The only way Britain can avoid a third wave of the virus as devastating as the first is to immediately ramp up Covid vaccinations to a rate of no less than two million a week.
That is the conclusion of a new study rushed out by the London School of Hygiene and Tropical Medicine (LSHTM) and delivered to SAGE over Christmas. The analysis calculates the new variant of the virus has increased transmission by 56 per cent. When that new number is fed into the university’s model it finds even the most comprehensive January lockdown – school closures included – is unlikely to prevent a repeat of the crisis we faced in April.
The LSHTM team is one of the country’s best and its model has proved broadly accurate from early March. Its latest study has yet to be peer-reviewed and it is not yet proven the new mutation is as transmissible as estimated but its findings are nevertheless stark:
“We found that regardless of control measures simulated, all NHS regions are projected to experience a subsequent wave of Covid-19 cases and deaths, peaking in spring 2021 for London, South East and East of England, and in summer 2021 for the rest of England. In the absence of substantial vaccine roll-out, cases, hospitalisations, ICU admissions and deaths in 2021 may exceed those in 2020.
“The most stringent intervention scenario with tier 4 England-wide and schools closed during January and 2 million individuals vaccinated per week, is the only scenario we considered which reduces peak ICU burden below the levels seen during the first wave”.
The study estimates total additional Covid deaths for the six months to the end of June to range from 118,000 (assuming a patchwork of tier one to three restrictions) to 35,700 assuming a nationwide tier 4 lockdown throughout January, plus 2 million immunised every week from January 1.
The projections will make grim reading for ministers, and it is little wonder that Michael Gove was equivocal about the prospect of schools reopening as scheduled when interviewed yesterday.
Gove told the BBC it was “our intention to make sure we can get children back to school as early as possible … We are talking to teachers and headteachers in order to make sure we can deliver effectively. But we all know that there are trade-offs”.
But it is on vaccination strategy that the study will have the most impact. Ministerial responsibility for this sits with the Nadhim Zahawi, a junior minister for business and industry.
He certainly has his work cut out. UK Covid vaccination rates are currently running at about 200,000 a week – a tenth of what the LSHTM study estimates is needed.
Currently, the speed of the rollout is being constrained by four key factors: vaccine supply, the logistics of dealing with the deep-frozen Pfizer product, the need for a double dose and the difficulty of getting to the oldest and most frail sections of the population first.
It is widely anticipated the Medicines & Healthcare products Regulatory Agency (MRHA) will grant an emergency use licence to the Oxford AstraZeneca jab in the next few days. If that happens, the current supply and logistics constraints will be greatly ameliorated.
AstraZeneca says it can deliver 40 million doses by the end of March, with four million doses arriving immediately. And unlike the Pfizer product, the Oxford jab can be stored in an ordinary fridge and has a much longer shelf life.
Mr Zahawi may be able to speed things up further by acting on the advice of Tony Blair and the former government scientific adviser David Sainsbury who proposed last week that people receive one dose of vaccine initially rather than two.
This strategy may make sense for the Pfizer jab as efficacy only slips from 95 to 90 per cent using a single dose, but it may not work with the Oxford jab.
Dr Penny Ward, visiting professor in pharmaceutical medicine at King’s College London, said last week: “The data for the Pfizer vaccine do suggest that the [it] might well be significantly effective even after the first dose. The difficulty is we don’t have the same quality of information on the Oxford vaccine, in the public domain anyway.”
Another option for Mr Zahawi – albeit a controversial one – would be to change the vaccine prioritisation list, bringing those who are easier to reach up the pecking order. Already unions representing NHS workers and teachers are making a case for their members to receive early jabs, citing the additional risks they face and the importance of their roles.
But there are two obvious drawbacks. First, the priority list is structured as it is for good reason. Those at the top are the most vulnerable to Covid-19. If you skip over them, you leave those most likely to die of the disease unprotected, defeating the objective of the exercise.
The LSHTM study assumes the government’s current prioritisation in its modelling, for example. If other groups were vaccinated in their place, the projected death toll would jump again.
A second problem is that once you move away from prioritisation on clinical risk – age and pre-existing conditions – you open the flood gates to many other claims.
Security guards suffered one of the highest death rates in the first wave, for instance. Hospital porters and bus drivers were also found to be at a greater than average risk. The poor are more vulnerable than the rich. Ethnic minorities are more impacted than whites. And men are at greater danger than women.
In America, this debate has been more open but it has arguably also been more toxic and divisive.
In Britain, the Joint Committee on Vaccination and Immunisation has sought to overcome the issue by focusing largely on age, while giving the NHS some flexibility around the edges to judge who among its patients are most at risk, taking societal factors like inequalities into account.
It is a very British compromise and not one Mr Zahawi, a former pollster, would relish or be well advised reversing.
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