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Covid vaccination sites out of reach for hundreds of thousands in England

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Hundreds of thousands of people in England without access to a car will struggle to reach their nearest Covid-19 vaccination centre, according to an analysis by the Financial Times that will deepen concerns of a postcode lottery in the UK’s ambitious immunisation programme.

Even as the UK is lauded for running the most effective drive in Europe — more than 4m have already received their first dose — the findings suggest the vaccine rollout risks exacerbating income, ethnic and geographic divides, condemning some to impracticably long journeys to receive the protection of a jab.

The uneven distribution of vaccine centres, particularly in rural areas, points to how the government’s ability to meet its target of vaccinating about 15m of the most vulnerable people in the UK by the middle of February may rely to a significant extent on volunteers ferrying those without vehicles to the locations providing the jabs.

Meanwhile, doctors and campaigners say the decision to focus on age as a criterion for receiving the vaccine has disadvantaged those living in low-income areas where poor health can set in 20 years earlier than in richer populations. 

The Joint Committee on Vaccination and Immunisation, which advises government, has set out nine categories of people to be prioritised for the vaccine, with care home residents and staff, over-80s and health and care workers at the top.

The NHS has rapidly expanded the number of vaccination sites since the first inoculations were delivered on December 8, and a total of 1,220 GP surgeries, hospitals and mass vaccination centres are now giving jabs to those considered to be the most vulnerable to the disease in England. The government’s vaccine delivery plan has a target to establish more than 2,700 sites across the UK.

However, FT analysis of data from mapping company TravelTime shows about 5.5m people in England live more than one hour’s travel on public transport from their nearest vaccination centre, of whom 336,000 are estimated not to have access to a car. A total of 1.3m of that group are aged 65 and above, of whom 166,000 are unable to use a car.

Pair of maps showing that hundreds of thousands of people in England will struggle to reach their nearest Covid-19 vaccination site using public transport, and that the rate of progress on this measure has been very slow relative to progress on serving those with cars

Data on car ownership suggest these “vaccine deserts” may also disproportionately affect members of black and minority ethnic populations, and the lowest-earning 10 per cent, who are far less likely to have the use of a car than wealthier white peers.

The addition of more than 200 local sites since the start of the year has reduced the number of people more than an hour away on public transport by only 16 per cent — while halving the number of people more than half an hour away by car. That disparity suggests poorly connected rural areas remain a tricky issue to solve.

The FT’s findings also demonstrate the particular difficulties for older Britons for whom walking even relatively short distances may be a challenge. If “within reasonable reach” is interpreted as a place within one hour of someone’s home on public transport with a maximum of 10 minutes’ unbroken walking time, 341,000 elderly people — one in 30 — will be unable to reach a vaccination site under their own steam.

Significant regional differences are evident in the official data now published daily by the government. The North East and Yorkshire have had the highest vaccination rates while London appears to be a laggard. However, the capital’s relatively low numbers look rosier when considered as a percentage of the number of over-80s in a city from which many choose to move as they age.

Calculated as a percentage of older residents, it is the East of England rather than London that has had the slowest rollout. The region also has among the country’s most limited public transport networks.

The UK’s notoriously wide income-related gulf in healthy life expectancy is also threatening to handicap some of the neediest Britons in the race to secure vaccination.

Rebecca Fisher, a fellow at the Health Foundation think-tank who practices as a GP in a deprived urban area, said her practice had very few patients over 80 “because poor people don’t live as long”. Pointing to a 10-year gap in male life expectancy between the most and least deprived areas, she said: “Someone of 60 in my practice is as likely to have multiple health conditions as someone of 85 in another area.”

Dr Fisher welcomed the recent announcement by the prime minister that practices that had completed immunisations of over-80s could move to those in their 70s but said areas with unvaccinated people in the older age group were still being prioritised for supplies. “So it means vaccine is literally going to richer areas where people live for longer. We need to make sure that deprivation is factored in to the equation for which areas get vaccine supplies,” she added.

Ruthe Isden, head of health at Age UK, the older people’s charity, described the dearth of people in their 80s and 90s in some areas as “a sad indictment of health inequalities more widely”.

She was cautious of interpreting variable coverage of over-80s as a postcode lottery, “because the demographics of the population are going to be quite different in different areas”.

Ms Isden added: “I wouldn’t want to start saying ‘there are some 90-year-olds who haven’t heard anything and in this area they’re vaccinating 75-year-olds’ because that might be the right thing to do — they may be the most high risk people they’ve got.” 

Richard Vautrey, a GP in Leeds in the north of England who represents family doctors for the British Medical Association, said the ability to set up vaccination sites had in some cases been “limited by geography”, with rural areas in particular finding it harder to find suitable locations.

But he insisted the key issue holding back the programme remained supply. “We want to be able to plan ahead so we know in nine weeks’ time we’ll have vaccine so we can book people in. We’re not there yet because the NHS isn’t providing us with long-term projections around vaccine availability. We’re working from hand to mouth at the moment,” Dr Vautrey said.

Health officials said sites were being added at community pharmacies, GP networks and surgeries, as well as larger vaccination centres and care homes across the country.

The NHS said: “Hardworking NHS staff have already stood up more than 1,200 vaccination sites, meaning the vast majority of people live within 10 miles of a centre and hundreds more, including more than 200 high street pharmacies, are due to come on online over weeks, as the NHS accelerates rollout to ensure as many people as possible get vaccinated.”

To calculate access to vaccination sites, the Financial Times used data from TravelTime to map the area around each of England’s 1,220 vaccination sites that is accessible using different forms of transport and different timeframes. The resulting areas were then cross-referenced against each of England’s 32,844 lower super output areas — neighbourhoods of around 1,600 residents each — to determine the numbers of people within reasonable reach of a vaccination site. This was then combined with census data on car availability by age to produce the numbers of people likely to be reliant on public transport or volunteer assistance.

The new nationwide lockdown rules in England

  • The main restriction is a firm stay-at-home message

  • People are only allowed to leave their home to go to work if they cannot reasonably do so from home, to shop for essential food, medicines and other necessities and to exercise with their household or one other person — once a day and locally

  • The most clinically vulnerable will be asked to shield

  • All colleges and primary and secondary schools will be closed until a review at half-term in mid-February. Vulnerable children and children of critical workers will still be able to attend while nursery provision will remain available

  • University students will have to study from home until at least mid-February

  • Hospitality and non-essential retail will be closed. Takeaway services will be available but not for the sale of alcohol

  • Entertainment venues and animal attractions such as zoos will close. Playgrounds can remain open

  • Places of worship can also stay open but one may attend only with one’s household

  • Indoor and outdoor sports facilities, including courts, gyms, golf courses, swimming pools and riding arenas, will close. Elite sport including the English Premier League will be able to continue

  • Overseas travel will be allowed for “essential” business only 

Full details are available on the government’s official website.



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Analysis

Signs of inflation emerge as Chinese producer prices leap

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For investors and governments eager to spot any sign of inflation as the global economy recovers from the coronavirus pandemic, Chinese factories are a good place to look.

The country this week released figures showing that the price of raw materials and goods leaving its factories rose 6.8 per cent year on year in April, its fastest pace of growth in more than three years.

For almost all of 2020, China’s producer price index was in negative territory as Covid-19 suppressed demand. The recent and sudden rise was partly driven by the comparison with a year earlier and, with consumer price rises still below 1 per cent, the overall inflation picture remained mixed.

But the data was nonetheless a sign of pockets of price increases emerging across China’s rapid recovery, where higher overall inflation is expected this year. It also reflected a global rally in commodity prices that has been supported by China’s voracious demand as well as hopes that other big economies will bounce back, too.

“A combination of China and external factors led to this PPI surge,” said Robin Xing, chief China economist at Morgan Stanley. “It’s like a perfect storm.”

Line chart of Producer Price index showing Producer prices in China rise at the fastest year-on-year pace since 2017

China’s PPI index is made up of prices of producer goods, such as wardrobes or washing machines, that factories sell to shops before they are sold on to consumers.

It also includes the prices of raw materials and commodities, such as coal, when they are sold from extraction companies to businesses that use them to make goods.

It was the latter that drove the recent surge in Chinese producer prices. Global commodity prices, which collapsed last year in the early stages of the pandemic, have since rebounded. Iron ore this week hit its highest level on record, while oil prices have recovered sharply from last year.

Xing estimated that 70 per cent of the April PPI increase was driven by commodities. That rally was also tied to China’s recovery, which has been backed by strong industrial growth and a construction boom that led to record output of steel last year.

As such, the data reflected both the pace of China’s recovery as well as a global commodity rally that it helped fuel and now extends beyond it.

For policymakers, one crucial question is whether higher producer prices will feed through to consumer prices. China’s consumer price index was just 0.9 per cent in April — its highest level in seven months, but far from a level that would generate immediate fears of broader inflation within China.

While economists expect a rise in CPI inflation in China this year, they suggested that any reaction from the People’s Bank of China to this week’s data was unlikely. The portion of the producer price index that represents the prices at which businesses buy consumer goods, as opposed to raw materials, was up only 0.3 per cent year on year.

Analysts at HSBC said transmission from PPI to CPI would be “limited”, allowing policymakers to remain “accommodative”.

Ting Lu, chief China economist at Nomura, forecast CPI inflation to rise to 2.8 per cent by the end of the year, with “pass-through” effects from PPI. But he suggested that the PBoC was unlikely to tighten in response to PPI, and that higher raw material prices instead posed a risk to Chinese demand and the wider recovery given controls on credit availability.

“For a typical borrower, $1bn six months ago may be enough to buy steel and cement to finish one project, but today it’s [maybe] not,” he said.

While the PBoC has not increased official rates since lowering them last year, the Chinese government has nonetheless tightened credit conditions over recent months.

It has also taken measures to rein in both its property sector, on concerns that easier money would encourage asset bubbles, and its steel sector, which has churned out the metal at a rate that threatens Beijing’s environmental commitments.

China’s gradual decarbonisation ambitions — and any production cuts they lead to within the country — are seen as constraints on supply, buoying the price of commodities further. 

Beyond raw materials, economists are closely watching other shortages. Iris Pang, chief economist for greater China at ING, said producer price inflation would be followed by chip inflation. A shortage of semiconductors, she said, was already beginning to drive price increases for consumer products such as washing machines and laptops.

Line chart of Per cent  showing Producer prices for consumer durables are gathering momentum this year

While the PPI index showed a much weaker increase in consumer goods than for raw materials, on a month-on-month basis there were notable rises. Durable consumer goods were up 0.4 per cent month on month in April, the fastest pace of growth since at least 2011, according to CEIC, a data company.

Apart from domestic construction, part of the demand for raw materials has been to drive the production of goods for export to western countries.

Data on Friday showed Chinese exports leapt 32.3 per cent year on year in April. But even when compared with April 2019, before the pandemic, the rise was about 16 per cent on an annualised basis, Morgan Stanley estimated.

Competition between producers in China meant this did not necessarily imply inflation for consumers overseas. Instead, China’s recent PPI jump hinted at just one of the global effects of western responses to the pandemic.

“If you try to figure out what is the end demand here for this PPI recovery, it is global stimulus,” said Xing. “External demand led to China’s export recovery, [and] now it’s far beyond its potential growth”.



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Covid batters India’s aspiring middle classes

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When Ram Prakash died after a feverish and breathless week, his wife and 16-year-old daughter’s heartbreak was compounded by fear that the modest middle-class safety net he had knitted together might be ripped apart.

The 53-year-old, a tax adviser to local businesses, was one of the millions who had joined India’s fast-growing middle class in recent decades. Their rising incomes, better education and consumption powered one of the great global economic success stories.

But the calamitous second wave that claimed the life of Ram, the family’s breadwinner, has shattered the Prakashes’ hopes for the future. “Our life was going good but now it’s all over,” said Uma, his widow.

Economists warned that the latest outbreak could have long-term ramifications for middle-class Indians, whose rising consumption was expected to be the country’s growth engine for many years.

“India, at the end of the day, is a consumption story,” said Tanvee Gupta Jain, UBS chief India economist. “If you never recovered from the 2020 wave and then you go into the 2021 wave, then it’s a concern.”

India reported more than 320,000 Covid-19 infections and 3,800 deaths on Monday. Experts maintain that both figures are vastly undercounted.

The disease has heaped suffering on Indians irrespective of background. Yet this time, it has also hit hard an aspirational middle class whose newfound privilege previously helped shield them.

A lack of oxygen has been blamed for thousands of deaths © Sanjeev Verma/Hindustan Times via Getty

Public-health experts pointed to signs that after widespread infection among the urban poor last year, sectors of society including the comparatively affluent were more vulnerable this time round. This was compounded by the near-collapse of private health services on which they relied.

“You’re affluent but you can’t get a hospital bed. You’re affluent but you can’t get oxygen,” said Saurabh Mukherjea, founder of Marcellus Investment Managers. “That’s deeply disorientating.”

India’s middle class was already severely weakened by the recession that followed last year’s lockdown, even if they were better protected from the virus.

The Pew Research Center found that 32m people fell out of India’s middle class — defined as those earning between $10 and $20 a day — in 2020. That represented more than half of those added to the category since 2011.

Bar chart of Estimated change in number of people in each income tier due to the global recession (m) showing India’s poor grew while middle class shrank in 2020

India’s economy was expected to roar back before the second wave struck. For middle-class Indians on the brink, such as the Prakash family, this second shock may prove too much.

Ram, the tax consultant, had moved his family to a one-bedroom house in a humble New Delhi neighbourhood, bought a car and sent his daughter to a low-cost private school, hoping she could become a chartered accountant.

“He gave us so much when he was alive,” said Vasundhara, his daughter. “I only hope I will be able to continue my studies.”

Experts have debated what drove the high caseloads among middle class and rich Indians during the second wave.

Anup Malani, a professor at the University of Chicago, suggested that those populations proved more susceptible, especially as new variants spread.

In Mumbai, for example, studies last year found that about 50 per cent of slum residents had Covid-19 antibodies, compared with less than 20 per cent in more affluent surrounding neighbourhoods.

This is believed to have left the middle and upper classes more vulnerable, particularly to severe disease, researchers said. Doctors have reported similar trends elsewhere in India.

“The first wave largely infected poorer populations,” Malani and two co-authors wrote this month. The second wave “is disproportionately composed of individuals who are from non-slums”.

Bar chart of Estimated number of people in each income tier in 2020 before and after the global recession (m) showing The pandemic sets back growth of India’s middle class

Researchers said more data were needed but other susceptible populations could include those outside cities, such as in poor rural areas with shoddy healthcare where the virus was wreaking havoc.

The outbreak was so sudden that it overwhelmed even India’s best hospitals, including private facilities in cities such as Delhi or Bangalore.

Fewer than 1 per cent of Delhi’s 5,800 Covid-19 ICU beds are available, while crippling shortages of oxygen have contributed to countless deaths.

After Ram Prakash’s oxygen levels dropped, his family spent two frantic days ferrying him to six separate hospitals — both private and public — in a desperate bid to find treatment.

In the end, they brought him home. Ram died on April 27.

Uma and Vasundhara fear economic ruin. They have a shortfall of Rs30,000 ($408) to meet immediate expenses, including school fees and the mortgage on a neighbouring unit that Ram bought as an office.

“Right now our worry is just to survive, to get food and meet our daily expenses. But there won’t be enough,” said Vasundhara.

They plan to sell their car and Uma, a former Sanskrit teacher, wants to find work again. But they worry hopes of a better life are over.

“We had never imagined this could happen to us,” Vasundhara said. “We just can’t get our head around this.”



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Reeves promotion underlines Labour shift to centre ground under Starmer

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When Sir Keir Starmer promoted Rachel Reeves to shadow chancellor late on Sunday night it emphasised his determination to defy the left of the Labour party and move in a more “centrist” direction after a series of disappointing local election results.

Reeves is unpopular with many “Corbynista” members — supporters of the party’s former hard left leader Jeremy Corbyn — because of comments she made in 2013 when she was shadow work and pensions secretary. That controversial moment saw her promise to be “tougher” than the ruling Tories on benefit costs.

Her role as vice-chair of Labour Friends of Israel is also contentious among many Corbyn supporters who oppose the actions of the Israeli government. And while other MPs agreed to serve on the Labour front bench under the Corbyn leadership in 2015, Reeves was one of a handful who refused to do so.

Starmer first considered making Reeves shadow chancellor when he became leader in April last year — only to drop the idea, fearing that it would prompt a backlash from left-wingers.

Yet it would be wrong to characterise the 42-year-old MP for Leeds West — a former junior chess champion — as a “Blairite” or “rightwinger” even in Labour terms.

Sir Keir Starmer promoted Rachel Reeves in a reshuffle of his front bench on Sunday © Stefan Rosseau/PA

During the last parliament she chaired the business select committee, a position she used to interrogate corporate failure by Carillion, the collapsed contractor. She meanwhile struck out as a writer, penning two books about female MPs.

In 2018, she used a speech in London’s East End to call for a new series of wealth taxes to raise more than £20bn a year — shifting the fiscal system from income to property. The then shadow chancellor John McDonnell resisted the idea, amid concerns over a backlash from middle class Labour voters.

Indeed, there was a moment in 2019 when some of Corbyn’s aides — including policy adviser Andrew Fisher — advocated bringing Reeves into the shadow cabinet.

Sharper edge but no shift in strategy

In the short-term her promotion to one of the most important roles in the shadow cabinet may give a sharper edge to Labour’s top team but not necessarily bring a shift in strategy.

That is because the party creates its election manifestos through a drawn-out process called the “national policy forum” over several years.

Starmer has eschewed creating new policies on the hoof in favour of a focus on rebranding, telling voters Labour is “under new management” after the electorally disastrous Corbyn, who lost two general elections in 2017 and 2019 — the latter by the biggest margin in nearly a century.

The opposition leader’s popularity rose last year as he forensically attacked the ruling Conservative government over pandemic failures. But with the Tories enjoying a bounce from the vaccine rollout, he was criticised during the local elections for a lack of a positive policy vision. Some Labour insiders blame that for the setback at the polls — in which the party lost 326 council seats and was defeated in the Hartlepool by-election.

On Monday, many colleagues were positive about the promotion of Reeves after a year in which she has been one of the most high-profile figures on the front bench.

As shadow Cabinet Office minister, she took the fight to the Conservative government over its spending on personal protective equipment — expressing anger at the many contracts given to Tory contacts. She has also kept up the pressure on the Conservatives over the Greensill scandal.

Colleagues said as shadow chancellor she will emphasise the need for Labour to show it can be trusted to run the economy — an area of traditional political weakness for the party.

‘Competent and sensible on the economy’

That would continue the theme set by Dodds, who said in a speech in January — using the word “responsible” 23 times — that Labour would offer “responsible economic, fiscal and monetary policy”. The Starmer team has already distanced itself entirely from Corbyn’s 2019 election manifesto, with £83bn of annual public spending increases.

In an interview with the Financial Times last year Reeves struck a similar tone, saying the party needed to be “competent and sensible” on economic matters.

Yet she is not expected to return the party to the “austerity lite” approach of Ed Balls, shadow chancellor under former leader Ed Miliband, who promised not to increase borrowing even for capital expenditure.

One ally said Reeves could be expected to draw up a “transformative” programme — involving changes to the tax system and the decarbonisation of the economy — while also reassuring the public that Labour would spend people’s taxes wisely.

The decision to shift Angela Rayner, deputy leader, from her job as party chair plunged the reshuffle into chaos at the weekend © Jacob King/PA

Starmer’s reshuffle at the weekend was thrown into chaos after allies of Angela Rayner, the deputy leader, leaked she was being demoted from her job as party chair after the local election failures. The ensuing political storm overshadowed some more positive electoral results on Saturday in cities such as Manchester, London and Bristol.

Rayner turned down the job of shadow health secretary and instead took Reeves’s old job as shadow Cabinet Office minister as well as “shadow secretary of state for the future of work”.

Deep discontent

On Monday, after a two-hour shadow cabinet meeting, Starmer was seen buying a coffee at Westminster with Rayner in an attempt to put on a public show of unity after a weekend of acrimony.

Starmer’s bungled reshuffle has sown deep discontent among senior Labour MPs. “You can’t understand how angry people are,” said one. Allies of Rayner said she felt a “deep sense of betrayal”.

The reshuffle saw Dodds move to party chair and Alan Campbell promoted to chief whip with the departure of 70-year-old Nick Brown.

Lisa Nandy, shadow foreign secretary and MP for Wigan, told colleagues she was convinced Starmer was planning to sack her and it was only a rearguard action by her supporters that persuaded him to drop the plan.

Nandy warned Starmer that she would quit the Labour front bench, rather than be demoted to another role.

Referring to the plans to demote first Rayner and then Nandy, one Labour MP said: “What genius would think it a good idea to demote not one but two women representing northern seats?”

 



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