A very large number of people have not been bitten, although the launch of the UK’s Covid-19 vaccine has generally been a huge success. Of the entire UK population, around 78% have received at least one dose – slightly above the G7 rich nations average of 77% – and that’s not counting the truly ‘world’s best’ booster campaign: 53% of Britons have received a third dose.

The total would be even higher if the UK had not been cautious about vaccinating under-18s. However, as of earlier this week, around 9.7% of the eligible UK population (ie those aged 12 and over) have not even received a dose of the vaccine – some 5.6 million people in all.

Around five million of these are over the age of 18 and have been eligible for a vaccine for many months.

Are they all committed opponents of vaccination?

There is certainly a sizable group in the UK who are vigorously opposed to Covid vaccination and attempts to promote it, on grounds ranging from libertarianism to distrust of modern medicine to conspiracy theories. They’ve held big protests in London; In some cases, they have harassed politicians and teachers and threatened public health officials. On December 29, protesters stormed an NHS testing and tracing center in Milton Keynes and attacked an emergency worker.

In terms of numbers, however, committed opponents of vaccination are rather insignificant. “They are very vocal and have a strong presence offline and online,” says Dr. Mohammad Razai from the Population Health Research Institute, St George’s, University of London. “But they are a very small minority.”

So should we be worried about them at all?

Yes, because they are spreading fear and disinformation to a much larger group, dubbed by public health officials as “vaccine hesitators” — who have no specific political agenda but are undecided and dubious for a variety of reasons.

Research from the Office for National Statistics (ONS) has found that the main reasons for vaccine hesitation among younger adults are distrust of vaccines; distrust of the government and those promoting vaccine roll-out; and concerns about side effects.

More prosaically, many also believe vaccines are unnecessary in their case as they have little risk of being harmed by the virus. And according to a recent study from Oxford University, up to 10% of the UK’s Covid vaccination delays can be attributed to needle phobia.

Who are the vaccine retarders?

In the UK, they belong disproportionately to certain social groups, particularly “young adults, people of black or black British ethnicity, the unemployed and people living in disadvantaged areas”, according to the latest ONS survey.

Ethnic minorities are significantly more likely to be reticent, particularly those with low levels of trust in government. For those over 50, the national rate of booster use is 75%; in the Pakistani ethnic group it is 42%; 44% in the Black Caribbean; 45% among black Africans.

Are some areas more affected?

Yes. In cities where there are young and transient populations, as well as a more diverse population, vaccination coverage is significantly lower than in other areas. In Manchester and Liverpool, around one in three over the age of 12 has not received a first dose; in the London boroughs of Newham and Hackney, 38% and 37% respectively did not receive a first dose.

This compares to 22% in the more affluent Borough of Richmond and 11% in more affluent and less diverse areas such as Wiltshire and Shropshire.

What is the impact of all this?

There is no doubt that the unvaccinated are making the pandemic much worse. The ONS found that the Covid death rate in England was 96% lower among people who had a second vaccination than those who were unvaccinated between January and October last year.

Currently, the Omicron variant reduces the risk of hospitalization by 90% for those who have received a booster shot. Conversely, the UK Health Security Agency estimates that unvaccinated adults are about eight times more likely to be hospitalized than vaccinated ones.

The latest figures show that unvaccinated patients accounted for 61% of patients admitted to intensive care with Covid-19 in the UK in December, despite representing just 10% of the population. Obviously these cases are putting a lot of pressure on the NHS. It is also now clear that while vaccinated people contract and spread Covid, unvaccinated people do so at higher rates.

How did the British government react?

It has largely confined itself to promoting vaccines through advertising campaigns and, more recently, public condemnation: last week Boris Johnson accused anti-vaccination activists of spreading “hocus pocus” and said it was time to “call them out.” “.

But unlike many other European nations, the UK has no history where vaccinations are mandatory; she has balked at the draconian measures abroad. In fact, such moves as she has attempted to take have proved to be a political minefield for the prime minister. When the vote was put on introducing Covid passes to enter some venues, the government suffered a major backseat riot.

How did the rest of the world react?

In November Austria – which had one of the lowest Covid vaccination rates in Western Europe – announced an “unvaccinated lockdown”: a stay-at-home order for those without proof of vaccination, with fines of 500s for those defying it . Even that wasn’t enough, apparently; it will be the first EU country to make vaccinations compulsory from February.

In Germany, too, the new Federal Chancellor, Olaf Scholz, is campaigning against the opposition of the coalition partners for compulsory vaccination. Italy has opted to make it compulsory for everyone over the age of 50. Greece is considering a similar move. In France, President Macron has vowed to “anger” the unvaccinated by making life as difficult as possible for them: by banning them from cafes, restaurants, entertainment venues and long-distance transport.

Many nations, from Canada to Ukraine, require all public sector workers to be vaccinated; In the US, all employees of companies with more than 100 employees are required to have immunizations or recent tests.

Singapore is now charging for Covid treatment of unbitten patients, arguing that they “represent a significant majority of those in need of intensive inpatient care and contribute disproportionately to the drain on our healthcare resources”.

What else can be done?

In view of the political situation, compulsory vaccination is out of the question. In any case, many British public health experts believe that making vaccinations compulsory would only serve to provoke a backlash.

Evidence suggests that when vaccination is hesitant, local-level advocacy works best: Many GPs and community leaders have worked tirelessly to recruit hard-to-reach social groups. It also helps ensure clear information is available in multiple languages, as does providing convenient booking windows, especially for those who are not online.

The good news is that reluctance has been falling steadily this year, and will likely continue to fall: nothing is quite as convincing as knowing other people who have been stung.