After pensioners, vaccine rollout should focus on high-risk occupations and deprived local areas
Deaths related to Covid show inequalities for working-age people.
Research published last week and this by the Office for National Statistics (ONS) show how much the risk of dying during the first wave from Covid-19 depended on what job a person did. For those working in caring, leisure or other service occupations the risk of dying from Covid-19 were three times higher for men and two times higher for women compared to those in professional occupations. For men, six out of the nine main occupation groups all had at least twice the risk of those in professional occupations. Besides frontline health and social care workers, high-risk occupations include taxi- and bus-driving, plant and machine operatives and sales and retail.
Commentary on the results has rightly drawn the conclusions that this shows the clear social, or class, link to the risk of dying among those of working age. The trades unions are calling for key workers to be prioritised for vaccinations.
But if this result is shocking it is not surprising. Back in June, data from Public Health England (PHE) showed that the fatality risk for those of working-age varied by a factor of two between those living in the most deprived local areas and those living in the least. Local area deprivation and occupation mix are not the same thing – but they are related.
That phrase “for those of working-age” is a crucial qualifier here because, as the graph below shows, the PHE data showed next to no gradient in the infection fatality risk among those aged 65 and above.
The risks in this graph (taken from our report, Evidence into action, written in collaboration with the Race Equality Foundation) only include part of the risk (that is, the risk of dying following a positive test). The other part of the risk (the risk of becoming infected) is also covered in the report. The importance of separating these risks has been explained by David Spiegelhalter.
Age-specific infection fatality ratios by local area deprivation, relative to the risks for those in least deprived fifth
It is important to note these are relative risks within each age group. The absolute risk is over seven times higher for those over 65 compared to those of working age, according to the data published by PHE in June. The implication though, as our report for the London Director of Public Health on People and places in London most vulnerable to COVID-19 and its social and economic consequences noted in September, is that both research and policy-making need to consider those of working-age separately from those over 65.
This now has a direct practical implication. As the vaccine rolls out, once people of pensioner age have been vaccinated, roll-out among those of working-age should certainly prioritise those in high-risk occupations. It should also give serious consideration to prioritising those living in more deprived areas.
This is certainly practicable. The ONS has a classification of occupations by risk for all 365 UK Standard Occupational Classifications (n.b. “economists, statisticians and actuaries” – i.e. us – are at the very bottom of the list). Local area deprivation is an extremely well-known and widely-used measure. Detail, however, is all important and it is precisely because there are choices here, notably about how local – neighbourhood, local authority, region – that we can only call here for deprivation to be considered as a factor. But for those who cared to look, these patterns have been visible in the data for many months now.
 Per every 1000 cases of Covid-19, 390 over 65’s died compared to 55 for those of working-age. Source: PHE disparities report, June 2020.