The vaccine is an incredible scientific achievement. But some of the political decision-making behind its rollout is rather less impressive.
[Boris Johnson: We are still in the tunnel of this pandemic. The light, however, is not merely visible but, thanks to an extraordinary feat of British engineering, if you like, the tunnel has been shortened, or we are moving faster through it. And that gives me great confidence about the future in the spring.]
30 December 2020, and an end-of-year press conference in Downing Street at which Boris Johnson promises that the end of the pandemic is, at last, in sight.
‚ÄúWhat, again?‚ÄĚ you might‚Äôve said‚Ä¶ and with good reason. We‚Äôd heard it all before.¬†
[Clip montage: Johnson and Cabinet ministers making assertions throughout 2020 about life going back to normal.]
But this press conference was different, for very important reasons.
I‚Äôm Matt d‚ÄôAncona and for the last few months I‚Äôve been looking into the government‚Äôs vaccination strategy, and the prospects of a promised roll-out before the spring of 2021. It‚Äôs been a bumpy ride‚Ä¶¬†
In search of the full story, I‚Äôve spoken to more than 20 sources ‚Äď ministers, government advisers, senior figures in the pharmaceutical sector, scientists and health professionals.
It‚Äôs a story that oscillates between genius and misadventure; tensions between pharmaceutical giants and nervous ministers; and the tantalising prospect of escape from the Covid prison, threatened by foot-dragging, logistical failure and this government‚Äôs fatal tendency to over-promise and under-deliver.
The story brings together one of the great scientific achievements of modern times ‚Äď the warp-speed development of a successful vaccine ‚Äď with a litany of mishap, bad planning and straightforward incompetence in Whitehall and Westminster.¬†
It‚Äôs a tale of British exceptionalism at its best and worst. Of scientific brilliance unleashed, versus the weaknesses of British manufacturing, supply chains and logistics in a sometimes dangerous brew with post-Brexit jingoism and self-congratulation.
It‚Äôs a back-and-forth, twisty tale, with flashbacks, subplots, and cliffhangers. But at its heart is a question that couldn‚Äôt be simpler: as one Cabinet minister put it to me, ‚ÄúWill the bloody thing work? And work in time?‚ÄĚ
So back we go to that all-important 30 December press conference. What made that day so significant?¬†
First, the government was now ready to concede fully that the new, more transmissible variant of the virus was having a disastrous impact.¬†
[Jonathan Van-Tam: The percentage testing positive with the new variant is increasing at really a very substantial rate indeed.]
Jonathan Van-Tam, the deputy chief medical officer. As a result, most of the country was moved into Tier 4, the level of restriction just below full lockdown.
[Johnson: First, we will introduce new restrictions in the most affected areas, specifically those parts of London, the South East, and the East of England which are currently in Tier 3. These areas will enter a new Tier 4, which will be broadly equivalent to the national restrictions which were in place in England in November.]
On the upside, the government had been cut two breaks that very day. At a speed that surprised even some senior ministers, the Medicines and Healthcare products Regulatory Agency ‚Äď or MHRA ‚Äď had given full approval to the Oxford-AstraZeneca vaccine.
[Clip: BBC News on the MHRA approval.]
Meanwhile, in a quite different form of approval, Boris Johnson‚Äôs trade deal with the European Union was rubber-stamped by Parliament even more speedily.¬†
Did this mean the end of the Brexit headache? Of course not. But it released a lot of political bandwidth so the prime minister could focus his energies on the pandemic, and work hand in glove with Matt Hancock, the health secretary, Alok Sharma, the business secretary, and Nadim Zahawi, the minister in charge of vaccine rollout.
From 30 December, the path was clear for the PM‚Äôs announcement, in a public statement five days later, of a full national lockdown, combined with robust promises about the delivery of the vaccination.
[Johnson: In England, we must therefore go into a national lockdown which is tough enough to contain this variant.]
There‚Äôs the stick.
[Johnson: By the middle of February, if things go well, and with a fair wind in our sails, we expect to have offered the first vaccine dose to everyone in the four top priority groups identified by the Joint Committee on Vaccination and Immunisation.]
And there‚Äôs the carrot.¬†
Though testing and tracing will still be needed, and probably for a long time to come, the PM is no longer primarily preoccupied by that particular fiasco.¬†
Instead, the success of his vaccine strategy has now become the government‚Äôs holy grail. If you look at the grail as being half-full, the fact that people are already being vaccinated in their thousands every day is already a national triumph.
If you see the grail as half-empty, on the other hand, the PM has recklessly bet all his political chips on the success of the vaccine plan as the means to get the UK out of its pandemic prison, bring down the death toll and surging infection rate, and get the economy running again.¬†
Everything, in other words, depends on a single pillar of public health policy ‚Äď and I do mean everything.
Let‚Äôs scroll back to January 2020 and ‚Äď however grumpy we may all feel right now in lockdown ‚Äď give a bit of credit where it‚Äôs due.¬†
Matt Hancock, the health secretary, has taken his fair share of criticism during the crisis. But he was quick off the blocks in acknowledging the need for a vaccine; a month before the virus even acquired its official name, Covid-19, and two months before the World Health Organisation declared a pandemic.
Last January, Number 10 believed that, if the virus spread in the UK, test and trace would be the solution. But as soon as the genetic sequence of the still-unnamed virus was published online, Matt Hancock began reaching out to government advisers, outside scientists and pharmaceutical companies in search of guidance and data about immunisation.¬†
He also believed ‚Äď as did Alok Sharma ‚Äď that the vaccine race would stand a better chance of success if it wasn‚Äôt the subject of a daily running commentary at Number 10 press conferences.
Reasonably regular updates would, of course, be necessary. The world would want to know what progress was being made. But ‚Äď in contrast to test and trace ‚Äď the health secretary wanted a measure of privacy, to give the scientists the space they needed.
As it happens, an Oxford-based team of researchers was moving even faster than Matt Hancock.¬†
Here‚Äôs Teresa Lambe, associate professor at the university‚Äôs Jenner Institute, on BBC‚Äôs Panorama, describing the weekend when she cracked the vaccine code:
[Teresa Lambe: The information that we needed to design the vaccine arrived in my inbox the early Saturday morning. The ping woke me up, I still remember. It was the genetic coding sequence for the virus. And when we had that information, a tiny bit from the sequence for the coronavirus‚Ä¶ and used that to put into our platform vaccine technology. And then I worked on it over the weekend.
Interviewer: So were you working remotely? Or were you in the lab?
Lambe: I‚Äôm afraid it wasn‚Äôt quite as glamorous as that. It was pyjama-wearing, in my bedroom, over a computer, trying to get this done with my colleagues.]
In layman‚Äôs terms, the Oxford vaccine introduces to the body a virus that causes the common cold in chimpanzees, engineered so that it can‚Äôt harm us. It‚Äôs further modified to produce so-called spike proteins which, in turn, stimulate the growth of antibodies and T cells that protect people from coronavirus.
Extraordinarily, the whole vaccine was ready ‚Äď at least in coded form ‚Äď within 48 hours. The detail would take weeks to finesse. But the main sleuthing was already complete by 13 January 2020.¬†
To say that such a huge scientific achievement was the easy part would be quite unfair. But it is true that the hard yards of the process that would get the vaccine into people‚Äôs arms had only just begun.
First, there was the process of clinical trials; conducted, again, as quickly as the Oxford team could manufacture the vaccine and give the prototype to volunteers. This was done in a double-blind procedure, where both doctor and patient had no idea whether they were giving or getting the real thing.¬†
[Elisa Granato: I‚Äôm a scientist, so of course I want to try and support science, scientific process, whenever I can. And, since I don‚Äôt study viruses, I felt a bit useless these days, so I thought this is a very easy way for me to support the cause.]
That‚Äôs Dr Elisa Granato, an Oxford microbiologist who was the first volunteer in the trials, on 23 April.
In a perfect parable of the challenges facing vaccine teams around the world, it was soon reported on social media that Dr Granato had died as a result ‚Äď a downright lie, fired off by anti-vaxxers to discredit the research¬†
[Elisa Granato: I‚Äôm very much alive, thank you! I‚Äôm having a cup of tea. It‚Äôs Sunday, 26 April, three days after my birthday and three days after I got the vaccine or the control ‚Äď we don‚Äôt know ‚Äď and I‚Äôm having a nice Sunday. And I hope everyone else in the world has, too.]
Even as the trials continued, Matt Hancock sought to get the Oxford team to the altar with a pharmaceutical manufacturing partner that would produce to scale and deliver 100 million doses to the UK.¬†
In this, he was greatly assisted by the university‚Äôs regius professor of medicine, Sir John Bell ‚Äď a charismatic, can-do character who was, in the description of one government adviser, ‚Äúamphibious‚ÄĚ in his ability to negotiate the worlds of Whitehall, academia and business.
In which context: Oxford‚Äôs usual collaborator in such cases was the US pharmaceutical giant Merck & Co. A deal for the coronavirus vaccine was almost struck between university and the corporation.¬†
But ‚Äď in a twist that hasn‚Äôt been reported before ‚Äď Merck would not make a legally binding undertaking to deliver the 100 million doses the government wanted.
So: exit Merck. Enter AstraZeneca
The company was less established as a vaccine technology company than its main competitors in the global corona-race, Pfizer and Moderna. But ‚Äď crucially ‚Äď it was ready to guarantee 100 million doses to the UK upfront and to operate on a non-profit basis for the duration of the pandemic.
On 17 May, Alok Sharma announced this formal betrothal of university and corporation:
[Alok Sharma: I can also confirm that, with government support, Oxford University has finalised a global licensing agreement with AstraZeneca for the commercialisation and manufacturing of the Oxford vaccine.]
As one senior government source puts it: ‚ÄúWere we nervous about AstraZeneca? Yes is the short answer. But the deal was too good to turn down. And, by May, we‚Äôd seen the full force of the first wave ‚Äď 1,000 deaths a day. In meetings, the necessity for a vaccine, and particularly a British one, was starting to be fixation for Boris and for Number 10. The pressure was really piling on now.‚ÄĚ End quote.
On 20 July, the Oxford team was ready to disclose its initial test results:
[Huw Edwards on BBC News: A team of scientists at Oxford University say they‚Äôve reached a really important milestone in their work to develop a vaccine for coronavirus. They say that the vaccine they‚Äôre developing appears to be safe and triggers and immune response, based on early trials involving more than 1,000 people. The government has already ordered 100 million doses of the vaccine.]
But there was still a bumpy road ahead. On 6 September, the AstraZeneca trials around the world were suddenly halted after a participant developed a neurological condition.
It later emerged, remarkably, that the company had withheld this information from the US regulator, the Food and Drug Administration, in a discussion about the vaccine‚Äôs path to approval in the American healthcare system. This discussion was just two days after the emergency brake had been pulled on the trials.
In Whitehall, this looked like the makings of a disaster. ‚ÄúWe all held our breath,‚ÄĚ says one ministerial source. ‚ÄúThis was September and infection rates were already starting to increase again into what became the second wave and then the present shitshow. We needed the Oxford virus to be okay. Badly.‚ÄĚ¬†
As it happens, AstraZeneca‚Äôs CEO, Pascal Soriot ‚Äď in conversation with Tortoise‚Äôs co-founder and editor, James Harding ‚Äď then announced that his company was still on course for rollout in early 2021. This was at Tortoise‚Äôs Global Leadership Summit on 10 September, four days after the trials had been halted.¬†
[Pascal Soriot: I still think we are on track for having a set of data that we would submit before the end of the year. And then, of course, after this, it depends on how fast the regulator will review and give approval. So we could still have a vaccine by the end of this year, maybe early next year, but by the end of this year is still visible. And by the way, there are two other vaccines that are actually moving very quickly. One is developed by Pfizer and the other one by Moderna in the US. Those are mRNA vaccines and they are also advancing quite quickly.
James Harding: So you think that it‚Äôs it‚Äôs feasible for people to, if not expect, at least hope for the distribution of the vaccine in the first half of 2021?
Soriot: I think so, yes.]
That disclosure made news around the world. The Oxford vaccine was back in business.
But, even then, nothing was straightforward. On 23 November, the vaccine was declared to have demonstrated efficacy ‚Äď a huge moment in the product‚Äôs development.
[AstraZeneca spokesperson: We‚Äôre very pleased with this result because it means that we can go forward and apply for regulatory approval, and get the vaccine out there and widely used.]
Hold on, though. It then turned out that the dosages in the trials had been of varying sizes. Many participants had been given only half a dose in one of their two jabs.¬†
Confusingly, those who had received, in total, only one and a half doses were shown to have 90 per cent resistance to the virus, while those who had been given two full doses scored only 60 per cent.¬†
‚ÄúThis was a confusion we bloody well didn‚Äôt need,‚ÄĚ says one minister. ‚ÄúNever mind explaining it to the public. Imagine explaining it to Boris. He hates complex messages that aren‚Äôt straightforwardly optimistic. And this was a difficult one to explain, right in the middle of the second wave as hospitals started to really struggle and the tiering system was causing us all sorts of problems.‚ÄĚ End quote.
All the same: production of the vaccine went full speed ahead, awaiting the regulator‚Äôs approval. Would AstraZeneca achieve its target of 30 million doses for the UK by the end of the year?
This is where, so to speak, the rubber stopper of the vaccine vial would hit the production line of reality.
No crisis, of course, is complete without a tsar, or a task force, or both ‚Äď and Boris Johnson has always loved appointing them.
On 17 April, the PM announced the formation of the Vaccine Task Force under Kate Bingham, a successful venture capital manager with deep knowledge of biotech investment.
Her mission was to join the dots between the UK‚Äôs research infrastructure and its manufacturing base ‚Äď to think strategically about the nation‚Äôs resilience in this respect. And, as the highest priority, to scale up the manufacturing of the vaccines for use as soon as possible.
Bingham ‚Äď who‚Äôs now reached the end of her secondment to the new task force ‚Äď had focused on procurement, as Matt Hancock reported to the Commons on 2 December.
[Matt Hancock: Thanks to the incredible work of the Vaccine Taskforce, the business secretary and Kate Bingham, we have already amassed a huge portfolio of different vaccine candidates. We have backed seven vaccines and ordered 357 million doses on behalf of the whole UK, one of the biggest portfolios per capita in the world. We have said from the start that a vaccine must be safe and effective before we would even consider deploying it.]
The health secretary was able to tell MPs that the Pfizer vaccine had been approved by the MHRA ‚Äď the first coronavirus jab to be approved anywhere in the world.¬†
The problem with the Pfizer jab was and is logistical: it must be stored and transported at 70 degrees below zero, a massive challenge for the NHS and every vaccination site across the land.
Still: the regulator‚Äôs approval was a momentous development. Six days later, in Coventry, 90-year-old Margaret Keenan became the first person on earth to receive the vaccine outside clinical trials.
[Clip: Margaret Keenan receives the jab.]
For Matt Hancock, interviewed on ITV‚Äôs Good Morning Britain, it was an emotional spectacle.
[Hancock: Well, it‚Äôs been such a tough year for so many people. And there‚Äôs William Shakespeare, putting it simply for everyone, that we can get on with out lives. There‚Äôs still a few months to go. I‚Äôve got this worry: we can‚Äôt blow it now, Piers. We‚Äôve still got to get the vaccine to millions of people. And so we got to keep sticking by the rules. But there‚Äôs so much work that‚Äôs gone into this‚Ä¶ it makes you proud to be British.]
But the question for Kate Bingham was whether these moments of national melodrama could be turned into a workable, consistent national strategy.
Though she‚Äôs married to Jesse Norman, the Treasury minister, those who worked with her describe a competent and clever businesswoman who was nonetheless something of a political novice ‚Äď unprepared for the attacks that quickly came her way.
On 1 November, the Sunday Times reported that Kate Bingham had shared a list of companies the government was considering for vaccine provision during a webinar for women in private equity.¬†
She was accused of a conflict of interests and even, spuriously, of insider dealing ‚Äď allegations she strongly denied. The media storm passed quickly, but Kate Bingham was badly shaken by the episode.
As one friend puts it: ‚ÄúKate was literally speechless and tearful about being accused, basically, of corruption. She had just never thought at any stage of her life that she would be linked to personal immorality.‚ÄĚ
A rough welcome to the political-media jungle, no doubt. But ‚Äď leaving this episode aside ‚Äď what mattered to Kate Bingham, who reported directly to the prime minister, was delivery, delivery, delivery.
And herein lay the problem. At a joint session of the Commons Health and Social Care and Science and Technology Committees on 4 November, Greg Clark ‚Äď chair of the latter committee ‚Äď asked whether the government would be able to keep its promises.
[Greg Clark: The day after your appointment, the Government announced that they had signed an agreement between Oxford University and AstraZeneca to make up to 30 million doses available by September for the UK. Has that been accomplished?
Kate Bingham: No. So, that 30 million doses was assuming a linear yield on scale-up. When you manufacture these vaccines, you basically start at test tube levels, then you scale up sequentially, and ultimately get to 1,000- or 2,000-litre scales. The projections that were made in good faith at the time, to get to 30 million doses in September, was assuming that absolutely everything would work and that there would be no hiccups at all in terms of how you scale up from micro-litre scales to 1,000- or 2,000-litre scales. And it hasn‚Äôt gone linearly. And it‚Äôs not through lack of care and attention, or availability of equipment, or anything like that. It is just that this normally takes a very long time. So the answer is no, but it is now at the 1,000-litre scale, and that is working. I am quite sure that we have the process which is now there, but we are growing live cells and it is not a straightforward activity. I have to say, the skills in the UK in advanced manufacturing are world-class. It is challenging.]
Greg Clark pressed his witness on what could be achieved:
[Clark: Four million by the end of the year?
Bingham: Yes. It then increases. Because having got to that scale, you can then run it quickly, but the challenge is to get to the 1,000-litre scale. Trying to vaccinate millions of adults in this pandemic, again, is a heroic achievement. It has not been done at this scale before.]
Next, Jeremy Hunt, chair of the health select committee, challenged Kate Bingham to play Mystic Meg on the likely success of the whole strategy.
[Jeremy Hunt: You have more than 50 per cent confidence that we will, by the early summer, have a vaccine that we can give to all vulnerable people. I appreciate that you are being optimistic, but I want to get a sense of what you actually believe, with the caveat that you are a natural optimist. You think that we could be in a situation by Easter or early summer where all the vulnerable people in the country have got a vaccine that will have some impact on reducing the dangers of coronavirus.¬†
Bingham: That is my view, yes. 50 per cent.]
Why would Kate Bingham, even as she declared herself an optimist, not go further?¬†
The answer, according to sources close to her, is that her optimism was tempered by realism born of what she had discovered on her travels through Britain‚Äôs science infrastructure and manufacturing base.
First, by November, she fully understood the difference between procurement and delivery.
To take one example that may seem basic but is capable of holding up the entire supply chain, there was a particular fragility related to the process of putting the vaccine into the tubular glass vials it‚Äôs then shipped out in.¬†
In AstraZeneca‚Äôs case, this takes place at a plant in Wrexham in Wales, owned by a separate company, Wockhardt.
And guess what? Most of this special-purpose glass ‚Äď borosilicate and other varieties ‚Äď is made in China. And there‚Äôs already a shortage of supply that will get worse before it gets better.¬†
Here, Kate Bingham tried to warn the committees of this banal but fundamental vulnerability:¬†
[Bingham: But I can say that we have 150 million vial stoppers and over-seals, and we have the supply chains in place for future vials. So that we have gone back from saying, in the case of revaccinations, ‚ÄúHow many future vials do we need?‚ÄĚ to, ‚ÄúDo we have enough tubular glass to make‚Ä¶.‚ÄĚ]
Does the phrase ‚Äúfor want of a nail‚ÄĚ spring to mind?¬†
Imagine all the scientific brilliance that went into coding the vaccine, subjecting it to trials and manufacturing it by the vat-load‚Ä¶ only to discover that there aren‚Äôt always enough glass tubes to put it in.¬†
As one senior government adviser says: ‚ÄúIt‚Äôs a case of a factory that makes the best jam in¬† the world ‚Äď but forgets to secure a steady supply of jam jars.‚ÄĚ
And ‚Äď to return for a moment to that all-important press conference we started at, on 30 December ‚Äď here‚Äôs Jonathan Van-Tam making the same point as diplomatically as he can.
[Jonathan Van-Tam: There is an absolute ambition across the whole of the system that the only thing that is going to slow us down is batches of vaccine becoming available. Many of you know already that it is not just about vaccine manufacture; it is about fill and finish, which is a critically short resource across the globe, always has been for vaccines.]
And that‚Äôs not all. To add to the complexity of the supply chain: the Oxford vaccine needs to spend 20 days in sterilisation. Every single batch ‚Äď which can vary hugely in the number of vials it contains ‚Äď has to be given approval by the MHRA regulator before it‚Äôs sent out.
As one senior source on the operational side puts it: ‚ÄúIt took ministers quite a while to clock how delicate and complex the manufacturing process is; how hard it is to maintain quality control and just-in-time supply of the necessary kit. Now they‚Äôve got the message and it is naturally worrying them.‚ÄĚ
This manifests itself in defensiveness within Public Health England ‚Äď the English executive agency of the NHS ‚Äď about the roll-out strategy. And on the AstraZeneca side, there‚Äôs a growing suspicion that they‚Äôre being set up as the fall guy, should the strategy fail.
Here‚Äôs Pascal Soriot on the BBC‚Äôs Today programme on 30 December, promising that his company can keep up:
[Soriot: We are aligning our delivery schedule with the government.
But here‚Äôs a different emphasis, to say the least, from Matt Hancock, interviewed on the same programme on 4 January.
[Hancock: The rate-limiting step is the amount of supply‚Ä¶. That is a matter for AstraZeneca.]
In other words: if they make it, we will vaccinate people with it. But there‚Äôs growing caution and, in some cases, outright scepticism on the government side as to whether AstraZeneca can meet its targets. As one manufacturing source concedes: ‚ÄúIt only takes a nudge for the whole supply chain to break down.‚ÄĚ
There were meant to be 30 million doses ready to go by the end of 2020. Then four million. In reality, the total was 530,000 doses.¬†
It‚Äôs not hard to see why nerves are frayed all round. Or why senior figures at Astra Zeneca worry that ‚Äď if the government‚Äôs plans falter ‚Äď their company will get the blame.
We‚Äôll return to the blame game ‚Äď but before then, let‚Äôs assume, for the sake of argument, that the supply chain works and the vaccine is available to scale, steadily, and without interruption. Who‚Äôll get it first, and how?
The question of priority was discussed throughout the year by the Joint Committee on Vaccination and Immunisation, a seriously grand group of experts chaired by Professor Andrew Pollard of Oxford University, which advises government departments and agencies.
The JCVI‚Äôs manual is called the Green Book and enjoys almost scriptural status in the medical and scientific world.
In its discussions, formal and otherwise, between May and December, the committee agonised over who, precisely, should be targeted in the crucial first phase.
The top four groups were not hard to identify. In order:
- People in residential care homes and their carers.
- Those over 80 years of age and frontline health and social workers.
- People over 75.
- And those over 70, plus those with serious clinical vulnerability.
After these top four priority groups, the nation is segmented downwards by age and vulnerability until we reach category 10 ‚Äď described as ‚Äúrest of the population,‚ÄĚ with the unsettlingly vague words ‚Äúto be determined,‚ÄĚ added in brackets.
Safe to say that if you‚Äôre under 50 and don‚Äôt have a serious condition or illness, you have a fair wait ahead of you.
For now, the government is committed to reaching the 14 million individuals who fall in the top four categories over the next five weeks.
But two particular categories continue to vex the committee. One is the ethnic minority population, which has suffered disproportionately during the pandemic ‚Äď to the extent that Black people are almost twice as likely to die from Covid as white people.
[Clip: News segment on BAME deaths from Covid.]
After data analysis revealed in the autumn that this was not related to genetic factors but to socio-economic causes ‚Äď jobs, housing and poverty ‚Äď the committee settled on a fudge that‚Äôs already attracted criticism.¬†
At its most recent meeting on 30 December, the JCVI resolved that health agencies and government at every level should ‚Äúwork together to ensure that inequalities are identified and addressed in implementation‚ÄĚ. It talked about how to get the communications right so that BAME groups come forward to be vaccinated.
To translate from Whitehall committee jargon: somebody else please sort out this looming problem.
The other category is teachers. Even when closed, schools have to provide a minimum level of support for vulnerable pupils and, crucially, the children of key workers, many of whom, because of the risks their parents run every day, are more likely to be asymptomatic carriers of the virus.¬†
[Clip: News segment on schools and the pandemic.]
If all this sounds like boring census talk or just another dry demographic inventory, consider what‚Äôs actually at stake: in the weeks and months ahead, who gets protection from a disease that has been killing 1,000 people a day? And who has to wait? And wait for how long?
‚ÄúIn the end,‚ÄĚ says one source on the committee, ‚Äúwe know we are rationing life and death.‚ÄĚ
Remember, too, that there‚Äôs no robust data on whether any of the vaccines diminish transmission rates. The jab may save your life and spare you from significant symptoms. But will it stop you passing on the virus? This is still one of the great known unknowns.
Another is even more straightforward. How quickly can Public Health England and the devolved administrations create an infrastructure of vaccine sites that amounts to more than a jumbled postcode lottery?
According to an analysis by the Sunday Times on 3 January, 13 million people live in a parliamentary constituency without a GP practice, hospital or community site that is administering vaccines. Eight million face a round trip of more than ten miles to get to a vaccine provider ‚Äď a significant challenge to many elderly or medically vulnerable people.
Ministers don‚Äôt dispute the dramatic variability of vaccine coverage around the country as we approach the middle of January 2021 ‚Äď but insist that the total of 700 of sites will soon rise to 1,000 and keep rising in the weeks ahead.
But what they don‚Äôt explain is why these sites weren‚Äôt already established and ready to go as soon as the doses became available. This system was decided over the summer.¬†
Yet that most basic infrastructure is not in place.¬†
In October, the 2012 Human Medicines Regulations were amended to allow retired health professionals to go back to work to help with vaccinations, under the NHS Bring Back Staff scheme.
Many thousands applied to do their bit ‚Äď and were confronted with a demand for 21 separate documents and qualifications, including anti-terrorism and diversity training. Important for fulltime NHS staff, no doubt, but hardly a priority for potential recruits to the emergency vaccine army.¬†
On this, Boris Johnson promised action in an interview with the BBC‚Äôs Andrew Marr on 3 January.
[Andrew Marr: Do you think it is reasonable that they should be filling in forms about deradicalisation, fire drills, etc.
Johnson: I don‚Äôt. I think it‚Äôs absurd. And I know that the health secretary has taken steps to get rid of that pointless bureaucracy.]
The question is, again, why did it take so long for such obvious obstacles to be removed, more than a month after the Pfizer vaccine was approved?
At times, it‚Äôs seemed like ministers and NHS officials don‚Äôt actually want the help that is being offered. On 27 November, pharmacies were sent a letter by NHS England inviting them to participate in the national mobilisation of the vaccine ‚Äď not least because so many of them, 11,400 to be precise, have first hand experience in the administration of winter flu jabs.¬†
Yet last week the UK‚Äôs biggest pharmacy chains, Lloyds and Boots, were expressing despair at ministers‚Äô failure to respond to their offer of help.
In public, ministers say the strategy is being rolled out as quickly as possible. In private, they admit there‚Äôs no point mobilising forces until they have the vaccine in vials, ready for them to use.¬†¬†¬†
As one senior government source puts it: ‚ÄúPeople keep saying ‚Äėbring in the Army, bring in vets‚Äô. And we will. But there‚Äôs no point in doing so until we have vaccines for them to put in people‚Äôs arms.‚ÄĚ
Which is, without doubt, the heart of the matter.¬†
In a letter published on New Year‚Äôs Eve, Chris Whitty and the other UK chief medical officers, put the matter as starkly as they could: ‚ÄúVaccine shortage,‚ÄĚ they wrote, ‚Äúis a reality that cannot be wished away.‚ÄĚ¬†
It felt like a sombre warning to the whole nation on the brink of 2021. As the global market for vaccines gets more fierce, as the demand grows for lockdown measures to be lifted, as the UK death toll climbs towards the once unimaginable total of 100,000 ‚Äď as all this happens, the clamour for jabs will increase. Will it be met by boxes of vaccine or gaps in supply and lengthening queues in the cold?
This led the chief medical officers to support ministers‚Äô new interim tactic of extending the time between the two vaccine doses from 2-3 weeks to 12 weeks ‚Äď an idea that had first been put forward by Tony Blair and was embraced quickly by ministers.¬†
The logic was straightforward: when vaccines are in short supply, why not extend a significant level of protection to twice as many vulnerable people, rather than full protection to a lesser number? The case, it was argued, was clear enough.¬†
If you could make both your parents reasonably secure from Covid, rather than give two doses to only one of them, wouldn‚Äôt you pick the option that made them both safer?
The decision was controversial, prompting none other than Anthony Fauci, the long-serving director of the US National Institute of Allergy and Infectious Diseases, to question its wisdom.
[Anthony Fauci: We know from the clinical trial that the optimal time is to give it on one day and then, for Moderna, 28 days later, and for Pfizer, 21 days later.]
In researching this story, the most striking discovery I‚Äôve made is that Johnson and his team see this single-dose tactic as an achievement rather than a last resort; as evidence of British enterprise and ingenuity in contrast to the conservatism of European medical practice.
‚ÄúIt‚Äôs a brilliant example of British exceptionalism,‚ÄĚ says one Cabinet source.
If so, what kind of exceptionalism? Not the scientific genius of the Oxford labs, but the defiance of regulations and original guidance in order to get quick results.
Ministers celebrate the ploy as buccaneering. Many scientists regard it as an undesirable risk.
What we must certainly do in the weeks and months ahead is keep our eyes on the precise meaning of the vaccination statistics.
The PM‚Äôs statement on 4 January was his most accomplished since the crisis began ‚Äď delivered with poise and conviction. But it also included a sly but all-important change in the definition of a ‚Äúvaccinated person‚ÄĚ:
[Johnson: I can share with you tonight the NHS‚Äôs realistic expectations for the vaccination programme in the coming weeks. By the middle of February, if things go well and with a fair wind in our sails, we expect to have offered the first vaccine dose to everyone in the four top priority groups identified by the Joint Committee on Vaccination and Immunisation.]
That‚Äôs 14 million people before, say, 15 February. The total who‚Äôd received their first dose by 5 January was 1.3 million. Let‚Äôs say, for the sake of argument, that a further million have been reached by today, 11 January. That still leaves about 12 million to be vaccinated ‚Äď or half-vaccinated, with a single dose ‚Äď in five weeks.
Or does it? Note that the prime minister conspicuously used the term ‚Äúoffered‚ÄĚ ‚Äď a weasel word that could cover anything from a GP asking a recipient sitting in his clinic whether he was ready for his jab, to an 85-year-old living alone in a tower block receiving a text inviting her to an appointment, a text on a smartphone that she has trouble reading without assistance. Does the unread digital ‚Äúoffer‚ÄĚ made to her count as a vaccination? And who will check?
It would be churlish to deny the achievement that the development of these vaccines represents.¬†
This is not a South Sea Bubble. More like a building that hasn‚Äôt been completed on time and may not yet be fully fit for occupancy ‚Äď but is being partially occupied anyway on the grounds that some shelter is better than none.
Always the gambler, Boris Johnson has bet his entire pandemic strategy, and perhaps his premiership, on a single vaccine plan that ‚Äď if it works ‚Äď will be a triumph but is still fantastically vulnerable to failure, disappointment and delay.
This really is the biggest bet of his life, which is saying something. The trouble is that many other lives are involved this time, too.
The rewards of success will be great. But so too will be the punishment for failure.¬†
As one senior minister sums it up: ‚ÄúIf this works, we‚Äôll be heroes. But if it doesn‚Äôt we‚Äôll be the bunch of pricks destroyed by a bunch of pricks.‚ÄĚ
Reporter: Matthew d‚ÄôAncona
Editors: Ceri Thomas, Peter Hoskin
Producers: Gabriela Jones, Tom Kinsella
Design: Oliver Bothwell
Pictures: Jon Jones