The UK’s World-Beating COVID Vaccination Rollout: Behind the Flag Waving

The UK’s World-Beating COVID Vaccination RolloutBehind the Flag Waving

Martin Rodgers calls on journalists to scrutinise the Government’s vaccine programme to ensure defeat isn’t snatched from the jaws of victory

The UK’s embattled Conservative Government is taking succour from a barnstorming roll-out of almost 10 million COVID-19 vaccine doses in January, powered from an aggressive purchasing and emergency licensing strategy.

Indeed, in recent opinion polls, the Tories had moved back into a four-point lead over Labour, a mere week after Boris Johnson sombrely announced the milestone of 100,000 COVID-19 deaths to the nation.

However, as the vaccinations accolades pour in, including from Labour leader Keir Starmer and traditional press critics of the Government’s approach, the scrutiny of what lies beneath the headlines has started to wane.

In a nation bruised and battered by its 12-month COVID nightmare, slowly awakening to the reality of its divorce from the EU, and where political discourse is held in increasingly binary and aggressive terms, the tendency to seek solace in good news seems overwhelming.

Looking under the lid of the UK’s vaccination programme, and beyond its shores to global equivalents, serious questions lurk, that if not addressed with urgency, could see vaccination becoming another catastrophic failure of this Government’s pandemic response, along with PPE procurement and outsourcing.

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The Vaccines

The UK has aggressively pre-ordered vaccines, with a total seven candidates secured covering 357 million doses for its 60 million citizens. This strategy has been conducted on the basis that not all candidates will be successful or pass approval. Of those, two have been granted emergency approval and are being used.

The UK has ordered 100 million doses of the AstraZeneca (AZ) vaccine, and 40 million doses of the Pfizer vaccine. As of 1 February the UK announced that 9.7 million people had received a first vaccine dose, with just under half a million having received second doses and thus being vaccinated.

UK-wide and region-specific data on which vaccines have been used on which age-groups, and the on the dosing interval for second doses, are outside of the public domain.

We have a perverse scenario whereby the more vulnerable are being issued with the weaker AZ vaccine on the basis of its ability to be easily distributed, as opposed to clinical best practice

Crucially, the UK Government does not break down its vaccine delivery statistics by manufacturer.

Despite lower efficacy, AZ is still a vital tool in the fight against COVID-19, given its much lower price per dose, and the fact that, unlike the Pfizer vaccine, it does not need to be stored at -80 degrees.

However, some controversy has surrounded the design of the AZ study, as data on subjects aged 65 and over is sketchy at best. Coupled with inconsistencies and gaps in the results from the Anglo-Swedish first-time vaccine producer, this has led to a tardiness in approval from other countries – most notably the USA, whose agency is running a much larger trial prior to granting approval.

The EU, during last week’s vaccine furore, approved the vaccine across its member states, with a note on untested efficacy among those aged 65 and over. The German national regulator went further, advising against its use in seniors, and other member states, including France and Spain, have expressed similar reservations. With the bloc recently securing an enhanced 600 million dose order from Pfizer in 2021, it is questionable to what degree AZ will figure in its over 65 cohort.

The UK has not made such a distinction between vaccine flavours, basing the bulk of its roll-out on getting the more plentiful AZ doses into arms the length and breadth of the country. Given the ease of storage and distribution of AZ, this has meant a bias towards GP surgeries, local health centres, and indeed care homes, with Pfizer doled out at volume in national vaccination centres.

Again, the national breakdown is not published, but Northern Ireland may be used as a reasonable barometer, and here the Health Minister, Robin Swan, has stated: “Those aged 70 and over are receiving the AstraZeneca jab from their GPs while those aged 65 and over are invited to book an appointment at one of seven regional vaccination centres for the Pfizer vaccination.”

Hence, we have a perverse scenario whereby the more vulnerable are being issued with the weaker AZ vaccine on the basis of its ability to be easily distributed, as opposed to clinical best practice.

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The Interval

AZ trial data, confused as it is, does appear to support a delay in dosage intervals. Hence the major concern is around the UK’s decision to override Pfizer’s instructions for a 21-day gap between doses and to opt for an interval of up to 12 weeks. 

In announcing this delay for Pfizer vaccine recipients, the UK took a dramatic public health decision, reversing its initial schedule after some had received first doses. Ministers went even further, giving the NHS licence to further extend the delay if operational reasons dictated, and to reserve the right to deliver a second dose of a different vaccine if duplication of the first was not possible (although this is not recommended).

The new schedule represents the longest dosing delay of any country in the world, and was met with consternation from the British Medical Association, which requested that it be halved to six weeks at the very most. Pfizer itself simply stated that departure from the tested regime is not recommended.  

Worryingly, recent field data from Israel, which is leading the world in roll-out with 75% of its population having received at least one dose, suggests that the UK Government’s figure is a hopeful projection.

In response to the Israeli data, the UK’s chief scientific advisor Patrick Vallance, in an interview with Sky News, said, “We know that when you get into real world practice, things are seldom quite as good as clinical trials. I don’t know exactly what data Israel are looking at, but we need to look at this carefully.”

Vallance’s bland assessment could be seen as a typical English understatement, or simply evading a difficult question on live television, but it is not surprising that he did not engage further on the subject. For, as chief scientific advisor, he will have been a party to the Government’s decision.

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Care Homes and a Disunited Kingdom

The UK Government does not publish which vaccines have been delivered in what setting and at what interval, and so it is impossible to obtain a national picture of the vaccination situation in care homes.

What we can ascertain, again using Northern Ireland as a barometer where the approach has been published, is that there are substantial differences across the four regions, and in all likelihood also within the regions.

Following the UK-wide decision on 30 December to delay second doses, the Northern Ireland chief medical officer stated the following: “Care home residents and staff in NI will get their second doses within the original three-week period.”

One month later, this objective has been met almost in full, with the vast majority of care home residents and staff receiving both doses of the Pfizer vaccine in and around 21-days.

Tragically, England’s sprawling privately-run care home network, which bore the brunt of the disastrous first wave of the pandemic, appears to have suffered once again. Whereas the government touts that all care home resident have been offered vaccines, the fact is that this only covers outbreak-free homes. Furthermore, only 50% of staff have been vaccinated, and there appears to be no official figures on Pfizer versus AZ dosage, though anecdotal evidence suggests that both are deployed.

Predictably, the death toll continues to rise even as England’s second wave appears to be finally plateauing.

Despite this harrowing picture, central government has doubled down, issuing a statement on 1 February refusing to budge on the 12-week gap between care home doses in England. It seems that no group of people is too at risk or vulnerable, or has suffered enough death or loss so as to be exempt from the Government’s one-size-fits-all mantra.

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Mutations and ‘Leaky Vaccines’

In recent months, it is mutations of COVID-19 that have prompted most concern worldwide, with notable strains deriving from Brazil, England, and South Africa.

As of right now, England has implemented a door-to-door Wuhan-style contact tracing response to the South African strain across eight regions, in a marked departure from the distant and largely ineffective outsourced Test and Trace infrastructure that has been synonymous with the country’s failure to mange the pandemic.

Some scientists have expressed concerns that the UK’s delayed dosage schedule, when applied against this rapidly evolving disease, increases the chances of new and potentially more infectious strains evolving. Indeed, the less perfect a vaccine is, the greater the chance of the virus surviving and mutating.

Research to date is far from conclusive, however one 2015 study on chickens seemed to suggest that this is the case. While all the chickens in the unvaccinated group died, the vaccinated chickens survived for 30 days or more, “allowing the virus to be transmitted to other birds housed within the same confines. These vaccines also allow the virulent virus to continue evolving precisely because they allow the vaccinated individuals, and therefore themselves, to survive”

Whether or not this effect is repeated in a human-hosted coronavirus remains to be seen, yet it is difficult to read the above without thinking of mutations to date. This is relevant in particular to the scenario in care homes in England, where groups of partially vaccinated residents mix with staff who may or may not have been vaccinated, or received different vaccines.

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Keeping Up with the Virus

A second concern, pertaining to mutations, is the ability of vaccine manufacturers to respond to virus mutations.

In this respect, Pfizer has expressed confidence in the ability of its mRNA vaccine to work against the two causing most concern at present, the South African and UK strains, and has expressed as much on its website.

The AstraZeneca/Oxford team has been much more circumspect, with John Bell – Head of Medicine at Oxford University – stressing on Times Radio that the South African strain has “really pretty substantial changes”.

The AZ/Oxford team has further spoken of the need to modify its virus platform and potentially to develop new vaccines.

With the UK in particular spooked by the South African variant, having majority-dosed with AZ, there is a question of whether a traditional, as opposed to mRNA-based vaccine, was appropriate for such a fast-moving coronavirus in the first place.

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Flying the Vaccine Flag

Since the beginning of 2021, concerns over the UK’s vaccination strategy have largely been buried beneath an outpouring of national pride as the NHS, with military support, has put jabs in arms at the astonishing rate of 1.5 million per week.

The Government-friendly broadcast news infrastructure has promoted the vaccine roll-out with gusto – Sky News has a live ticker of vaccines administered based on the daily figures, whereas the BBC has frequently led on the story, and has examined the case studies of various individuals.

In the worst month by far of the pandemic – with more than 1,000 daily deaths expected to be logged on average, and a daily case rate hitting 50,000 at worst – it was the vaccine rollout and not the new level of carnage that made headlines.

Britain’s largely right-wing print media predictably led the charge on the good-news vaccine front, and was afforded an unmissable opportunity when the EU suggested it would have to restrict the supply of vaccines to the UK.

When the EU ultimately sought compromise, the Daily Mail compared the UK’s victory to the Falklands War campaign.

Amidst the jingoism, a change in tone could also be noted in the reporting of the traditionally pro-EU and left-leaning Guardian. Previously questioning of all aspects of the Government’s response, its sister paper the Observer ran a series of articles in defence of the regime and even questioning the BMA, the trade union representing frontline staff.

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Herd Immunity II

On 13 January, it was reported by Byline Times that Dr Mary Ramsay, head of immunisation at Public Health England, said in front of the UK parliamentary committee that the country would need to “allow the disease to circulate in younger people where it’s not causing much harm” while protecting “the people who are really vulnerable”, if the vaccine fails to sufficiently slow or prevent COVID-19 transmission.

Whereas herd immunity is the goal of any immunisation programme, this apparent nod to the discredited Great Barrington Declaration approach – in essence allowing COVID-19 to spread while in theory protecting vulnerable population categories – was met with surprise from leading epidemiologists. Ramsay went further, alluding to another false doctrine, conflation of COVID-19 with the flu.

“That may be the situation that we are going to, like we are with flu where we accept that a lot of people get flu but we protect those who are most vulnerable. That may be the outcome,” she said.

As we know, however, COVID-19 is not flu. Rather, it is a fast-developing RNA virus, which has spawned numerous contagious and quite possibly more deadly variants. Government policy decisions from 30 December – the date of emergency AZ approval – appear to support this herd immunity at-all-costs narrative.

At best the UK approach may not deliver the desired results as rapidly as intended, but at worst could reap a host of unintended consequences, both in immunological and political terms.

But all is not lost. More people have received vaccines in the UK than anywhere else on earth, and the vaccines do afford some protection. This can only be good. But in order to ensure that the programme succeeds, the Fourth Estate needs to stop flag-waving, and instead redouble its efforts to scrutinise the Government.