccine gap are immeasurably more complicated, as no end of statistics prove. According to the latest numbers published by the UK Health Security Agency, 30% of eligible people in Liverpool are yet to receive their first jab. In Birmingham, the figure is 33%; in the London boroughs of Newham and Tower Hamlets, about 38% and 34% respectively. Conspiracy theory and misinformation are sizeable and worrying features of the Covid era, and our politicians still say surprisingly little about them. But particularly in cities, beyond high levels of mobility and transience, figures showing large numbers of unvaccinated people reflect much deeper questions of age, class, ethnicity, faith and language – and what poverty, insecurity and institutionalised prejudice do to people’s relationship with the state. In that sense, the limits of the vaccination drive remind us of one of the most simple truths of power and politics: that if governments continually ignore fundamental issues of trust and basic empathy, any big social rupture will instantly reveal the consequences.

Earlier this week, I spoke to Manisha Kumar, an inner-city GP in Manchester and the medical director of the city’s health and care commissioning partnership, which is steering a grassroots vaccination drive that involves an array of local organisations centred on the city council. The main figures she and her colleagues work with are based on people registered with a medical practice. Some come with caveats, but they show the proportion of eligible Mancunian adults who have not received even a single vaccine dose currently standing at about 30%. In more affluent areas of the city, less than 20% of eligible people have not been jabbed, but in some poorer neighbourhoods, the figures tend to hover at about 50%. In aggregate, white people who identify as English, Scottish, Welsh or British register vaccine uptake levels of more than 80%, whereas the current number for people from a Caribbean background is 52%; among those classified as Gypsy or Traveller, the figure is 28%.

Such numbers, she said, only tell you so much: what is important is to get to the complex combinations of factors that make people either hesitant about vaccination, or downright hostile. “People come to this with their beliefs, their experiences of Covid, their perception of risk – there isn’t just one sort of person who hasn’t come forward,” she said. In some parts of the country, she went on, “you can just open your doors, send out a text, and people will come.” Her patch, by contrast, requires much more delicate and detailed work. “The majority of the city is hugely deprived, and lives in very small communities defined by culture, identity and geography. Knowledge of those communities is really important.”

What is lacking from a lot of people’s understanding of the vaccine gap, she told me, is any real sense of the sheer weight millions of people have borne over the past two years, and how precarious their lives often are. “The pace of change, the amount of information coming out – for some people it’s just been overwhelming. They’ve gone: ‘I can’t do this – it’s too much. I’ve lost my job, I’ve got issues with domestic abuse, my children are out of school.’” She also talked about huge issues around access to the internet, made worse by vaccines being introduced during lockdown. “People didn’t have phone credit or data roaming, or wifi in their houses. So when you sent out a link saying ‘Book on the national booking service’, they couldn’t do it.”

By way of getting to the heart of it all, a PowerPoint presentation she sent me made mention of “historic lack of trust in public institutions including health services within some groups and communities”. In some black communities, she said, people’s relationships with authority are so poor that that some have chosen to be vaccinated well away from where they live and work, “because they’re almost embarrassed to be vaccinated, thinking their community isn’t behind them.” She paused. “There’s no easy fix. We just keep on talking.”

In a lot of what she said, there were echoes of the kind of government actions that have only furthered people’s distance from the state, from the creation of a cruel and punitive benefits system, to the hostile environment doctrine that quickly led to the Windrush scandal. Cutting spending on English tuition was always going to keep people confined to the social margins; the innumerable other ways that austerity has hacked back even the most basic everyday help has made things even worse. If you are white, middle class and confident enough to play the kind of games large institutions always demand, the state might look benign and dependably helpful. But if it usually treats you with a mixture of hostility and indifference you will tend to keep your distance, even when it says it has your best interests at heart.

In the UK and elsewhere, what all that means for any attempt to make all of us move in lockstep is simple enough. The vaccine gap shows us how far we are from being a society that understands itself collectively, and how easily we still break into “us” and “them”. It demands not judgment, but a level of understanding we have yet to get near.

• John Harris is a Guardian columnist

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