I hadn’t expected any Covid-19 vaccine to come on stream before the spring of 2021. Then, without warning, on 3 November UK general practice was told to begin immediate preparations to deliver a coronavirus immunisation campaign from early December. Something seismic must have been happening behind the scenes. Quite how seismic was revealed six days later, with the announcement from the US pharmaceutical giant Pfizer that its partnership with the innovative German company BioNTech had produced a vaccine with a stunning 90 per cent efficacy at protecting against Covid-19.
I have been critical of many aspects of the UK government’s response to the pandemic, but its decision to hedge its bets with six different promising vaccines has proven wise. One of those six was the Pfizer/ BioNTech product. As a result, we are set to obtain sufficient quantities to begin immunising the 20 million most vulnerable people before the end of the year, subject to regulatory approval.
When, in June, the UK’s Recovery trial proved that the cheap steroid dexamethasone reduced deaths from severe Covid-19 by up to a third, it was the first good news we had received since the start of the pandemic. But the prospect of an effective vaccine has provoked an entirely different level of optimism within the health service. It feels like an incredible tonic as we advance deeper into what is anticipated to be the most challenging winter many of us will ever have faced professionally.
The UK government appears to have learned lessons from the dismal performance of the privately run “NHS” Track and Trace, and is looking to existing public services to deliver the Covid vaccination campaign. There is talk of a parallel new national service run, one anticipates, by yet another exorbitantly expensive yet ineffectual outsourcing company. But at least our network of established general practices is to be in the vanguard. Even as I write, there are thousands of GPs and practice managers across the country – all highly experienced and effective at organising immunisation programmes – working on the logistics.
The vaccine’s reported storage requirements and short shelf-life mean that most individual surgeries will be too small to churn through the number of jabs that will need to be administered each day. Unlike any other immunisation campaign we run, then, the Covid service will have to be offered from designated practices on behalf of all neighbouring surgeries. Over the past few years, general practice has been reorganised into primary care networks – groups of surgeries serving 30,000-50,000 patients – meaning, thankfully, we already have the framework for this novel approach.
The government will have to get the details right, though. This will be a huge additional workload, so we need the suspension of all non-essential activities and bureaucracy. And determined as most GPs are to step up at this time of crisis, the economics have got to make sense. The currently proposed funding – based on the costs of seasonal flu vaccination, which is substantially less time-consuming to administer and monitor than the Pfizer product will be – looks inadequate.
There are other caveats to temper any euphoric sense that the end to the pandemic might be in sight. First, Pfizer’s claim of 90 per cent effectiveness is based on tiny numbers – 94 Covid cases in a study population of 44,000 – and, crucially, it refers purely to the vaccine’s ability to prevent individuals from developing any level of symptomatic coronavirus infection – the vast majority of which is trivial.
What we actually need from a jab are two very different things. One is the prevention of severe Covid-19, the extreme form of the disease that sends up to 4 per cent of patients into hospital and kills a substantial proportion of them. The other is the prevention of virus transmission between individuals.
It may seem intuitive that a vaccine which prevents symptomatic infection will achieve both of these things, but it is absolutely not a given, and the Pfizer data is too small to tell us anything in this regard. It is entirely possible that we could roll out a mass immunisation programme at high speed, only for it to make little or no difference to the two aspects of the pandemic that matter.
To try to prove effectiveness in these “hard” outcomes would require studies a whole order of magnitude bigger or longer. Neither Pfizer nor any other vaccine manufacturer is attempting such a feat. The time involved in obtaining this kind of definitive proof strikes many as unconscionable – not just because of the lives that are being destroyed and lost as the pandemic burns on, but also because of the need to restore the economy. The political judgement is that the potential prize suggested by the preliminary results is eminently worth the gamble.
We have been seeing an unusually high uptake of the flu jab in our practice, suggesting that the pandemic has sharpened patients’ desire for protection. This should translate into enthusiasm for Covid immunisation. However, attitudes to vaccination have still not recovered from the shock wave set off in 1998 by the disgraced former physician Andrew Wakefield, who published claims – latterly discredited – of a link between the MMR jab and autism. My understanding is that the Pfizer jab causes a febrile reaction in around 20 per cent of patients. And there will be rare, serious adverse events that the trials have been too small and time-limited to have detected.
People’s perception of risk is heightened by unfamiliarity. The fact that this is a vaccination against a novel pathogen, developed at astounding speed and in great haste, may yet render it vulnerable to “bad news” stories that tip public attitudes in unpredictable ways. Some colleagues are voicing disquiet at being expected to recommend an immunisation under such conditions. But it is like every other medical intervention: a balance of benefits versus risks. Individual patients, properly informed, will be capable of making up their own minds.
This article appears in the 18 Nov 2020 issue of the New Statesman, Vaccine nation