Vaccination, vaccination, vaccination

Part 4 of the pandemic review asks if the UK’s approach to vaccines was laser focussed or tunnel visioned

No one can question that from very early on in the pandemic the UK set it’s sights firmly on vaccination as a route out of restrictions, and applied serious resources into their development and procurement as a result.

One of the most fascinating insights into the process comes from Kate Bingham, the first head of the vaccine task force who was previously a venture capitalist. Her appointment was initially decried, although she ended up a hero.

Let’s take a look at the UK’s approach to vaccination for Covid-19.

Investment

The UK invested heavily in the development of the Oxford/AstraZeneca vaccine (for which I had the honour of being involved in clinical trials from the very beginning), as well as purchasing vaccines “off plan” - before they had proven efficacy. Most of these investments were fortunate to pay off handsomely in the short term, and will likely pay dividends long into the future.

The UK also benefitted from it’s oustanding clinical trials network through the National Institute for Health Research (NIHR), enabling it to run trials for the Oxford/AstraZeneca vaccine, Novavax, Valenva, Medicargo and Janssen to name a few.

The vaccine task force also took a long term view with research, funding trials into different combinations of vaccines and the worlds biggest Covid-19 booster study, COV-BOOST (I have also had the fortune of being the lead fellow for the COV-BOOST study, which has been keeping me busy since April 2021). These studies have provided valuable information not just for the UK, but for countries around the world, including for the use of vaccines which were unlicensed at the time.

Focus

It is true that the almost singular focus on vaccination for Covid-19 by the UK government has sometimes been the source of criticism.

In reality, the UK’s laser focus on vaccination to protect its population has been it’s greatest success.

Whilst a huge amount of morbidity and mortality was accrued prior to vaccines being available, the scale and pace of the UK vaccine roll-out was almost unparalleled. This was fundamental to keeping rates of severe disease and death at manageable levels even when cases rose during the Delta and Omicron waves. This was in many ways thanks to the JCVI, who made the brave but calculated decision to increase the gap between the first and second dose of the vaccine to 12 weeks. This maximised the speed of protecting the most elderly (despite heavy criticism from some quarters, and which subsequently also turned out to increase the effectiveness of the vaccines). It was also right to keep the roll out simple - invitations directly to individuals based predominantly on age, or a simple list of significant comorbidities. This prevented confusion from slowing things down.

To see why it is so important to prioritise immunisation, one only needs to look to the tragedy which has subsequently unfolded in Hong Kong.

All the efforts that go into delaying infections are wasted if you cannot vaccinate your elderly populations.

Trust

What is more, the UK has managed to achieve extremely high uptake of vaccinations with no need for mandates or imposition. The government fortunately U-turned on mandates for health and social care workers. Instituting it initially for care workers and announcing it for hospital staff was a mistake, but at least it was eventually undone (although many care workers were lost in the process, who are a scarce resource).

This is important for the long term prospects in vaccine confidence. Whilst mandates may increase uptake in the short term, they are often perceived as coercive and provide ammunition for nefarious anti-vaccine groups. Gaining uptake via mutual trust and respect between the public and public health institutions is vital.

Children

There was certainly controversy over the delay in vaccinating teenagers. I do not think this was a cut and dry case, and given the unexpectedly high rates of myocarditis in young males, caution was warranted. It now appears that given a delay between the first 2 doses, this risk can be significantly reduced which makes the risk benefit profile much more favourable.

This information is only available with hindsight.

Perhaps a single dose could have been offered earlier, but the differences between this and what eventually happened would have been small. The same can be said for children aged 5-11, where the risks are lower for both vaccination and Covid-19. Given rates of infection in this age group are now likely 90% or higher, most of the margin of benefit from vaccination has been eroded.

Importantly, the most vulnerable children were able to access vaccines from extremely early on.

In the controversy which engulfed this issue, the important detail which was overlooked was that the size of the risks and benefits were both marginal. This was a low stakes decision for any individual healthy child. The reason for deliberation on behalf of the JCVI was precisely this - because at a population level, small risks and benefits can easily tip one way or the other when factoring in the financial and opportunity costs of whole-sale population deployment programmes.

Summary

The focus on development and deployment of vaccines have proven the UK’s greatest success during the pandemic. The impact of vaccination (especially among the elderly) dwarfs all other interventions in protecting populations from Covid-19, and is the only one which is not simply delaying infection.

For this, at least, we can be glad.

This is part four of the UK pandemic review mini series. For the introduction and to read other parts of this series, you can click here.