Omicron or no Omicron, high-income nations should have promoted a more equitable distribution of vaccines

29 Nov

After a fairly “relaxed” few months in the Coronavirus wars, many of us were dispirited last week to learn of the emergence of a highly transmissible new variant, Omicron, which was first identified by scientists in South Africa

In a joint press conference on Friday with Patrick Vallance, England’s Chief Scientific Adviser, and Chris Whitty, Chief Medical Officer, Boris Johnson levelled with the nation about its seriousness – and what measures the UK would take to combat it, from the re-introduction of compulsory mask wearing and a new PCR test requirement for people arriving at airports. Jonathan Van-Tam, Deputy Chief Medical Officer, has today expanded on the threat it poses.

Whether the Government’s steps are enough will be the subject of many questions over the next few weeks. But perhaps the most important is what Omicron symbolises for the international community; specifically around whether the distribution of vaccines has been as equitable as it could have been.

From the early stages of the crisis, prominent experts and the World Health Organization have warned of the importance of equitable vaccine distribution, first for moral reasons, but also because an imbalance could leave a vacuum for new variants to develop, and evade vaccines/ treatment. The emergence of Omicron has only added to that concern – due to the fact that it emerged in a part of the world with low inoculation rates (only 24 per cent of the population in South Africa has been inoculated).

That the variant was discovered in South Africa does not mean it is where it originated (rather, its scientists have some of the best detection tools); indeed, there are cases in Hong Kong, Canada and the UK. But it has nonetheless opened up the debate on whether more even vaccination rates around the globe could have made a difference, and how many new variants will take off elsewhere without better-protected communities. 

There are still shocking statistics on inoculation rates worldwide; only 2.5 per cent of the population in low income countries, for example, have received full protection, with 3.5 billion people across the globe waiting for their first dose of the vaccine. At the same time, 66 per cent of high-income countries have been vaccinated, with many onto their booster jabs and plans to inoculate children.

Could high-income countries do more? It’s worth saying that many have gone to extraordinary efforts to get vaccines out. In July this year, for instance, the UK began donating millions of vaccinations as part of the international Covax scheme, and has pledged to donate 100 million overseas by June 2022. 

As of September, the United States had donated approximately 140 million doses to around 83 countries, making it the highest donor, followed by China, Japan, India, the UK, France, Canada, Spain, Sweden and Poland

But even these staggering figures – Covax’s initial goal is to provide two billion doses of vaccines worldwide in 2021 and 1.8 billion doses to 92 poorer countries by early 2022 – may need to be improved upon. There will also be pressure on countries to be more flexible about vaccine patents; the European Union is being asked to share more information with others.

Furthermore, some countries may need help overcoming logistical challenges to rolling out their vaccines, from having difficulties with storage, to experiencing shortages in health workers who can administer inoculations. It is not a simple case of more jabs, job done; governments have to consider these additional barriers.

Either way, it’s clear that equitable distribution will become much more of a talking point with the new variant; it is a reminder that the world is in it “together” when it comes to beating the virus. This often seems to be forgotten in all the talk about booster jabs – and it’s a shame that it only gets brought up when growing variants hit home. Even before Omicron, developed nations had a duty to do more here.

James Somerville-Meikle: Religious services are essential for many people; the Government must not stop them again.

9 Nov

James Somerville-Meikle is Head of Public Affairs at the Catholic Union.

To ban religious services once could be seen as unfortunate. To ban them twice in a year looks like carelessness.

Unlike Oscar Wilde’s The Importance of Being Earnest, this is sadly not a comedy.

The Government has once again prohibited religious services in England as part of its second national lockdown. While places of worship can still open for private prayer, religious services are banned until December 2.

Something that seemed unthinkable at the beginning of the year has now happened twice. We must not allow it to happen again.

While closing places of worship in the first lockdown was extremely painful, it was understood that we faced an unknown virus and the priority was to protect the NHS and save lives. We now know significantly more about this virus and how to control it.

If you’ve been into any church since the summer, you will have probably encountered an army of masked cleaners with disinfectant spray, one-way systems, and people collecting contact details for NHS Test and Trace. The efforts of thousands of volunteers across the country have made churches, and other places of worship, examples of how to make public buildings Covid-secure.

This has given faith leaders confidence to speak out against the ban. Cardinal Vincent Nichols, leader of the Catholic Church in England and Wales, spoke of the “deep anguish” felt by Catholics at seeing churches closed for services. A feeling shared by many other people of faith.

The decision was also criticised by many MPs and peers during the limited time for debate on the regulations in Parliament. Edward Leigh MP, the Catholic Union President, described “outlawing religious services” as a “disproportionate response to the pandemic”.

Outlawing religious services – taking away a basic pillar of religious freedom – is a grave intrusion into our fundamental human rights. It should never become an acceptable response to the challenges we face, particularly not for a Conservative government.

Talk of “outlawing” religious services is no exaggeration. The Government is not simply asking Christians to stop attending church, or suggesting to Jewish people that they should stay away from synagogues, or encouraging Hindus and Sikhs to give up Diwali celebrations. It is forcing them to do this by using the law.

Of course, it’s not just faith groups who are affected by these restrictions. Daily life has become harder for almost every person in England and had consequences for people across the United Kingdom. Millions are worried about their jobs or businesses. There are a growing number of people in need as a result of this pandemic, and faith groups are often on the frontline in providing help.

People of faith are not asking for special treatment, but for religious services to be treated like other services deemed essential for health and wellbeing. It’s an important test of whether we understand the importance of faith to people’s lives and whether we’re prepared to reflect that in policy.

The new restrictions are significantly different to the full lockdown earlier in the year, in many ways for the better. More institutions are considered to be providing essential services, including schools and universities. A greater number of shops have been given essential status, including garden centres. And there will be far more essential journeys, with people encouraged to go to work if they cannot work from home.

The decision to label more aspects of life as “essential” under the new restrictions may help to avoid the social and economic trauma of a full lockdown. But it has also led to the Government straying into difficult territory by determining what is and isn’t essential in our lives – something which is generally best left to people to decide.

Excluding religious services from this list sends a message to faith groups that collective worship is deemed unnecessary.

This was not helped by the Prime Minister failing to mention places of worship in his speech on October 31. People were left to check on the Government’s website to see how the new restrictions would impact their churches, synagogues, and mosques. For the millions of people for whom prayer and worship is the rhythm of their lives, this omission will have been noted.

It shows that once again the “religious literacy” of those making decisions needs to be improved. A good start would be giving more clout to the Faith Taskforce, which was set up by Robert Jenrick, the Communities Secretary, to advise on reopening places of worship after the last lockdown.

The ban on religious services is particularly frustrating given the lack of evidence for the decision. Are people really more at risk of catching the virus in a socially distanced church service than they are in a garden centre or lecture theatre? Or for that matter is a church used for praying more of a public health risk than a church used for worship?

When pushed for evidence on the spread of the virus in places of worship, Patrick Vallance, the Government’s Chief Scientific Adviser, told the Commons Science and Technology Committee: “I don’t think we have good data to answer that with any degree of certainty.”

Had any evidence existed, the response from faith leaders would have been very different. People of faith have shown they are just as prepared as anyone to make sacrifices in the national interest. Closing places of worship was accepted earlier this year, while energy was focused on maintaining the services they run – such as food banks and bereavement support groups. Given the lack of evidence for the current ban, faith leaders have every right to complain.

Controlling the second wave of the virus was perhaps always going to be harder than the first. If there’s one thing worse than not having evidence, it’s being faced with a huge body of evidence and needing to make tough decisions.

Increasingly it seems that policy priorities are shaping the Government’s response to the pandemic, just as much as science and evidence. This is not necessarily a bad thing, but it means we need to get our priorities right. Policies that allow people to go to a garden centre on a Sunday morning, but not church, suggests that a rethink is required.

Over the next few weeks, difficult decisions will need to be made once again about the way out of lockdown. Above all, this will be a test of what we value. The Government should listen to our country’s faith leaders who have called for places of worship to reopen fully in light of their essential nature.

Banning religious services must not become part of the “new normal.”

Vaccine optimism has gripped the nation. But the Government’s reliance on it will fade away.

22 Oct

In recent months, there has been huge enthusiasm over the possibility of a Covid-19 vaccine. I know because I have experienced it myself, dreaming of the day I roll my sleeve up in the GP surgery; small pain, big gain, I might whisper to myself. Everyone wants a way out of this nightmare, and with every Government announcement of investment for vaccine studies, it was easy to get carried away – that this was the way out.

Over the weekend, the prospect of a vaccine became all the more palpable when The Mail on Sunday released photographs from inside US pharmaceutical company Pfizer’s Belgian factory, in which thousands of doses were whisked through the production line. That same day, The Sunday Times reported that Jonathan Van-Tam, one of the Government’s chief scientific advisors, has said that one version, manufactured by AstraZeneca, could be ready as early as December.

But why all the excitement? For shortly afterwards Patrick Vallance, the Government’s Chief Scientific Adviser, delivered a crushing blow to the vaccine dream, telling those on the joint committee on National Security Strategy that the “notion of eliminating Covid is not right”. He added that the disease would “start to look like annual flu more than anything else and that may be the direction we end up going.”

Vallance’s words should remind us that while the Government initially placed a lot of political hope in a vaccine, ministers are actually moving in a different direction now – to a new testing programme entirely. As Paul Goodman wrote for ConservativeHome on Monday, this would involve rapid “lateral-flow” tests, which render a tracing programme obsolete, as well as the Government using LAMP tests – concentrated on testing asymptomatic NHS staff.

This is a sensible direction – for all the excitement around vaccines, the truth is that they’re just as likely to have major hiccups as test and trace. That much is obvious from both medical and political perspectives.

On the first front, what’s obvious is that it’s incredibly hard to completely vaccinate against a virus. Indeed, smallpox is the only disease that has ever been completely eradicated by a vaccine. Kate Bingham, the chairman of the UK Vaccine Taskforce, has said that a Coronavirus vaccine would probably have the same success rate as the flu jab (50 per cent). But even that could be optimistic. SARS and MERS come from the same Coronavirus family, and do not have vaccines (though there are candidates being developed for MERS).

Optimists will point out that the World Health Organisation is currently tracking 196 studies into Covid-19, which is a fantastic number. Even so, an expert in medical innovation tells me it’s quite hard to make predictions about which will be a success – because of the ways vaccines are created. They tell me that “the vast majority of majority of new drugs and vaccines that are developed fail. It’s not like a construction project, where you know it’s possible to build the building, but you can run into unforeseen issues.”

“It’s more like you don’t know if you’re taking the right approach to constructing the building in the first place, and it may never get built. There are multiple approaches to vaccine development and it’s not clear yet which may or may not succeed.”

If we do get a vaccine, the next big hurdle is making sure it passes rigorous safety assessments that could add a lot more time onto the process. It can be expected that some governments will try to bypass important regulatory processes (the Chinese government has allowed citizens to get a vaccine that hasn’t completed clinical trials, with people queueing up for it).

And then there’s the next question of who gets the vaccine. This is already causing a political headache, especially when (aforementioned) Bingham said that only 30 million of the 67 million people who live in Britain woud get a vaccine. Already MPs are getting ready for warfare; in the House of Commons yesterday, James Grundy, the Conservative MP for Leigh, asked the Government to prioritise areas which have lived with restrictions longest when and if the vaccine comes.

This is far too premature a question, incidentally; there is no vaccine, and when it arrives there’ll be a global response to who gets it (i.e. the UK will have to share it out with other countries). Yet Grundy’s words demonstrate some heated arguments to come – that the Government will no doubt want to avoid with its new testing strategy.

So it is no wonder that the Government is moving away from its initial idea. Ben Spencer, the Conservative MP for Runnymede and Weybridge and previously a psychiatrist, has recently written about the need for Plan B in the UK’s management of Covid-19. He tells me: “I really hope we are successful in inventing a vaccine that helps and saves lives, but we have to make plans on the basis that there won’t be one, or at least one which isn’t a game changer.”

“Although it’s difficult picking apart the figures for flu alone, it’s worth remembering that in 2019, 26,000 people died from influenza and pneumonia, despite having an effective vaccination programme in place for the flu in the UK.”

It seems that the need for another plan is what the Government has sensed, and that’s why it has gone for a new strategy, having had to navigate such difficult areas. It’s clear that the vaccine isn’t the silver bullet many of us imagined. The quickest way the Government can avoid the horrible political scramble that is about to emerge is spurring on its new programme. The pressure is on…

Dying by numbers

24 Sep

Covid-19 can cast a “long shadow”.  Its aftermath effects include “fatigue, a racing heartbeat, shortness of breath, achy joints, foggy thinking, a persistent loss of sense of smell, and damage to the heart, lungs, kidneys, and brain”.

One study suggests that the proportion of those who first catch the virus and then develop such persistent symptoms is about 15 per cent.  But there’s still much we don’t know about it and evidence is hard to come by.  Nonetheless, it is clearly wrong to claim that the Coronavirus is no worse than flu.

The long shadow effect is also a reminder that one doesn’t either get Covid-19 and end up in hospital, or else not get it at all.  However, the UK, like other countries, would not be responding to the virus with a mix of shutdowns, new laws, voluntary action and testing were the Coronavirus not a killer.

As this site explained yesterday, we believe that a choice between more mass lockdowns and a Swedish option would be the wrong one: the best policy to counter Covid-19 is mass testing.  But successful testing will inevitably be go hand in hand with social distancing and other preventative action.  And the scale, duration and sweep of all anti-virus measures will ultimately be shaped not by the long shadow, but by death numbers.

These are notoriously hard to calculate, both here and abroad.  The NHS in England has changed the way in which they are assessed at least twice: in April and August.  The daily figures “do not include deaths outside hospital, such as those in care homes”, and each daily release is always lagging, since “reporting in central figures can take up to several days”.

Furthermore, there is over-counting, because the figures include cases in which Covid-19 was mentioned on the death certificate, which doesn’t necessary mean that it was the main cause of the death, and under-counting, because the figures can’t catch every single case. Those that follow are therefore heavily caveated.

Two similar peaks are recorded as having being reached: 1,152 deaths on April 9 and 1,172 on April 20.  Were England to suffer, say, eleven hundred Covid deaths a day for a whole year, that would be some 369,600 deaths in all, plus more in the rest of the UK.

But nothing like that, of course, has actually happened.  Writing on ConservativeHome, Raghib Ali says that “we now have good evidence from death certificates that Covid-19 was the underlying cause of death in about 50,000 people”.  Still, that’s about 30,000 more than the 20,000 that Patrick Vallance said would be “a good outcome”.

Those recorded deaths began to fall in late April, and the last figure we can find, yesterday’s, was 37.  Since August 8, they have ranged from 55 to zero.  Those inclined to minimise the severity of Coronavirus will quote those low totals, while those disposed to maximise will quote Vallance’s figure, from his presentation earlier this week, of some 200 deaths a day by November – some 5,600 that month.  Or point out that it could be higher.

Replicated each day for a year, that would suggest about 67,000 deaths.  But that’s based on cases doubling every seven days, as at present – with no change.  Vallance himself conceded that such an assumption is “quite a big if” – which raises the question of whether he should therefore have raised it at all, or at least clearly put it in a more rounded context.

Which would include looking at what’s happening in two other European countries whose increase in numbers we seem to be following: France and Spain.  (As last spring, the figures suggest that the UK is treading in the footsteps of some other European countries.)

If 50,000 cases in mid-October were to be followed by 200 deaths a day by November (“the Vallance model”) 10,000 cases a day (“the French/Spanish model”) would be followed by 40 deaths a day.  If we play the same game of replicated that number each day for a year, we get 13,440 deaths.

That would be lower than annual flu death totals in England during recent years. Public Health England estimates that on average 17,000 people died from flu in England annually between 2014/15 and 2018/19.

But whether the number of deaths each day by November is 200, more than 200, or 40 (or fewer), there is no reason to believe that a rise from present levels would be sustained.

Ali says that “deaths should also be significantly lower due to the lower age profile of cases…better shielding of those at highest risk and possibly a lower viral load  due to social distancing and masks. We are also now much better at managing the disease with more effective treatments.”

Were we to follow Spain and France after all, and if test and trace doesn’t show clear signs of improvement, the mood on the Conservative backbenches is likely to shift away from Government policy, which is ultimately based on state-enforced lockdowns, and towards Sweden’s, and mass voluntary action.

We’re “hoping for the best, but planning for the worst”, says the PM, in one of the most optimistic conferences of recent

17 Jul

At today’s press conference, Johnson gave one of his most confident deliveries in recent weeks. As he laid out the next steps for the nation, he managed to be both cautious and hopeful in offering a vision of the future. 

The Prime Minister began by reeling off encouraging statistics about the country’s battle with the Coronavirus. “For three weeks now, the number of cases identified through testing each day has been below 1,000” he announced, adding that SAGE has calculated the R rate to be between 0.7 and 0.9, and that the number of infections was shrinking by five and one per cent every day.

What SAGE hasn’t been as encouraging about, however, is the Government’s plan to reopen workplaces. Yesterday Patrick Vallance, its chief scientific advisor, told MPs at the Commons science committee that there was “absolutely no reason” to change the guidance to stay at home. “A number of companies think it’s not detrimental to productivity and in that situation absolutely no reason I can see to change it”, were his words.

But today Johnson told businesses they have “discretion” over whether they want their employees to return from August 1 – and how they do this safely. Much of this demonstrates, as ConservativeHome has written before, that the Government has never been fully “guided by the science”. Indeed, when Vallance’s absence was remarked upon, the Prime Minister responded “in the end decisions are taken by elected politicians.”

August 1 will also mark the reopening of leisure settings, such as bowling, skating rinks and casinos, as well as allowing close contact services to resume, although nightclubs and soft play areas still need to stay shut.

The Prime Minister explained that some of the approach to Covid-19 has changed in line with new information about its epidemiology and “intelligence on where it is spreading”. Going forward in England, the NHS Test and Trace, alongside the Joint Biosecurity Centre, will be concentrating on “targeted, local action”.

Johnson highlighted that this approach had been used in Weston-Super-Mare and Kirklees, as well as in Bradford and Blackburn with Darwen. He added that restrictions in Leicester would soon be relaxed, based on the fact that “the percentage of people testing positive” fell “from a weekly rate of 12.2 per cent on 29 June to 4.8 per cent yesterday.”

He assured people that he understood that local measures would be “hard going”, but that “there is no point shutting down a city in one part of the country to contain an outbreak in another part of the country.” 

It reinforces Johnson’s point about the Government’s strategy shifting with new data. Some will remember that on April 29, Matt Hancock told reporters: “We did think about moving with London and the Midlands first because they were the more advanced in terms of number of cases, but we decided that we are really in this together”. But all that has changed drastically.

Overall Johnson’s speech emphasised a transition of power from central Government to other bodies – namely, businesses and local councils. From tomorrow the latter will be able to “close specific premises, shut public outdoor spaces, and cancel events” at their will, in the hope that this will speed up how quickly Coronavirus is identified and isolated.

While the Government and scientific bodies will get little credit for this, they have clearly gone to enormous lengths to step up preparedness in case of further Coronavirus outbreaks, particularly a dreaded second wave in winter. Data suggest the country is now carrying out more antigen tests (to identify if someone currently has the virus) than anywhere else in Europe.

Furthermore, it has set up 200 mobile units for testing around the country, hugely increased ventilators (from 9,000 to nearly 30,000) and is rolling out the biggest flu vaccination programme in the history of the NHS, on top of an additional £3 billion of funding for the NHS.

From ConservativeHome’s perspective, this was one of the most reassuring press conferences from the Prime Minister, showing intense preparations that have been going on behind the scenes, while emphasising one of Johnson’s main strengths: optimism.