This post is Part 1 of three on the Covid-19 pandemic. Part 1 is focused on the UK vaccination rollout and looks at whether it is a success, Part 2 will be on the catastrophic mistakes that the UK government made that has led this country to have the worst death rates from Covid in the world, and Part 3 will be more about pandemics generally, and the positive actions that can be taken to prevent them.
I began this first post some weeks ago, which means that the total number of people vaccinated in the UK changed from around 6 million when I started writing to well over 17 million people. Indeed, the government has hit its target of vaccinating the first 4 of 9 priority groups, which means that nearly everyone over 70, plus nearly all the extremely clinically vulnerable and frontline health and social care staff, have been vaccinated. Wow! That’s good, I guess, although I say nearly everyone as there are people who have been missed, but nevertheless 95% of the over-70s have been vaccinated (See*for reference).
This is a good news story isn’t it? Well, yes, and no, because as ever, it’s complicated. And what’s more our government is muddying the waters somewhat by going against the results of the vaccine trials and prolonging the gap between the 1st and 2nd vaccine from 3 to 12 weeks in order to give protection to a greater number of UK citizens. This is unlike, I think, any other country, although I believe some countries are looking closely at the UK’s decision and playing a waiting game. That means that for the time being we are going it alone on this one. But, you know, the thing is vaccinating the greatest number of people, which we are doing very successfully, that’s not a bad thing, is it? Well, we don’t know for certain. So, let’s see what we do know.
Facts about size
Here’s an interesting thing to ponder. Did you know that all the Coronavirus in the world, on any one day, can fit into an ordinary coke can? A statistician (**see reference below) worked this out by calculating that the number of people around the world infected each day is probably 3 million, and that each of these individuals will have a peak viral load of around 1-100 billion particles, so that the total viral load at any one time of these current cases will be roughly two quintillion (that’s two billion billion) virus particles.
Apparently, that’s the same as the number of grains of sand in the entire planet. But of course, the virus particles are much smaller than sand, so after finding out the volume of a single (very, very tiny) particle and multiplying it with the (very, very large) number of particles, then taking into consideration something called ‘close sphere packing’, the total volume is about 160ml, enough to fill a coke can with space to spare.
Well, there you go. And how are we dealing with these minute but dangerous and deathly particles? Up to the end of 2020 it has been very much maintaining our distance, wearing a mask, washing our hands and attempting to track people in contact with the infected and note the word ‘attempting’ – more about that in the next piece. Actually, do you remember at the very beginning of this pandemic it was all about washing our hands? We now know that the virus is airborne, so the current advice is more about wearing a mask and ventilation of indoor spaces.
However, extraordinary work on the part of scientists around the world has resulted in a whole range of vaccines being available, and the UK’s rollout of the two vaccines it has at the moment is motoring along. It appears that this is indeed a good news story.
The UK vaccine procurement story
Let’s begin with how the UK procured its vaccines. In January 2020 Prof Sarah Gilbert told her colleagues at the Oxford University’s Nuffield Department of Medicine that she had a vaccine, repurposed from her work with Ebola and Mers, that could take on this new Coronavirus. It was given the go-ahead, money was found and the development of the Oxford vaccine began. By April 2020 it was clear the Department needed a pharmaceutical giant to manufacture at the scale the country and the world required, so after a deal with US company Merck fell through, the Anglo-Swedish firm AstraZeneca came on board on the 30 April 2020, with another contract signed a fortnight later detailing the delivery of 100m doses to the UK. This, of course, is good news as it’s not only about scientific bravado at Oxford and their good sense to get going with their vaccine development at such an early stage, it is also about their altruism in seeking out a pharma giant prepared to sell at cost, as AstraZeneca will sell the vaccine globally at no profit, essential for the poorer nations of the world and exactly what the scientists at Oxford wanted.
However, producing a vaccine is not like manufacturing a car with all the parts available on the factory floor, the Oxford vaccine has to be ‘brewed’ for three months and there were filtering glitches in the early stages but, because of this early start, these were ironed out, with production in manufacturing sites in Oxford and Keele going full speed ahead long before the vaccine was approved in December 2020.
However, things did not run so smoothly in Europe and I think it important to mention that a major row broke out between the UK and the EU around the supply of the Oxford AstraZeneca vaccine, with the EU threatening all sorts of action, including using Article 16 of the Northern Ireland Protocol, an article which is to be used only in extreme circumstances. This arose, because, in January of this year, AstraZeneca revealed it would only deliver 30 million doses of its vaccine to the EU rather than the 80 million it was contracted to deliver. The early stages of producing the vaccine for the EU had not yielded as much vaccine as they had hoped (see above) and the later contract between the EU and AstraZeneca meant that while the vaccine would be delivered to the UK in full, it would not be able to deliver all the vaccines to the EU. This is not the place to go into the profoundly challenging situation we have in Northern Ireland and its border with Ireland, but whilst I am a fan of the EU (yes, still) and bitterly regret the UK leaving the EU, I’d say that with this the EU over-reacted.
I shall say a bit more about nations and their vaccine contracts nearer the end of this piece, but the row seems to have quietened down. It’s a shame as the shortfall is temporary as AstraZeneca has said that they are scaling up operations both in the UK and Europe with global production increasing to 100 million doses a month.
In the meantime, another key part of the successful UK roll-out was the UK vaccine taskforce created by the UK government and run by the entrepreneur Kate Bingham. She has not escaped some criticism with ‘consultants’ paid what seems enormous amounts of money but the whole operation has been a huge success. Bingham surrounded herself with experts. So, were these the highly paid ‘consultants’ the vaccine experts? I wouldn’t know, but a little transparency wouldn’t go amiss. Anyway, these experts went out seeking vaccines, with the result there are contracts to buy the UK 360 million vaccines from seven different companies, including Pfizer and Moderna.
At this point I congratulate the UK government for accepting that speed was necessary and risking enormous amounts of public money on these new untested vaccines. You might think I do nothing but criticise, but on this I acknowledge it is the one thing that the government has got right, they were slow to accept the dangers of Covid, slow to put us into the first lockdown, slow in so many, many ways (see the next post for My Other Blog) but with this, hats off.
With the vaccines pretty much secured the job of putting a jab into the arms of the population was handed to the NHS and it appears that this has been spectacularly successful. Now why is this?
Community based medicine works
On 21 February 2021 Israel has vaccinated more people than any other country in the world at 82.4% (per 100 people) closely followed by the United Arab Emirates at 56.1%. The third country is the United Kingdom at 26.3%, and the fourth country, closely following the UK is the United States at 18.3%. (Sky News at *** updates these figures daily)
I can’t speak for the UAE but both Israel and the UK deliver their medicine and health care through a community-based model. Furthermore, in the UK when it came to getting an actual jab into someone’s arm the job of organising the roll-out was not farmed out to a private contractor but given to the NHS and public health to organise and, boy, has this worked.
It worked because in the UK our first port of call for anything medical is the local General Practitioner (GP) who either treats you or sends you on to a specialist. The system is that to use this model you register with a nearby GP surgery, consequently very nearly the whole UK population has an NHS number. And I wonder if any of you reading this over the pond think our ‘socialised’ medicine has made us a bit too biddable and conformist, and, even worse, a little bit 1984, as through our NHS numbers they also know our addresses and phone numbers. But this knowledge was gold dust, as that is how the entire UK population has been, or will be, systematically contacted to get their vaccines.
The roll-out programme began by the drawing up of ten priority groups. These groups were based on age, whether you were a frontline health and social care staff, a resident of a care home (the 1st group) or clinically vulnerable, with vaccinations beginning mid-December targeted at the first four groups. And remember I asked, are we a little bit conformist and a little bit biddable because at the start of the roll-out we had strict instructions to wait our turn and not ring up our local GP surgery for the vaccination. And you know what, that is exactly what happened, on the whole, we waited in the expectation that we would be contacted. Why? Because we know the NHS, we trust the NHS, and above all it’s fair. At the end of January, like most people in my apartment block, I was contacted by a text asking me to ring the vaccination centre allotted to me. The phone was answered immediately, and we were booked in for a vaccination 3 days later. There was a belt and braces approach from the NHS as five days later we were sent a letter by the government asking us to book an appointment at the same local vaccination centre. Yes, you could be texted, sent a letter or in some instances, phoned.
The organisation of the vaccine venues was also efficient. GP practices joined with other practices with some beginning vaccinations in mid-December but note that I say I had my vaccination in a centre (or hub as it’s sometimes called) and, in this instance, the vaccine centre is a racecourse. Around the country there are large vaccination centres in racecourses, community centres, church halls, museums, concert halls, mosques and other large venues, and in one city, a cathedral where the organ is played throughout the day. These larger centres are set up to deal with the tricky business of handling the Pfizer vaccines that have to be kept at very low temperatures. Now more and more vaccination hubs and centres are being set up including some large pharmacists, and the GPs who have agreed to do vaccinations within their own surgeries are calling patients in.
The system has changed slightly in that as well as receiving a letter or text, people can now ring in to book their jabs before a letter or text arrives. But people still wait their turn as, with the population told that the target of vaccinating the first four categories has been reached, and it is the turn of groups 5&6, we understand this and we comply, as it is those people who are phoning in to be vaccinated now.
But the success is not just down to a compliant population, the entire effort to organize, set up and deliver vaccines to the UK population is based on the logistics of getting actual jabs into actual people’s arms. This is a public health approach that is given to any vaccine that the UK population needs. There was no difference when it came to the Covid-19 vaccines, yes, it is the largest programme of vaccination ever, but getting a jab into someone’s arm was the entire aim. That’s obvious, isn’t it? And yet it seems not elsewhere.
This, by the way, is not a criticism of the USA, but it is interesting to read how the roll-out of the US vaccination programme differed from the UK’s programme. Apparently during the time of the Trump administration there were two task forces (see below for reference): one was the White House task force that included Dr Deborah Birx and the Center for Disease Control and Prevention director Dr Robert Benfield; and the other was Operation Warp Speed a public-private partnership set up to develop and distribute Covid-19 vaccines which included the Secretary of Health and Human services Alex Azar. Membership of this latter group included many different agencies including the Department of Defence.
Operation Warp Speed, very much like the UK vaccine taskforce, has been spectacularly successful in funding the development of several vaccines, and yet the distribution of these vaccines into people’s arms has not been quite as successful. The reason being that there was a culture clash between Operation Warp Speed’s idea of a huge, speedy, military style roll-out of vaccines to states, as opposed to the public health approach of Drs Birx and Benfield of delivering vaccinations to individual citizens. Basically, there was a big turf war and Operation Warp Speed, with its many participating generals, won the war, and that meant the whole emphasis was on getting vaccines delivered to states, what the states actually did was up to the individual states. Hence, unlike the UK co-ordinated public health roll-out to the community-based centres and hubs, with IT systems at the ready to contact populations, vaccinators ready to jab and volunteers available to usher people in and process people as they arrived at the centre, the US roll-out limited the federal assistance to simply a military operation of getting the vaccines transported. Once delivered, this was, in effect, seen as mission accomplished. Consequently, with vaccines arriving in hospitals and storage depots states were left to their own devices; a notable few were efficient (apparently West Virginia and Connecticut) but many states faced huge problems of underfunded public health departments, crashing IT systems and little in the way of any infrastructure to get people and vaccinations together. Since the inauguration President Biden has, of course, rushed to solve this challenge and much has been done to rectify the original approach.
So, with a community-based system of medicine already in place, the UK’s public health dominated roll-out has become a great success. Yes? Well, let’s see. Because there are caveats to this story.
Success yes, but with caveats aplenty
It is not enough to vaccinate the population of your own country. Can I remind people that even with a vaccine available world-wide it took almost 200 years to eliminate smallpox and that only happened through a huge effort through the 1950s and 60s, to the last known case in 1975. A vaccine in itself, bought and distributed and administered within the wealthy countries of this world, is not the answer to eradicating Covid-19. Every case has to be eliminated, everywhere, in every part of the world, and that will take some time to do as, unfortunately, we know that 130 countries have not yet received a single Covid vaccine, while notably 10 countries have administered 75% of all vaccinations done so far.
There does, however, appear to be some movement to rectify this. There has been a recent meeting of the Group of Seven, which is made up of seven major industrial nations including The US and the UK, and promises have been made by the UK government that our excess vaccines will be given to poorer nations. And there is the Covax programme which has been set up by the WHO to buy and deliver vaccines to the poorest countries. With the Biden administration re-joining the WHO there have been assurances that the US will work towards expanding the manufacture and distribution of vaccines to poorer nations. China and Russia as well, for various reasons, have not hesitated in donating vaccines to various third world countries. I say, whatever their motives, the more vaccines sent to these countries, the better. Also let us not forget the conflicts zones around the world – Syria, Yemen, South Sudan and Ethiopia, these countries are all unstable and vaccinating their populations will be challenging.
The reason that vaccinating the world is so important is that the virus constantly changes and adapts to its environment. Every time it reproduces there are minute changes, and some of these changes become fixed and become the dominant virus, with the danger (to us) that these so-called variants may be resistant to the current vaccines around at the moment.
Furthermore, what is key to the safety of us all, is that no variant will ever stay in the country of its origin unless we shut down all borders around the world completely, which is what many leaders including Johnson will not do. And anyway, while I would have wanted the UK borders to be shut in March last year, can one continue to shut borders ad infinitum? No. But viruses are not being devious when they change, they are not sentient beings, their entire reason for existence is to exist and reproduce, and to do that variants will arise and are going to be part of this pandemic until we get herd immunity, with either the entire world having had the virus and/or all us vaccinated. There is a precedent for that because that is the way the 1918 flu pandemic ended, you either died (50-100million around the world died as opposed to the 2 million and counting with this one) or were immune because you’d had it.
With variants of the Covid-19 here to stay, because it is what coronaviruses do, it is good to know that companies are already working on new and/or booster vaccines. Having a booster jab every year is probably the way things will go.
As we have seen there are many countries still to receive any vaccines, so it is galling that within first world countries that there is vaccine hesitation, and even vaccine resistance. It is absolutely right and proper to ask questions as the speed of developing and producing these vaccines world-wide is astonishing. We should be reassured though, not only with the stringent safety checks within the trials that have been run concurrently rather than one after the other, but hey, I said to myself when I received my first jab, here’s another statistic for doubters, I’m another old person accepting a vaccine and no problems with it either. Just look at all these frail, older people being vaccinated, we’ve had the jab, so why not you?
While I will not tolerate the nonsense spouted by vaccine resisters (microchips ffs…) there are people with genuine concerns and fears, and here I’m thinking of the BAME population. I cannot speak for them, but I do know, having heard these views, that the inbuilt racism within our society has not helped. But it’s great to see BAME influencers urging people to get the vaccine and public health endeavours like modified vaccine buses going to mosques and other community venues to take the vaccine to the people.
Still, there’s a lot of people in danger of being missed because while around 90% of the UK population is registered with a GP, what about the 10% who are not: the hard-to-reach, the homeless, low paid migrants, illegal immigrants, other ethnic communities? Everyone must be included and vaccinated.
There is also some vaccine hesitancy in Europe with some populations far more reluctant to accept a Covid vaccine than in the UK. There is also some hesitancy around accepting the Oxford AstraZeneca vaccine in both Europe and in the UK, as trials have indeed shown that the Pfizer vaccine has a higher rate of efficacy than the AstraZeneca vaccine. But here’s the thing, although there is some emerging evidence that both Pfizer and the AstraZeneca vaccines do have some protection against transmission, vaccines on the whole don’t prevent you getting the blasted disease. What the evidence does indicate is that the current vaccines, Oxford AstraZeneca included, prevent you from getting seriously ill or dying, which, I think is a pretty good reason to accept any vaccine. I quote an epidemiologist and public health worker who said that for him,
“the best vaccine is the one in your arm.”
So, to sum up, note that I have barely scratched the surface of the information that is out there about Covid-19 vaccinations, but here in the UK, the vaccination roll-out is a really good news story, as long as we acknowledge that not everyone in the UK is being vaccinated, there are people being missed, even when everything to do with the roll-out is brilliant. And then there are so many other countries that have not begun vaccinating. Furthermore, boasting about numbers vaccinated, and small wars between 1st world nations as to what one particular contract of one country or another, might, or might not have said, does not help and is far too narrow a focus on what will actually save the world from the continuing presence of this unwelcome visitor. But overall, yes, for one small country, the vaccine roll-out is all mostly good, but no, it is not yet a good news story for the safety of the world and its population.
Penny Kocher, 21th February 2021
*Michael Le Page, Clare Wilson, Jessica Hamzelou, Sam Wong, Graham Lawton, Adam Vaughan, Conrad Quilty-Harper and Kayal Liverpool. Covid-19 news: 95% of over 70s in Great Britain given vaccine. New Scientist. Health. 19 February 2021.
**Christian Yates, All the Coronavirus in the world could fit inside a Coke can, with plenty of room to spare. The Conversation, February 10, 2021
*** Philip Whiteside, Ganesh Rao, Covid-19: How close is the government to reaching its vaccination target? Sky News February 21, 2021
Katherine Ebdan, “A Huge Potential for Chaos”: How the Covid-19 Vaccine Rollout Was Hobbled by Turf Wars and Magical Thinking. https://vanityfair.com/news/ February 8, 2021
Ian Sample, Vaccines: who has had one and when can we expect an impact. The Guardian, February 14, 20201
Dr Donald Macarthur and Dr Meriem Bouslouk-Marx, Efficacy Controversy Hits European Covid-19 Vaccine Rollout. https://www.pharmexec.com February 16, 2021
Associated Press, Wildly unfair: UN says 130 countries have not received a single Covid vaccine dose. The Guardian, February 18, 2021