Since records began in 1953, more than 250 people have died trying to climb Mount Everest. The vast majority lost their lives not on the hard, upward ascent, but on the descent. Having relished the glory of the mountain’s peak, they succumb to the cold or to the altitude on the way down.
News that the UK has authorised a Covid-19 vaccine means we are now in the descent of the pandemic – and as with Everest, that descent is littered with dangers.
Key among them will be the need for a successful distribution of the vaccine. A vaccine has always been our most likely route out of the Covid-19 crisis, but that doesn’t make it an easy one. The vaccine will only work if there is high and equitable access across the country. As such, it was future difficulty, not unbridled optimism, that the Prime Minister was keen to stress in his December 2nd statement:
As we celebrate this scientific achievement, we [must not be] carried away with over-optimism. Or fall into the naïve believe that the struggle is over. It’s not.
He’s right to be worried. The successful delivery and distribution of the vaccine will rely on the three things his government have struggled with during this pandemic.
1. Effective Health Information
Much has been written about the threat anti-vaxxers pose to the distribution of the virus, but they’re actually something of a red herring. Earlier this year, the Institute for Public Policy Research (IPPR) ran a survey of people’s views on vaccines. They found that while 6 percent of people are fully convinced that vaccines cause autism, a massive one third were ‘unsure’ about the link.
This implies that we’re not contending with a small group of militants, whose extreme views will do little to threaten herd immunity, but instead facing a scenario where most people have some scepticism about the vaccine and need to be convinced. That’s actually a trickier problem.
It means a much bigger number could opt out the vaccine, not just anti-vax die-hards. The same IPPR research showed that nearly half (48 percent) of all British people had either seen or been sent ‘fake news’ about Covid-19. For many, one piece of fake news could be decisive in whether they do get vaccinated.
A smart government would put out a significant public awareness campaign. It would focus on explaining what a vaccination is, and the balance of risks it involves. It would treat people with respect and empathy – as partners in the vaccination process, with understandable fears and doubts. And it would be consistent.
But the government struggled with good health information back in the spring. Health information campaigns on hand-hygiene and mask wearing both turned to farce; the former was undercut when the Prime Minister declared he had been shaking hands with people in a hospital that may have had Covid patients, and the latter when Cabinet Minister Michael Gove visited a Pret-a-Manger in Westminster just days after saying he believed people should wear masks in poorly ventilated indoor areas. This time round, they must do significantly better.
2. Protecting the Most Vulnerable
The government has realised that the vaccine must be used to protect the vulnerable first and foremost. Recently released lists of priority groups have put NHS workers, the clinically vulnerable and older people at the top.
But there’s something missing: frontline roles, age and health status are not the only Covid risk factors. The virus has thrived on class and race-based inequalities. People in the poorest parts of the country have been twice as likely to lose their lives, and if the white population had faced the same risk as black communities during the first wave, 58,000 more people would have died.
Research has also indicated that people from minority ethnic groups are less likely to be willing to accept a Covid-19 vaccine – sometimes up to 2.7 times less likely. But that shouldn’t come as a surprise. Evidence has long shown that people who are less well served by institutions are less likely to trust them.
It does, however, present a risk. If the government is not able to adequately target its strategies, we could see Covid-19 continue to drive significant health injustices. It could continue to thrive in some places and communities, even as we get a grip on it in affluent, white areas.
3. Effective Logistics and Distribution
It can’t be understated how difficult this vaccine is to store and distribute. It needs to be kept at between minus seventy and minus eighty degrees, otherwise it begins to degrade. That means it will probably need to be transported to health settings on dry ice, and then stored with very specialist equipment. Once thawed, the virus will be viable for just five days.
The UK is lucky enough to have forty million doses, enough to immunise twenty million people. But a massive and efficient distribution chain will be needed to a) get the vaccinations to the right place, b) get the right people to the right place, and c) administer the two doses needed.
It’s an operation that will resemble track and trace. There, we needed to get tests to the right place, get people to the right place, and then trace the people who had been in contact with those who tested positive.
And in that case, we failed. Spectacularly. Many people were asked to travel hundreds of miles, tests needed to be sent abroad for processing, and outsourced contact tracers delivered deeply disappointing results.
In order to avoid repeating history, it’s crucial the government learn two lessons. First, the Prime Minister must abandon his idea ‘that there comes a moment when the state must stand back and let the private sector get on with it’ – as he said at this year’s Tory conference. Vaccine logistics must not be outsourced.
Second, he must not act exclusively through central diktat. Local public health teams and NHS trusts have been amazing through this pandemic: they know their local populations, and they should have the power to make key decisions.
Beyond the Vaccine
Even if we get the vaccine in place, spring will not be ‘back to normal’. The vaccine is just a first step in the Covid fightback. The health of the nation will remain under threat for a long time yet.
After the jabs will come a massive health and care backlog. Millions of cancer screenings, tests and treatments were delayed in 2020. People going to A&E for heart attack symptoms halved. Electives were cancelled. People in lockdown saw their mental health deteriorate. The vaccine will release a flood of health need.
Without action, it’s unlikely our NHS can cope with the added demand. Compared to the rest of Europe, we have a low number of beds, a disastrously stretched workforce, and less effective tech. It’s entirely predictable that this will cause big problems from spring 2021 onwards, unless the government acts now. We need more capacity, a concerted effort to do better for health and care workers, and a plan for the backlog.
The vaccine is good news – but we can’t risk mistaking it for a silver bullet. Rather, it’s the beginning of the long and dangerous descent from the steep Covid peak.