Ryan Bourne: How many lives will we save by choosing our own vaccination programme, not the EU’s? Let’s start at nine thousand.

3 Feb

Ryan Bourne is Chair in Public Understanding of Economics at the Cato Institute.

Delay is extremely costly in this pandemic. When the post-mortems are written, lethargy will rank high on the list of consequential policy mistakes. With a rapidly spreading virus, procedural bureaucracy or a failure to grease the wheels for vaccine rollouts will be found to have cost tens of thousands of lives in each advanced country, alongside incalculable damage to livelihoods.

As I explain in my forthcoming book, Economics In One Virus, governments have certainly spent big on testing, tracing, and vaccines. But the sums are piddling in comparison to the amount allocated for economic relief.

The latter is demanded by voters, but it would have been wiser to put more funds into paying over-the-odds to encourage vaccine manufacturing scale-up, to overcome bottlenecks, and to facilitate around-the-clock rollout as soon as vaccines were ready. This would have handsomely paid for itself in a more rapid economic normalisation, not to mention the lives saved. As economist Alex Tabarrok has written, this was the easiest cost-benefit analysis in the world for policymakers. When the inquiries begin, governments will lament their relative stinginess on spending where it mattered most.

As of writing this on Monday, the UK’s vaccine rollout performance is improving still, of course, with nearly 600,000 jabs registered Saturday and England’s figures for Sunday up 45 per cent on the week. It might seem a bizarre time then to lament that we didn’t go quicker still. Yet two months after the first vaccine was approved, still only around 14 per cent of the public have received at least one dose. While the manufacturers and the NHS are (understandably and heroically) pulling every lever given where we are, we will surely regret in future not having had an Israeli-style mobilisation in place.

That’s not to say the UK’s performance has not been *relatively* impressive. The dexterity of the MHRA in understanding the trade-offs associated with the approvals process puts the US to shame, as that country stalls on approving AstraZeneca’s vaccine despite tens of thousands of Americans dying per week. The UK government’s willingness to stump up more cash has exposed the false economy of the EU’s haggling over pennies in contracts too.

For the costs of delay are exacerbated by the way this virus and the vaccines operate. An infection might take three to four weeks before it manifests as a death. Vaccines themselves take a couple of weeks before they are high efficacy. So now we see the consequence of the relative lack of acquired protection for many elderly people in mid-January. It is only in the next three to five weeks that we should start seeing the big vaccine-induced falls in mortality, if indeed vaccines really do have near the 100 percent touted effectiveness in preventing deaths.

The Covid-19 Actuaries Group (CAG) believes that if the Government delivers on its eminently achievable target of vaccinating all over-70s, care home staff, frontline health and social care workers, and the clinically vulnerable, by mid-February, daily Covid-19 deaths will fall by two-thirds by the end of the month. By the tail end of March, deaths should be down 86 percent against a world without vaccines. So one can understand the angst inside the EU—their tardiness in getting vulnerable populations vaccinated will cost lives that will be all the more observable if British trends go as expected.

How many extra deaths have we avoided through our speedier rollout? Calculating the exact magnitude is extraordinarily difficult. Lockdowns and tier restrictions perversely lower the immediate “lives saved from vaccines,” because without them more people would have been exposed. Working out how many lives the UK will save compared to the EU in the coming months is also muddied by not knowing the eventual speed of each country’s vaccination program or the underlying prevalence of the disease for the nations.

But comparing the UK to France, Germany, Italy and Spain (the EU-4) gives us an idea of magnitudes. These countries have only vaccinated between two and four percent of their populations respectively, and are currently vaccinating at a rate of 0.11 to 0.12 percent of their populations per day.

The UK has vaccinated 14 percent of its population, and is currently vaccinating over 0.55 percent of its population per day. If extrapolated forwards, the UK would vaccinate its four priority groups once by mid-February. The EU-4 would achieve the same proportion of population dose numbers by mid-to-late July. Indeed, even if the EU-4 were suddenly able to up their daily vaccinations to UK rates from now, they would not hit the same number of doses as a proportion of the population as the UK’s February target until early March—three weeks behind.

My calculations based on the Covid-19 Actuaries Group report suggests that, if the vaccine is 100 percent effective in eliminating death, the UK has already seen around 1,300 fewer deaths as a result of vaccines. Given the lags discussed between infections and deaths, as well as the time it takes for vaccine efficacy, this is almost certainly close to 1,300 more lives saved than would have been saved had we been as tardy as the EU.

Projecting forwards to how many lives are being saved from the recent and current vaccinations is more difficult. We have to try to model what cases and deaths would have looked like absent a vaccine. We would also need to know how fast the EU vaccination program will become, something that I profess no knowledge of.

But, for illustrative purposes, let’s assume that, absent a vaccine, deaths would otherwise have fallen through February and March as a pure reflection of how they rose in December and January. Under this scenario, the UK has already locked in 9,000 fewer deaths through mid-April than if it had moved at the EU-4’s vaccination pace to date (saving 20,000 lives overall). And that’s assuming the EU-4 countries wake up tomorrow and suddenly match the UK’s speed.

Realistically, of course, some of the EU-4 are not planning to widely vaccinate for a month or two, while they are sticking to the regimen of two doses sooner that will leave fewer people on the Continent protected in the near-term. So, it’s very safe to say the UK will have saved tens of thousands of additional lives relative to going at the EU-4’s pace over the coming months, with the gap especially dramatic if the EU does not up its game in the very near future or if, as a result of vaccinations, the UK then relaxes its lockdown restrictions. The costs of delay in public health and economic terms are clearly enormous.

Allie Renison: Pregnant and breastfeeding women deserve choice over whether they have the Coronavirus vaccine

22 Dec

Allie Renison is Head of Trade and EU Policy at the Institute of Directors. She writes in a personal capacity.

Choice. It’s often what divides the world view of Right from Left, or at least is what the former tends to identify its ideological principles around in differentiating itself. But there are some areas of government intervention where there should be no distinction, and the administration of vaccines to fight the current Coronavirus pandemic is one of them.

Sadly, for all the rush to claim glory in being first to authorise for emergency use, the UK is falling far short in equality of access to those who need it. The MHRA has decided to advise against pregnant and breastfeeding receiving the Pfizer vaccine, and in a universal public healthcare setting which is tightly controlled, that means they will not be able to access it.

The argument goes that as these cohorts were excluded from clinical trials, the minimal theoretical risk is irrelevant without sufficient data. Pregnant and lactating women have often long been excluded from such trials on safety grounds, and it is an exclusion which brings its own risks and delays to innovation and medical research development writ large.

But in a pandemic setting, we are in acute danger of missing the bigger picture. Namely, that the risk and severity of Covid – particularly for this patient group – outweighs the theoretical unproven risk of the vaccine. And while there is a role for caution in giving medication to women in this group, it is essential to remember the specific and inherently low-risk nature of these kinds of vaccines.

While they are not extensive, studies conducted so far paint an alarming picture, and one where precautionary red tape for its own sake should not be the chief determinant. In the US, a CDC report from earlier this year found pregnant women with Covid-19 (particularly in the third trimester) were three times more likely to require ICU admission and that their risk of death is 70 per cent higher than those who are not pregnant, and that is before adjusting for other demographic variables and comorbidities. This should hardly be surprising; pregnancy itself is considered high risk for developing severe diseases.

Compounding this is the fact that those at risk, particularly from minority ethnic backgrounds, are often much more likely to work in healthcare, so it’s not hard to see a ticking time bomb. Only, with a vaccine now not only on the horizon but in place, this is one time bomb that has no reason to go off – certainly not without women having a choice in the matter. It is likely for this reason that regulators in both Canada and the US have allowed that choice to proceed and left it up to them to decide.

In the UK by contrast, it appears the precautionary approach endures well beyond the EU and Brexit. Beyond women having had to suffer through births and miscarriages alike alone, with bans on partner accompaniment, they now face an agonising set of choices in the absence of being able to access the Pfizer vaccine, even if in a higher risk category. Breastfeeding mothers in particular will have to weigh up feeding their children naturally or being inoculated against the virus. For medical professionals, it is even worse – many openly say the choice is between lying about their condition (unthinkable) or carry on treating patients without being able to protect themselves.

The NHS and government websites don’t even try to sugarcoat it, calling this an explicitly precautionary approach: “there’s no evidence it’s unsafe if you’re pregnant or breastfeeding. But more evidence is needed before you can be offered the vaccine”. The unconscionable position this in particular puts many healthcare workers confounds neonatal experts up and down the country. Ultimately, the severity of this disease surely has to outweigh theoretical risks to its cure, and surely women should have a choice in making that decision.

After all, as many point out, the ingredients in the Pfizer vaccine themselves have all previously been found safe for them to use. The Hospital Infant Feeding Network and many other advocacy bodies for healthcare professionals – the subject matter experts, we should remember – say this is putting these women in a discriminatory position, and are calling on the MHRA to amend its guidance to follow the US FDA’s approach and urgently commit to collecting more patient data. Studies in pregnancy are to be prioritised but no such plans have yet been made for women who are breastfeeding. Public Health England would be failing in its duties for this approach to carry on.

Beyond this, the narrative which authorities claim to be concerned about with respect to combating anti-vaccine sentiment, will continue to spiral for as long as this restriction remains in place. No one will care that this is simply a precautionary rather than evidence-based approach. It provides the confirmation bias many want, and it will be – indeed is already being – exploited. Hundreds of breastfeeding doctors alone are on hand, willing to be vaccinated and give their breastmilk for research, yet days continue to pass without any take up.

Personally, as a woman of childbearing age, I find it downright terrifying, infuriating and more than a touch paternalistic that this kind of choice could be kept from me. More safety data is absolutely needed as we go, but the inability to make that decision myself leaves me with no agency over my own body. Knowing the state is withholding that control, not to mention from those caring for Covid patients and with higher risk profiles, leaves me feeling I live in a thoroughly socialist country, not one where risk and choice are balanced against one another.

Ultimately, big picture thinking simply must come before process. After all, it is for this reason that emergency use authorisations were put in place for vaccines to begin with – the wider risks to public health have to come first. If there is one case to plead for women’s rights being more than just a passing fad, it is this.

No one should have to forego access to lifesaving drugs because of their biology. This is why many in the neonatal healthcare community have banded together to petition authorities in the UK to reassess vaccine eligibility. Action is not only needed in the short term but also in the long haul, which is why experts are urging a “presumption of inclusion” for all future clinical vaccine studies.

And lest anyone think feminists incapable of compromise, we can at least make the call for female workers on the front line to benefit from some choice here. Stop putting them in impossible positions which constrain their ability to fight the pandemic effectively. Amend the guidance for medical professionals and move to gather additional evidence needed. Listen to the subject matter experts. Take heed from other countries. And above all, trust women to make informed choices about the risks to their own bodies.