Tackling barriers to COVID-19 vaccine uptake in London: a mixed-methods evaluation.

BACKGROUND: In response to the COVID-19 pandemic, the first vaccine was administered in December 2020 in England. However, vaccination uptake has historically been lower in London than in other English regions. METHODS: Mixed-methods: This comprised an analysis of cumulative percentage uptake across London between 8 December 2020 and 6 June 2021 by vaccine priority cohorts and ethnicity. We also undertook thematic analyses of uptake barriers, interventions to tackle these and key learning from a qualitative survey of 27 London local authority representatives, vaccine plans from London's five Integrated Care Systems and interviews with 38 London system representatives. RESULTS: Vaccine uptake was lower in Black ethnic (57-65% uptake) compared with the White British group (90% uptake). Trust was a critical issue, including mistrust in the vaccine itself and in authorities administering or promoting it. The balance between putative costs and benefits of vaccination created uptake barriers for zero-hour and shift workers. Intensive, targeted and 'hyper-local' initiatives, which sustained community relationships and were not constrained by administrative boundaries, helped tackle these barriers. CONCLUSIONS: The success of the national vaccination programme depended on conceding local autonomy, investing in responsive and long-term partnerships to engender trust through in-depth understanding of communities' beliefs.

Comparison of Goldmann applanation tonometry with the Tonopen for measuring intraocular pressure in a population-based glaucoma survey in rural West Bengal.

AIM: This study was undertaken to compare the measurement of intraocular pressure (IOP) in a population-based glaucoma survey by the Goldmann Applanation Tonometer (GAT) and the Tonopen with respect to IOP readings, the time required to measure IOP and subjects' preference for the two instruments. The purpose of the study was to see which of the two instruments could be more suitable in a rural survey, particularly house-to-house, in trying to find cases of advanced glaucoma. METHOD: The study was conducted on a total of 203 subjects as a part of a population-based glaucoma survey. The IOP of one randomly selected eye of each subject was measured, first with the GAT and subsequently with the Tonopen. The time taken for each procedure was noted and subjects' preference was ascertained. RESULTS: The mean of the paired differences between the readings of the two instruments (Tonopen minus GAT) was 1 mm Hg with a standard deviation of 2.28. The Tonopen readings were within +/-3 mm Hg of the GAT readings in 86.2% of eyes. In 7.4% of the eyes the paired differences were > or =+/-5 mm Hg. Measurement of IOP by the Tonopen was much quicker, the mean time difference being 38.7 sec. Subjects' preference for the Tonopen was higher. CONCLUSION: The overall agreement between the measurements of the two instruments was good but a small percentage of large difference (> or = +/-5 mm Hg in 7.4%) may be of concern in a population-based survey. The time to measure IOP and the subjects' preference were strongly in favour of the Tonopen.