On December 31, 2020 the four UK Chief Medical Officers (CMOs) published a statement announcing changes to the dosing schedule for the second dose of the Pfizer/BioNTech and University of Oxford/AstraZeneca vaccines. It stated that the interval between the first and second dose should be extended from 3–4 weeks to up to 12 weeks. This rapid response examines the evidence behind this decision.
- Over 1,100 experts have shared with us their concerns about COVID-19 and COVID-impacted areas in the immediate and longer term future.
- This report outlines social and community concerns.
- Experts are concerned about social inequalities beyond health. They note that in the long term groups may have different access to opportunities. This could be particularly true for those with protected characteristics such as women, members of the BAME community, and members of the LGBTQ+ community.
- Experts are also concerned about how changes in Government measures may lead to negative responses from the UK public. These could range from the public becoming less motivated to follow guidance, to public resistance of contact tracing for fears of increased surveillance.
- Experts also note risks to social cohesion; from an increase in racist or xenophobic behaviour, to an erosion of trust in democracy and democratic institutions. However they point out that COVID-19 could also present an opportunity for positive cultural change.
- You can find all our horizon scanning work on COVID-19 here.
Our survey of over 1,100 experts asked them what their most important concerns were in the short (next 3 months), medium (next 3 to 9 months) and long-term (beyond the next 9 months) relating to the COVID-19 outbreak. Their responses were analysed and synthesised. This synthesis comes from survey responses submitted between 3 and 30 April. Experts raised 866 concerns relating to society and community. Below are the areas of concerns that experts have relating to this area.
There are 470 concerns that focus on the effect of the COVID-19 outbreak on social inequalities in the short, medium and long-term.
Experts suggest that the economic impact of the COVID-19 outbreak and Government responses (such as social distancing, shielding of vulnerable individuals and closure of schools) will widen social inequalities. Social inequalities are where different groups experience different life opportunities and life outcomes. For example, there are differences between groups in their access to education and employment as well as their life expectancy and quality of life. Experts note that social inequalities have been widening in the UK over the past decade.
Experts suggest that without Government intervention, the COVID-19 outbreak is likely to widen all forms of inequality in the short, medium and long-term. In the short-term, experts are most concerned about health inequalities. They note that some groups are more likely to be infected with the virus and more likely experience poor outcomes, including death. In the medium-term, experts are concerned about widening economic inequalities, noting some groups will be more affected by unemployment and reduced income. In the long-term, experts are concerned about the effect of the COVID-19 outbreak on a range of life opportunities. They suggest that some groups are more likely to experience negative effects in many different areas of their life, including in future career prospects, educational opportunities, sense of community, and life satisfaction.
Social inequalities can stem from various factors, including having a protected characteristic or living in a particular area. Social inequalities also intersect, meaning a person may have many factors that mean they experience inequality. Having multiple characteristics associated with inequality may have a compounding effect, meaning a person experiences worse inequality with each additional characteristic.
Experts note that particular groups are at risk of being most affected by the COVID-19 outbreak, especially in terms of job loss, reduction of income, increased caring responsibilities and reduced access to educational and social opportunities. These groups include those with protected characteristics. Over 80 experts note that people with protected characteristics will experience greater inequalities. Experts suggest that those people with protected characteristics who are likely to be most negatively affected by the COVID-19 outbreak and Government responses include: people with special educational needs and disabilities (41 responses), women (23), people from black or minority ethnic backgrounds (8), older people (7) and individuals who are LGBTQ+ (4). Over 180 experts note that people who belong to disadvantaged or vulnerable groups will experience greater inequalities. These include: migrants (83 responses), children and young people (15), people who have been asked to shield by the Government (13), people who are homeless (9), refugees and asylum seekers (7), people who have been trafficked (6), gypsies and travellers (4), people with addictions (4), and people with mental health conditions (3).
Experts also raise 75 concerns about people living with low income. They suggest that these people are more likely to be pushed into poverty, experience malnutrition, be infected with the virus and experience poor outcomes. They are also more likely to experience social and economic effects (such as being unemployed) for longer. Other experts express concern about the number of adults and children living with domestic abuse and neglect (44 responses). They suggest there may be an increase in injury and death for these individuals in the short-term. They also note there could be long-lasting effects on mental health and well-being for these people. Some experts suggest that there should be an increase in Government support for people experiencing domestic abuse during the COVID-19 outbreak to allow them to leave abusive homes.
There are also 26 concerns about regional inequalities. Some experts suggest that some people living in some areas of the country may be at greater risk of being infected and may experience worse outcomes. They also suggest that pre-existing regional inequalities may widen unless specific support is provided. For example, some geographical regions may experience more unemployment, greater reductions in services and worse educational opportunities than others in the long-term.
Experts also note that parents and carers are likely to be affected more severely during the COVID-19 outbreak (14 responses). This is because school closures and reductions in social services mean they must dedicate more time to caring responsibilities. This is likely to affect them financially in the short-term and may also have longer-term impacts on their career. Some experts suggest that, as women tend to provide more unpaid care than men, there could be long-term increases in gender inequality (such as lower income and reduced promotional opportunities) in the workforce unless policies are put in place to protect women.
Example of a typical medium-term concern in this area: Need to analyse gendered impact of Covid-19 on individual economic wellbeing, as women are more likely to be working part time, in lower paid jobs and on fixed-term contracts as well as have a more care responsibilities of family members.
There are nearly 270 concerns that focus on the behavioural responses to Government actions during the COVID-19 outbreak in the short, medium and long-term.
The majority of concerns (over 220) experts raise in this area are about changes to lockdown and the Government exit strategy. They suggest that communities are suffering through social distancing, with relationships being negatively affected and society at risk of becoming less cohesive. However, experts note that it is unclear how the UK will be able to lift restrictions over the short and medium-term without a vaccine or effective treatments for the virus. They are concerned that small changes in social distancing (such as allowing people to meet those outside their household) could lead to people feeling more confident in breaking continuing restrictions (such as having multiple people visit someone’s home). Experts also suggest that if restrictions are lifted, the general public may struggle to accept them being reinstated if there are second waves of the virus. Experts want to know what evidence is being used to decide the exit strategy and what data are being collected to see if people are abiding by the guidance. Some experts suggest that the COVID-19 outbreak may continue at a low-level beyond 2020. They are concerned that there is not adequate planning for how society might be able to ‘coexist’ with the virus and be adapted to allow social cohesion while protecting people from infection. Some experts question what role ‘immunity passports’ (documents proving a person is immune to the virus) might play in the long-term. They suggest that these could be divisive if citizens with immunity are granted more freedoms than those without.
There are nearly 30 concerns that focus on contact tracing in the medium and long-term. Experts suggest that contact tracing is likely to be important to prevent future waves of the virus. However, they are concerned about how this could be implemented. They suggest that the public may be resistant to an increase in surveillance and their responses may make it difficult to carry out contact tracing. For example, if the majority of people refuse to download a contact tracing app, this will make it ineffective. There are also some concerns that people will not want to report symptoms of the virus because they may wish to avoid themselves and their close contacts being asked to isolate. Experts suggest that the Government needs to consider how to increase adherence while respecting people’s freedoms.
Experts raise over 10 concerns about a lack of clear behavioural evidence being used to inform Government decisions. They suggest that some of the models of likely public behaviour are potentially unreliable. Experts want more data to be gathered on how people interact within communities to ensure that there is better evidence available for any future public health crises.
Example of a typical medium-term concern in this area: What is the transition plan from lockdown to less restrictive movement measures, whilst maintaining the right to information and managing the expectations of citizens over the economic, political and social changes that will be observed in the near and distant future due to the most recent pandemic outbreak?
Experts raise nearly 130 concerns about changes to society as a result of the COVID-19 outbreak.
There are nearly 30 concerns about social cohesion in the UK in the short, medium and long-term. Experts suggest that time spent isolated may mean people feel less like they belong to a community. They suggest this effect could be increased in the long-term if certain businesses that allow gathering (such as shops, cafes and restaurants) close in large numbers. In the short and medium-term, experts express 19 concerns about volunteer groups and faith groups. They note that these groups are working in their communities with little support from the Government. They suggest that these groups may require funding to continue their work. In the long-term, 31 experts raise concerns about the erosion of trust in society. They suggest that fear caused by the COVID-19 outbreak may mean that trust in others reduces. There were particular concerns that this could lead to an increase in racist or xenophobic behaviour. Some experts also suggest that there could be an erosion of trust in democracy and democratic institutions, especially if the public believe that the COVID-19 outbreak was mishandled. Others suggest that there could also be an accompanying mistrust in science and scientists. Experts want to know how trust will be built in different communities when restrictions begin to be lifted.
Many experts note that it is likely that UK society will either take a long time to return to ‘normal’ or may never return to how it was before the COVID-19 outbreak. Experts suggest that this is an opportunity for positive cultural change in the UK. They are concerned that trying to return to ‘normal’ may mean that progress made in some areas (such as reductions in air pollution or increases in people being able to work remotely) could be lost. They suggest that the UK Government and the public should decide what they want society to look like in the future and that all policy decisions should contribute towards that. For example, some experts suggest that the UK could focus less on restoring GDP and more on improving well-being. Others argue that there is the opportunity to make a sustainable, environmentally friendly recovery after the COVID-19 outbreak.
Example of a typical long-term concern in this area: After this life-changing pandemic, the Government has great opportunities to reorient the economy and society in ways that are transformationally more responsive to the social and environmental issues of our time.
You can find rapid response content from POST on COVID-19 here.
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