By Professor Dominic Harrison, director of public health Blackburn with Darwen Council

The Prime Minister announced the plans for lockdown lifting on Monday with four steps ending on June 21 when the remaining limits on social mixing may be lifted and all settings will be re-opened along with large scale events.

Each stage of lockdown lifting has a five week gap to assess the effects on transmission, hospitalisations and deaths. It is acknowledged that each stage of the lockdown will drive some increase in the rates of people infected and that the emergence of any new riskier variant of the virus could slow down the process.

The lockdown lifting risks will be balanced by more of the population being protected by vaccination and an extension of regular asymptomatic lateral flow device testing in schools, workplaces, and communities. We will need to continue to wear masks in enclosed public space, wash hands regularly and maintain social distance throughout the lifting stages.

This plan is broadly sensible and is to be welcomed, but it has ignored a critical issue: inequalities in risk. Word searching the 68-page plan reveals that the words inequality, inequalities, equity and equality are not mentioned once! The plan simply has nothing to say about managing inequalities of risk across the UK. This glaring and inexplicable policy gap is a big risk for Pennine Lancashire.

The national Joint Biosecurity Centre recently produced a report, detailing why some areas such as Blackburn with Darwen, Bradford and Leicester have had consistently high and enduring rates of transmission across the whole period of the pandemic. They identified a number of structural risks (to do with infrastructure, economics and demographics) that make high rates very likely in such areas. These include: higher levels of deprivation, more frontline workers, more workers unable to work from home, smaller houses, larger multi-generational families, an inability of much of the population to self-isolate if infected due to the low level of financial support available and a reduced level of performance of the national test and trace system in those communities.

Due to our communities continued lockdown efforts, Pennine Lancashire’s rates are now coming down more rapidly than many other areas of the UK - albeit from a higher level. Blackburn with Darwens weekly rates on the February 17 were down 36 per cent -one of our biggest weekly falls in the whole pandemic. The risk for us now however, is that as lockdown lifts, those structural factors will drive our rates up again faster than the national average at each lockdown lifting step.

We urgently need the government to have some sort of plan to meet this challenge. One strategy, which would work well, would be to accelerate the rollout of the vaccine in local authority areas with high and enduring transmission risks. The government has the knowledge, the capacity and the means to secure equal life chances across the UK if it takes this action now.

If the government continues to choose not to do this, then any attempt to impose localised tier control measures in Lancashire following higher rates over the summer will be unfair, unjust and avoidable. To protect the health of our local population we are going to need to be noisy, not quiet, about this emerging injustice. Lancashire’s directors of public health are doing just that, Let’s hope London is listening.