With the UK’s journey out of the Covid-19 pandemic increasingly appearing to be a race between vaccination and variants, how to reach – and jab – those who are ‘vaccine hesitant’ is becoming an urgent priority. A workplace-based vaccination pilot has shown that trusted, occupational health-led communication and education may be one answer. Nic Paton reports.
As Occupational Health & Wellbeing predicted back in December, OH practitioners have up to now mostly had a secondary, if still important, role to play in the Covid-19 vaccination programme.
Yes, NHS OH teams have been instrumental in helping to set up and maintain the infrastructure that underpins much of the hugely successful health service-led programme, and individual practitioners have been proactive in volunteering to help with delivering jabs into arms.
But from a workplace health perspective, much of the focus of OH practitioners has been around managing and supporting any absences associated with side-effects from the vaccinations, including the (thankfully rare) more severe allergic and blood-clotting reactions we have occasionally seen. Not that, of course, practitioners have exactly been idle, what with still having to manage and lead on Covid infection control and return to work, especially against the backdrop of the spread of the Delta variant.
Things may be starting to change, however. We are now moving into the end-game of first adult jabs, still expected to be completed by the end of July. As we look at the rest of the summer and into the autumn, the focus will begin to shift to following up with second jabs, potentially extending to even younger cohorts of the population and even the prospect of a new round of booster or variant-resistant jabs.
On top of this, there is still vaccine hesitancy and misinformation to contend with, especially among those from Black, Asian and minority ethnic heritage and lower income backgrounds and, to an extent, among younger age groups.
Jaguar Land Rover workplace vaccination pilot
This issue of overcoming hesitancy is one important area where workplace-based vaccination programmes may be able to make a difference, as a recent workplace vaccination pilot has found.
The pilot, carried out at Jaguar Land Rover’s (JLR’s) 300-acre factory in Solihull as well as its Battery Assembly Centre and Castle Bromwich plants, ran over eight days in April and saw 4,502 employees, contractors and delivery partners being successfully vaccinated with Oxford/AstraZeneca first jabs out of a target of approximately 7,000 workers. Importantly, it was also successful at reaching potentially vaccine-hesitant populations.
Dr Steve Iley, chief medical officer, human resources, takes up the story. “We’ve been lucky that we have quite a strong relationship with our local director of public health [Ruth Tennant, director of public health at Solihull Metropolitan Borough Council],” he tells Occupational Health & Wellbeing.
“We have, in total, about 10,000 people on site who, potentially, we can get access to. From Ruth’s perspective, with a plant this size, there is always going to be a risk of cases; we are always going to be a Covid risk.
“So, she said to me, ‘would you be interested in trying to do a pilot? One that could be fed through to NHS England about delivery on site?’. We of course said yes, we’d love to give it a go,” Dr Iley says.
Ruth Tennant adds: “We’ve worked really closely with literally hundreds of organisations – schools, care homes, supermarkets to control Covid and manage outbreaks throughout the pandemic. Our relationship with Jaguar Land Rover as a major local employer is really important for Solihull and JLR is almost a community within a community.
“Because of the size and demographic of the workforce, JLR was a ‘canary in the mine’ throughout the pandemic and it often gave us a very early warning sign when rates were increasing. So we knew the site was an important focus to reduce transmission.”
The uptake was made easier by being on site. At various points on one of the days we actually had line stoppages, which means the line stops and we are not building cars. So the guys were just standing around and the nurse literally went over and said, ‘well, if you’ve got nothing else to do, come and have a vaccine’!”
Of the 10,000 total workplace population, some 3,000 by this point in April had already had first jabs, primarily because of being aged over 50. But that still left approximately 6,000-7,000 to ‘capture’. A joint application between Solihull MBC and Jaguar Land Rover to run a pilot was therefore put into NHS England.
“The idea was it would be everyone aged over 18, so no rules about who got it. It wasn’t age-banded; it was, literally, anyone over 18 who is on the site can have it,” says Dr Iley.
“The approach and ‘sell’ to NHS England was, let’s research if delivering it on site means you get better uptake in the young, or under-30s, and do you get a better uptake among ethnic minorities? The goal was to see if we could prove or disprove if there was a better uptake in the young and ethnic minorities by delivering it on site as easily as possible.
“NHS England approved it. We then had about 10 days to stand it up from approval, so it was very quick; this was a very big undertaking.
“We gave them the whole occupational health department. We all, basically, moved out. We took all our physios, our counsellors, our occupational health nurses out. They moved in. They also had two mobile vans on site. And they could run eight lanes all at once; it was a big operation,” Dr Iley adds.
“The NHS did the jabbing. Our job within occupational health was to coordinate the communication and the bookings. We were the front-end to get the person to the door, if you like. Once in, the NHS took over and did the actual flow through the department.
“That did, however, mean there was still a lot of prep, and I think that was one important lesson we learned; the importance of having a multidisciplinary team. We had clinicians, communications experts, IT experts, security experts, and a manager all on the project group on our side liaising to make this happen,” Dr Iley advises.
“We needed to put in new IT infrastructure for the NHS team. We needed to put in new passes for them, to get them on site. We also built a new booking system within a week. We deliberately made that open source. We took the risk that some people would try and book who weren’t entitled, but we thought it was much better to reduce or remove any barriers to people being able to have the vaccine. The worst-case scenario, after all, was that more people would be getting the vaccine.
“Communication, it was clear, was also going to be key. Communication-wise, we did something we haven’t really done before, which was a tripartite letter. So it came from me, from the plant director and from the trade union convenor. That was something quite unusual for us,” Dr Iley adds.
Pre- and post-pilot employee surveys
Workers were also surveyed anonymously pre- and post-programme. For the pre-vaccination survey, which aimed the gauge the level of interest in and likely take-up of in the programme, some 4,570 responses were received, with 3,085 people agreeing they would be up for it.
Of those, the main reasons cited were to protect their health (36%) and that of loved ones (45%). Of those who said they would not be prepared to take part, for the vast majority this was because they had either already received or were about to receive a vaccine. However, a significant minority (20%) said it was because they did not believe the vaccine was safe.
For Dr Iley and his team, the imperative therefore was twofold: make it easy and get out on the ground and ‘sell’ the benefits of the programme.
“The uptake was made easier by being on site. At various points on one of the days we actually had line stoppages, which means the line stops and we are not building cars. So the guys were just standing around and the nurse literally went over and said, ‘well, if you’ve got nothing else to do, come and have a vaccine!’ That helped,” he points out.
“Making it really, really close to them and really easy definitely helped. We did a lot of communications around that. We didn’t say, ‘you must have it’. We said, ‘if you’re wondering about the vaccine here is where you can go to read about it’. Because there is quite a lot of social media misinformation.
“We fed headlines through in the communications strategy, and then showed people links to trusted sources of information. We also had the help of our BAME (Black, Asian and Minority Ethnic) network. The first person in was deliberately chosen to be from an ethnic minority. We videoed and filmed him and, with his permission obviously, put that out as well,” explains Dr Iley.
“We had ‘vaccine diaries’, where we had people talking about their experiences of either having the vaccine or family members not having it, and the problems they had had. So, it was just about trying a multimedia approach to get people to engage.
“We have a weekly newsletter that goes out electronically to the plant. We also have printed material. We also have emails. For this we actually used their personal emails via one of our apps. There is an agreement that we don’t use their personal emails for everything but we felt this was sufficiently serious to warrant that.
We had ‘vaccine diaries’, where we had people talking about their experiences of either having the vaccine or family members not having it, and the problems they had had. So, it was just about trying a multimedia approach to get people to engage.”
“We held talks – simply talking to people out on the shopfloor and telling people it was going on. We have screens around the factory, where we can show videos and share clips, and so we used those as well.
“We found face to face was particularly effective; you can’t beat it. Making it specific, so ‘this is for you, in Solihull’, obviously was good. But, actually, face to face was the big one. We had our nurses go out and talk to people, although of course there was a limit to their capacity, and that is one of the challenges with face to face.
“Anecdotally, we heard a lot of ‘my wife told me I should have it’. We have a predominantly male workforce, they’re mostly somewhere between 30 and 55. So, there was quite a lot of ‘my wife told me’. I think if we were having our time again, we would probably target the partners more,” Dr Iley adds.
This positive response was echoed in the post-pilot overview survey. This received 1,779 responses, split 50/50 between participants and non-participants.
Overall, as figure 1 shows below, participants gave the programme a rating of 4.82/5 stars on average, so a strong thumbs-up. Suggested improvements included making the booking system available 24 hours a day, extending vaccinations to family members, and making more appointments available around shift times.
Figure 1. Results of the Jaguar Land Rover post-pilot employee survey
A total of 96% of participants said they would have had the vaccine once it was available, meaning just 4% would have declined or not been sure.
Of those who decided not to participate (figure 2 below), for most (81%) this was, once again, because they had already had or were due to receive a vaccination. Just 4% said they did not believe the vaccines were safe, although other reasons cited were because of being ‘under 30’ and worries about risk of side-effects, especially from the Oxford/AstraZeneca vaccine.
Figure 2. Results of the Jaguar Land Rover post-pilot employee survey from non-participants
Managing concerns about side-effects
This issue of side-effects was a concern more widely for the occupational health team, highlights Dr Iley, not least because the programme unfortunately coincided with the news first breaking about rare blood clotting side-effects associated with the Oxford/AstraZeneca vaccine.
“We were really worried that, actually, giving the vaccine all at once that we’d have a load of people off the next day,” explains Dr Iley. “We measured it because we thought that would be interesting to see. Thankfully, we saw less than 1% off with side effects, so a really, really low number. We and the NHS were surprised, pleasantly surprised, how few people were off.
“Another issue, giving that the programme was solely Oxford/AstraZeneca, was that on the Wednesday of the programme the news broke about the blood clots. The NHS paused giving the AstraZeneca jab to the under-30s for about two hours in the morning while they worked out what to do. The decision we came to was to offer it to the under-30s with appropriate counselling. The great majority of them said, ‘I’ll have it’,” he adds.
That positive response will, hopefully, feed into take-up for second jabs, which are due to happen from the end of this month, with the NHS returning to the Solihull site.
“For the second jabs we’re aiming to compress it, so I think we’re aiming for five days this time. The NHS has got faster and faster at this. The first day they said was one of the most successful first days they’ve had. By the second day they were doing 1,000 a day. So, they now know they can reach that and so they reckon they can do everyone in five days,” says Dr Iley.
As for lessons or learning points for practitioners to take away, Dr Iley reiterates that the key, at least for Jaguar Land Rover, was being able to being a truly multidisciplinary response to bear.
“We could not have done this without our communication, security and IT colleagues. The thing that trips you up is not the clinical bit actually; the clinical bit, as clinicians, we were perfectly comfortable with. But getting the messaging out, making sure the NHS could do what it needed to do; don’t underestimate the IT complexity of what they need,” he says.
The NHS told us that it was a great success. So it does want to replicate it. Obviously, the closer you can get to people, the easier it is to jab them in the arm. So I do think they will do far more workplaces going forward.”
“A multidisciplinary team from the start made it happen within such a short period of time. Not a chance we could have done it on our own, not a chance. That, for me, is the key. The logistics were super complex. You need to be able to get all the staff on site, the vans on site; you need to be able to store the vaccines; you needed passes; you need to work through things like where are they going to go to the toilet, where are they going to eat? There are so many bits to it.
“We’ve actually suggested to the NHS that it develops a checklist for companies. So, hopefully, by the time they come back to us they will have a checklist they can just give to a company and say, ‘this is what we need, now go and get ready’,” Dr Iley adds.
Finally, what does – or might – this all mean for occupational health as we look to the autumn?
Dr Iley points out that the success of the pilot does mean it is now a model on the NHS radar. “We’ve been told by Public Health England and the NHS England it is, we understand, going to be a strategy going forwards. And it is just starting to happen for other workplaces. So, although we are pretty confident we were the first, we understand they are now starting to do it in other areas and other locations,” he explains.
So, could this sort of workplace-based model be some something we see coming more into play from the autumn? “Absolutely,” says Dr Iley. “The NHS told us that it was a great success. So it does want to replicate it. Obviously, the closer you can get to people, the easier it is to jab them in the arm. So I do think they will do far more workplaces going forward,” he adds.