London is significantly behind in the race to immunise older people, with several areas in the capital reporting that one in three people aged 70 and over have not yet received a first dose of the vaccine, according to a Guardian analysis. Some of these areas have large black, Asian and minority ethnic (BAME) populations and high levels of deprivation, prompting concerns that the NHS is failing to reach marginalised groups. The Central London clinical commissioning group, which covers the Westminster area, had given a first dose to just over 60% of residents aged 70 and over by 14 February, significantly less than the national rate of 94.5% in England. West London, Tower Hamlets, Newham and City and Hackney CCGs also reported levels below 75%. By contrast the percentage of people aged 70 and above in North East Hampshire & Farnham CCG who had received a first jab was 99.8%. In London as a whole, 83.7% of people aged 70 and over had been given a first dose by 14 February, well below the national rate. The gap between London and the rest of England has also widened since the previous week. The south-west reported the best coverage rate, with 97.9% of the 70-plus age group having received a first dose, according to figures published by NHS England up to 14 February. Dr Billy Palmer, a senior research fellow at the Nuffield Trust, said: “One area of huge concern for London is whether enough is being done to overcome the challenges of getting the vaccines out across a diverse population. Data suggests that the 15% of the adult population offered but not taking up vaccines skew towards ethnic minorities. The vaccine rollout must be responsive to the needs of those with English as a second language, or those whose historical experiences with health services mean they are less likely to come forward.” London lagged behind the rest of England in the early stages of the vaccine rollout, after not enough doses were distributed to GPs’ surgeries in the capital. However, more than two months into the national scheme, issues with vaccination rates have not been resolved. Dr Halima Begum, the chief executive of the Runnymede Trust thinktank, said the disparity highlighted longstanding difficulties in accessing healthcare for some of the most marginalised. “I find the rhetoric around uptake and hesitancy challenging because the assumption is that the individual is to blame for not coming forward. Historically we’ve known that groups who are disadvantaged and marginalised will have difficulty accessing health services and vaccination. There’s an issue around access, advocacy, whether BAME elderly people are listened to and whether they feel like they are receiving the same service as others. And that has been historic and cumulative,” Begum said. “We’ve had to campaign for nine months to get the government to understand that our communities are overexposed and underprotected.” Data from OpenSafely, which looks at anonymised patient records, has shown people living in the most deprived areas and BAME populations have consistently been less likely to be vaccinated than people living in wealthier areas and the white population. At the current pace the government is on track to meet its target to offer a vaccine to 32 million people in the nine priority groups by Easter, well ahead of the May deadline. A spokesperson for the mayor of London said: “NHS staff and volunteers have worked incredibly hard to deliver the vaccines to Londoners, and we owe them a huge debt of gratitude. However, the initial issues with the government’s original distribution formula and ongoing concerns about vaccine hesitancy in parts of the city means more work must be done.” Martin Machray, a joint chief nurse for the NHS in London, said: “Thanks to the efforts of staff, the biggest and fastest vaccination programme in NHS history has already vaccinated over 14 million people across the country and in London, everyone in the priority cohorts, including all health and care staff, have been offered a vaccine. “We are continuing to reach out to eligible groups, working with local authorities, care homes, faith and community groups and others to encourage uptake of the safe, effective vaccines which will help save lives.”