The UK’s vaccine roll-out is a well-known success story. (Indeed, Downing Street appears to be releasing a movie on its own heroics). The latest data from NHS England, released yesterday, shows that 93.7 per cent of eligible care home residents, 94.8 per cent of front-line NHS staff, 95.9 per cent of everyone over 70 – including 94.8 per cent of those over 80 – have received a first dose of a Covid vaccine. That is extremely high take-up for what appear to be extremely effective vaccines.
That level of take-up is higher than in government models and assumptions, which should give confidence as the UK sees to unlock in line with current plans in four remaining stages, on 29 March, 12 April, 17 May, and 21 June.
But there are two points to note. First, the UK’s roll-out has been slowing for weeks. After reaching a rate of three million first doses a week for a fortnight in early February, the UK has since administered 2.4 million, 2.5 million and 2.1 million first doses per week: a sustained fall of over 20 per cent. This week, after three days of data, it is on course for just 2.0 million.
If so, that will mean three million fewer first doses have been administered over the last four weeks than if the UK’s pace had remained at three million a week.
Fortunately, the downtick appears to be temporary. New waves of supply were due to reach the NHS yesterday, according to a fairly obscure but eminently accessible NHS planning document, which anticipates the UK’s vaccine rate rising to nearly five million a week from next week.
With second doses now accounting for around a quarter of all doses in recent days, that implies a rate of around 3.5 to 4.0 million first doses a week in the future. If so, it will take a month of vaccinating at that level to make up for the shortfall in first doses over the past month. This is the key point to remember if the UK’s vaccine roll-out surges next week: it will be both welcome and overdue.
Nevertheless, the UK’s most vulnerable have – have they not? – been vaccinated. This is the second key point: despite the success of the vaccine roll-out, more than a quarter of a million over-70s remain unprotected across the UK, and few of them are being reached each week.
If we extrapolate from the data provided yesterday by NHS England, around 280,000 over-70s across the UK remain unvaccinated (data is provided for England alone, which accounts for 85 per cent of the UK population). Yet in the first week of March, the most recent for which data is available, only 20,400 over-70s were vaccinated across England, implying a rate of around 24,000 across the UK. This implies a three-month wait to vaccinate the rest.
But in fact, almost no over-80s are now being vaccinated. Coverage for that age group, the one most at-risk, seems to be stuck at around 95 per cent. The government may be accepting that level of coverage.
What is the risk to the UK’s unlocking if that is the case? If we use the infection fatality risks estimated by Imperial College London in its paper last March – the paper that sparked lockdowns both here and in the US – then the UK may be at risk of as many as 15,000 to 20,000 deaths among the unvaccinated over-70s, in a group that is supposed have been vaccinated (or at least offered a vaccine).
The extraordinary effectiveness of the UK’s roll-out makes that number relatively low. It is around the number of people who died of flu each year in the UK prior to Covid, and a fraction of the 125,000 who have officially died from Covid so far.
It is also, arguably, needlessly high when the remaining quarter of a million over-70s could all be vaccinated in a day (even at the UK’s current restricted pace) – if they were identified and if they were willing.
Does the government know who and where they are? Take-up of the vaccine is lower among ethnic minority groups, as identified by the ONS, and also lower in London. Is it a question of capacity or will? What is being done to reach or persuade those over 70 who are yet to be vaccinated?
The government does not discuss the detail of its programme, nor explain why supply ever falls. Because the UK’s roll-out has been so much more successful than almost all the rest of the world, it has been able to get away with simply highlighting periodic milestones.
But a further surge of 15,000 to 20,000 deaths in the over-70s may, at least in part, threaten or slow the UK’s unlocking in the coming months. There is a case for the government to aim for 100 per cent vaccination in the elderly, rather than accepting 95 per cent coverage as at present.
The UK is fortunate to be a country with extremely high take-up, where so much of the task has already been done. But that final 5 per cent are an outstanding risk. The government needn’t resort to mandatory vaccination. But a targeted campaign to reach or persuade the unvaccinated elderly should greatly reduce any remaining peril, if the vaccines prove to be effective as they appear to be at preventing serious illness and death.