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Has the government’s Covid-19 vaccine strategy failed?

A third wave is coming – and is likely to be the most unequal yet.

By Ben van der Merwe

The long-awaited 21 June reopening is expected to be delayed by up to four weeks today, as the Prime Minister responds to concerns over a recent uptick in cases and hospitalisations.

The number of people testing positive for the virus each day grew by 53 per cent in the first week of June. The virus has only ever spread so fast three times before – each time precipitating a disastrous wave of infections, hospitalisations and deaths.

Covid-19 has not spread this fast since early January
Week-on-week growth of daily UK cases (rolling 7-day average)
Source: Public Health England

The rise in cases is believed to be due to the emergence of a new, more infectious variant. First identified in India, the Delta variant is thought to be around 64 per cent more transmissible than the previously-dominant Alpha variant, according to a report released by Public Health England on Friday.

While case numbers from other strains have been falling consistently since late March, cases from the Delta variant have grown rapidly since mid-April. As of last week, the Delta variant is now the overwhelmingly dominant strain across the UK, accounting for 91 per cent of all new cases, according to figures released by the Health Secretary.

Evidence presented to Sage last month also showed that the Delta variant was significantly more dangerous than the Alpha variant, with those who catch it more than twice as likely to end up in hospital.

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Though the roll-out of vaccinations has proceeded rapidly, there is little chance of the programme preventing a third wave. Vaccines can only prevent the virus from spreading exponentially if a sufficient number of people are immunised, a stage known as herd immunity. 

As of 9 June, 55 per cent of UK adults were fully vaccinated. However, the level of immunisation required to reach herd immunity against the Delta variant is estimated to be 64 per cent under current restrictions and as high as 77 per cent after reopening.

Unlocking raises the bar for herd immunity
Share of population that is fully vaccinated and estimated threshold necessary for herd immunity
Source: Public Health England/Tony Blair Institute for Global Change

Fortunately, the vast majority of those yet to be fully vaccinated are under 65 and thus less vulnerable to severe symptoms from Covid-19. 

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Since the beginning of the pandemic last spring, five in every six deaths to the virus in England and Wales have been among the over-70s. Today, over 95 per cent of this group are fully vaccinated in England, Scotland and Wales.

By vaccinating the most vulnerable first, the government’s hope is that any third wave will be concentrated among the young and healthy, severing the link between cases, hospitalisations and deaths.

 

To some extent, the strategy is working. Though hospitalisations have increased, they are doing so at a far slower pace than last autumn.

There were 884 Covid-19 hospital patients in England on 11 June, one week after the seven-day rolling average number of daily cases hit 3,839. A week before the autumn wave reached a similar level of hospitalisations, average daily cases were at just 2,654.

 

Despite evidence that vaccines are somewhat less effective against the Delta variant, particularly after just a single dose, they do nonetheless seem to be working. Of the 126 people hospitalised in England with the Delta variant by 3 June, only two were fully vaccinated.

In fact, the number of cases per hospitalisation has never been higher – demonstrating that vaccines have had considerable success in loosening the link between infection and hospitalisation.

 

The fact that those in hospital are significantly younger than in previous waves suggests that the link between hospitalisation and death is also likely to be weaker this time around. People aged 18 to 64 made up 72 per cent of the 714 people hospitalised with Covid-19 in the week to 8 June, compared to just 44 per cent in the first week of the autumn wave.

However, while vaccines might be reducing the number of hospitalisations per case, they are not eliminating hospitalisations entirely. The concern raised by Sage is that with a large enough volume of cases, the number of hospitalisations could still overwhelm hospitals and lead to a significant number of deaths.

A delay to reopening will not stop the wave of infections that is currently building – only increasing restrictions could do that – but it will slow the pace. Delaying the reopening by four weeks could give the vaccine programme time to reach the large number of unvaccinated people in younger age groups, as well as those in older age groups that have yet to be vaccinated.

Most worrying for the government may be London, where just one third of the population has been vaccinated – compared to over half in every other region and nation of the UK.

This is not just because of London’s relatively young population. One in five over-90s in the capital has yet to be fully vaccinated, rising to as high as one in three in Lambeth. Almost 15 per cent of Londoners aged over 90 have yet to receive even their first dose, compared to just 6 per cent across England as a whole.

London's low vaccination uptake isn't just about age
Share of English population that is fully vaccinated by age group and region, 9 June
Source: Public Health England

Only one in six British adults express hesitancy in getting vaccinated, according to a survey conducted last month by the Office for National Statistics (ONS). However, vaccine hesitancy rates vary significantly by class and ethnicity.

The survey found that one in every eight people working in elementary occupations (routine, often low-income work) is resistant to or unsure about getting the vaccine (12 per cent), compared to just three per cent of professionals and six per cent of managers, directors and senior officials.

Even more strikingly, one in five black British people surveyed was hesitant to get the vaccine (21 per cent), far higher than for any other ethnic group. A separate ONS study found that British people aged over 40 and from a black Caribbean background were eight times more likely to be unvaccinated than white British people of similar age and sex.

Despite its extraordinary progress, the UK’s vaccination drive will not achieve herd immunity in time for the coming third wave of infections. A delay to the reopening is necessary to avoid accelerating the spread of the Delta variant, but will not stop it.

Unless the government is willing to consider a ramping up restrictions again, rather than just delaying their easing, a third wave is coming – and is likely to be the most unequal yet.