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The healthcare industry: did it move quick enough?

Tuesday 1 December 2020


The UK was one of the world’s best-prepared countries to deal with a pandemic, second only the USA, according to an October 2019 international review of pandemic planning. Covid put this theory to the test, and the evidence suggests the UK underperformed on almost every count.

But there is hope: three vaccines, including one developed in the UK by Oxford University and AstraZeneca, have proved in at least some doses over 90 per cent effective in stage three trials. How has the healthcare industry performed in this effort? What will vaccine rollout look like in the UK? How much should we fear vaccine refuseniks and what should be done to limit their influence?


Behind the breakthrough

The world breathed a collective sigh of relief when it was announced on 9 November that Pfizer and BioNTech’s vaccine was highly effective. The following day Moderna said its own vaccine was 95 per cent effective; AstraZeneca’s announcement came a week later. But how does its vaccine compare with the others?

  • Developing a vaccine usually takes a decade; these three were produced in just 10 months.
  • The Oxford University/ AstraZeneca vaccine is 62 per cent effective when administered in two doses, but apparently up to 90 per cent effective if administered as a half dose followed by a second dose three weeks later. 
  • Rather than relying on patients to self-report their symptoms, as Pfizer/BioNTech did, the AstraZeneca trials also checked participants for asymptomatic infections – which are often the most infectious. This means that the results may appear less promising, but they are likely to be more accurate.

Is there anything to fear?

The Oxford trials were twice halted because of two study participants who became seriously ill. The details of these side-effects were never released. AstraZeneca insists the vaccine was “well tolerated”.

AstraZeneca has also been criticised for a lack of transparency about its data. Following the announcement that a half-dose, followed by a full dose, of the vaccine yields 90 per cent efficacy, the company announced it had made this discovery due to a “serendipitous” error in dosage. It is unclear why an initial half dose works better than a full dose. AstraZeneca also tested the half-dose on a smaller group of people – 2,800 compared with 8,900 – and did not provide age breakdowns of those participants, so it is unclear whether this will yield similar results in vulnerable patients, including over-55s.

If time were not of the essence, this would be the moment to iron out these questions.


What happens next?

The Oxford/AstraZeneca is expected to be approved imminently for use in the UK by the Medicines and Healthcare products Regulatory Agency. 

The Department of Health and Social Care then has responsibility for rolling out the vaccine to the public. Much of the operational work will fall to the NHS, although in England the army has been enlisted to help. 

The government has already agreed a £50m contract with CP Pharmaceuticals in Wrexham, north Wales, to make several million doses of the Oxford/AstraZeneca vaccine over the next 18 months, though the exact number is unknown. It is known, however, that firm is behind schedule. The original goal was to have 30 million doses ready for use in the UK by the end of September; it is now on track for 4 million by the end of the year. (Thirty million doses will be available, but it will take time to transfer these into vials).

“We don’t know if we’ll be getting coronavirus jabs yet, but we have had two weeks of promising news…so we are preparing the roll-out.”

Matt Hancock, 20 November 

Dry runs of the rollout are already being staged in Wrexham. The NHS is meanwhile assessing potential vaccination centres across the UK – including sporting facilities and hospitals – that may be able to safely store vaccines that need extreme refrigeration, such as Pfizer’s.

The NHS has been instructed to prepare for mass vaccination from 1 December, with plans to dispense 1,000 doses a week at each of 1,500 GP practices and drive-through centres. It is understood that retired doctors, medical and nursing students will be called in to help with the rollout. Hundreds of other doctors may also be seconded to the vaccination programme. Some fear this will slow down crucial work in the NHS; the government says it is justified by the fact that the vaccine could be a life-saving end to the pandemic.

How does the Oxford/ AstraZeneca vaccine work?

Unlike Pfizer and Moderna’s vaccines, the UK’s does not inject part of the virus’s genetic code into patients. Instead, scientists have attached the same spike protein that lives on the surface of the coronavirus to a harmless version of a common cold virus found in chimpanzees. 

The body produces antibodies to fight off the spike protein, and these provide a defence against the virus.


Who will be prioritised?

The provisional plan would see 88.5 million vaccination doses delivered across England, with two doses for every person over 18, by the end of April. The priority list is currently as follows:

  • Early December: healthcare workers, care home residents and staff
  • Mid December: ages 80+
  • Late December: ages 70-80
  • Early January: ages 65-70, all high- and moderate-risk under 65s
  • Mid January: ages 50-65
  • From late January: ages 18-50, with the bulk of this group vaccinated in March

Vaccine scepticism

Alongside the logistical challenges posed by distributing the vaccine, there is another concern brewing – that not enough people will take it for it to be effective. From vaccine sceptics, who distrust the vaccine because of the speed at which it has been produced, to full-blown conspiracy theorists who believe that vaccines contain government-led microchips, there’s a lot of fake news flying around. Preliminary research has shown that misinformation could drive down vaccine uptake by as much as 6.4 per cent.

However, a major study by the Lancet found that vaccine confidence in the UK is on the rise: up from 47 per cent in May 2018 to 52 last November. A recent Ipsos poll was even more promising, suggesting that 85 per cent of Britons would get a Covid vaccine should it become available.

Studies suggest that anywhere from 55 to 80 per cent of the population would need to be vaccinated in order to achieve herd immunity. The exact figure depends on the efficacy of the vaccine – and all three have exceeded expectations.


Further reading