“UNKNOWN” IS THE HALLMARK OF THE DISEASE
If any word characterises Covid -19(CV), it is “unknown”. From the start of the pandemic, nothing was known about CV; how to combat it best was a steep learning curve, especially if flu was mistakenly the original model to follow. The state of knowledge today is astonishing, given the standing start, as there are now drugs to mitigate its worst effects, there is confidence about who is worst affected and who is not, and what are good habits to prevent infection. So far, the only identified way for the world to return to a relatively unrestricted way of living, working and mixing again, let’s call that normality, is through effective vaccination programmes, on a global scale. The miracle of discovery of vaccines now in mass production in less than a year from starting from scratch is recognised. Another year of lockdowns is surely unsustainable without wrecking society as known today.
However, once again there is much unknown about how effective vaccines will be in fact, in both preventing infection and mitigating the effects of CV once caught. Those approved in the developed world to date – Oxford/AstraZeneca(OAZ), BionTech/Pfizer(BIP) and Moderna(MOD) – are known to work with two doses, and to some degree (but precisely how much is unknown) with one dose, against the strains which are well known; but mutations occur all the time and modifications to vaccines could be ongoing for some time to combat these mutations: nobody knows the future battles to be fought. At any one time people will have to work with what they have which is known.
But for now, the UK vaccination programme is going “really, really well” quoting from Alibhe Rea in the New Statesman morning call of 19 January 2021. The roll-out is a credit to the UK Government (UKGOV) and the health services delivering it. The same New Statesman piece referred to some glitches such as the “postcode lottery” some like to talk about, exaggerating an issue of disparity of volume in jabs between regions. At that time England and Scotland were experiencing more efficient delivery than Ireland and Wales, and Northern England much better than London. But given the data shortage these were regarded as minor matters for now. A Times headline concerning the previous day shouted concern over supply as the number of inoculations had dropped for a day, but the next day they were back up to over 300,000. Knee-jerk daily headlines are unhelpful. How the programme will complete is unknown as many unforeseeable factors could throw activity off course in minor and major ways. Emphasising successes, and solving the problems as they emerge as such, is the way forward, not speculating and promoting doom.
OBSESSING WITH EQUALITY UNDERMINES – IT WILL NEVER BE ACHIEVED
Obsession with the unattainable grail that everything must always be equal, and if it is not then its wrong and flawed, taints assessment of many human activities and the vaccination programme is no exception. There now appear in some newspapers a league table regularly on volumes of vaccinations by region. The media reports on, and perhaps seeks out, regional disparity; GP practices which may be short of supply compared to others; dissatisfied individuals; in some areas take-up being less enthusiastic, such as in black communities; some care homes being quicker to be done than others. The programme – to vaccinate all UK adults by a time in September – is a colossal challenge. There are priority groups determined by the Joint Vaccination Committee, informed by health experts, and getting each done in order will happen less than perfectly: a 70-year-old here and there will get a vaccine before some 80-year-olds. There will be supply hiccups- the BIP is coming slower as Pfizer revamps its Belgian factory to a higher capability level, and so the programme will be hit, and sadly the EU will suffer even greater delays as it is highly dependent on the supply of BIP.
Some will argue certain key workers need to be further up the queue. The order may or may not change. However, as long as those charged with delivering jabs as quickly and as efficiently as possible are doing their best, it is only to be hoped that nit-picking arguments to find fault in the decision-making and the roll-out do not prevail and are beaten aside. A question being asked with regularity is why the roll-out is not 24/7? If it is simply not practicable to do that, say because vaccinators and others organising may for example need a rest or the general populace may not turn out in numbers at 2am, perhaps that simply must be accepted. As with so much about this pandemic, many in the media seem to search out incidents of imperfection from which to draw sensational, often unjustified, conclusions,
That the peer Joan Bakewell, not the most representative of her generation though sometimes portrayed as such, should take UKGOV to court alleging their policy decision is illegal beggars belief. It displays perhaps a special selfishness, or total lack of appreciation of the difficult balancing acts and trade offs required in any forward- looking decision about dealing with CV. The policy decision concerned is the decision to postpone second jabs of OAZ and BIP so that more first doses can be given rapidly. That will immunise to some degree, thought by experts advising UKGOV to be enough, a far greater number of vulnerable people more quickly. There are risks, as with any decision where there is not perfect knowledge or science – the unknown is the feature of CV – but the good faith best judgement is that they are outweighed by potential benefits. This is at a time when the risk of some health services being overwhelmed is thought to be high, and so the decision is aimed to reduce that risk.
It is certain that in the vaccination roll-out there will be bumps along the road: not everyone everywhere will be treated equally. Some scientists now make the obvious warning noise that those vaccinated will be tempted to ignore the restrictions and best practices to reduce infections. Fair comment, but, just as with lockdowns, the policies work best when most people find a way of generally behaving sensibly as they have done all along.
A GLOBAL PROBLEM
The WHO is pointing accusatory fingers at the wealthy developed nations buying up all the vaccine, while the poorer underdeveloped countries are left until last. A decent balance needs to be struck. To aspire to equality will not work. It is recognised that, during normality, global interconnection of people is a key feature of life, across borders and continents. Therefore, while controlling CV in developed countries is an achievement, there will be no real control while many countries, particularly poorer, are out of CV control. Gavi Covax AMC is the international project established with the aim of ensuring that 92 middle and lower income countries that cannot afford vaccine get access equal to richer countries and at the same time. The UK is a primary fund raiser through a matching donor fund raising commitment which has raised $1billion.
The reality however is that equality will not be achieved, not least because, it is understood, the wealthy nations have already got orders for over 50% of the likely amount of the most hopeful 8 vaccines of which only 3 are now in use, and in many countries far more than their populations need. It is said that 96% of BIP and all of MOD vaccines for 2021 has gone in this way to wealthy nations. At least OAZ is committed to distribute 64% of its 2021 production to developing nations and at cost only: but at best it seems only 18% of the poorer population will get vaccine in 2021 (unless the Chinese and Russian vaccines, as yet unproven by normal trial standards, are readily available). The UK has at least demonstrated a real commitment towards developing nations, putting its values into action. When discussing the position of the poorer countries, it is important to remember that in many cases the reason for much of the poverty is not the greed of developed countries, but the corruption of the ruling elite and its paid followers.
The harsh reality is that the lower income nations are never treated in anything equally with the richer and are largely dependent on them. Even among the wealthy nations bonded to each other such as in the EU, there is vaccine nationalism being demonstrated. COVAX is a correctly directed project but espousing the equality it does dooms it to underperforming.
MITIGATION NOT ERADICATION
UK health advisers have made it very clear that in reality CV will have to be lived with for a very long time. If the sting of CV can be sufficiently mitigated by vaccine, then the sooner people come to view it as a fact of life, like flu, the better. Normality will return so much the quicker. This will be easier and realistic if the mortality rate and serious illness rate due to CV can be reduced to proportions that can be absorbed in minds as low risk. This reality will require positive and consistent messaging, without deceiving. However, for a cross border and global mentality to return to normality, real international cooperation and thinking in a global way will be required, with all nations dumbing down the terror which they have promoted to obtain popular compliance. International standards and practices of testing and vaccinating, and quarantining, need to be established soon, so that countries can have a confidence in each other regarding CV, which is lacking today.
