Vaccine ethics and policy are still perilous for the government

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The Prime Minister has a spring in his approach. The stock market is on the rise. Some economists even predict a “roaring” decade to come. Families are looking forward to next year and the time, thanks to Covid vaccines, that life can return to normal.
However, the road to normality remains long and difficult. In Britain, the government will have to administer tens of millions of vaccines in just a few months. Ministers will rely on a state apparatus that has failed to fulfill some of its most basic functions. And the logistical, ethical and political challenges will be immense.

The government starts from two advantages. Despite its poor performance on tasks such as contact tracing and purchasing protective equipment, Britain is in a relatively strong position when it comes to vaccine procurement. The ministers obtained 357 million vaccines from seven different developers, including 100 million from AstraZeneca and the University of Oxford, 40 million from Pfizer and BioNTech and seven million from Moderna. And the MHRA, the regulatory body that will need to approve vaccines, is a strong player that has had a good crisis, quickly clearing the use of new ventilators and approving dexamethasone to treat Covid patients.

Buying and approving vaccines is one thing; administer them, another. Nadhim Zahawi, the new minister of vaccine deployment, will face a complex supply chain challenge. Each vaccine requires two doses, the second within 28 days of the first. Any problem or delay in the production or supply of vaccines will seriously delay the program.

The Pfizer vaccine, which has a higher success rate than its rival AstraZeneca, must be stored at -70 ° C. This will likely require “freezer farms” and a large number of refrigerated trucks, and will make administration of the drug difficult. vaccine in existing facilities. Zahawi will need to build a series of specialized vaccination centers capable of delivering doses safely, at speed and on a large scale. It must therefore mobilize not only the NHS and probably the army, but also the local authorities and their planning services. And all this in a few weeks.

Zahawi will need the continued political support of Boris Johnson and his government colleagues. The Prime Minister, and ministers keen to put the country back to work and life, will desperately want vaccines to end the cycle of lockdowns as soon as possible. But they need to be clear on a number of factors.

Will the plan to open up the economy as soon as the most vulnerable have been vaccinated, or will we remain more cautious? If vaccines cannot completely eliminate the virus, is the goal simply to keep the infection rate low? Do we need regular mass tests as well as vaccines before we open? What percentage of the country should be vaccinated and by when? The right way to put vulnerable people first by giving them the fastest and most effective vaccines? And once we get Britain on the right track, how are we going to help deliver vaccines to the world?

Answering these questions is critical to a successful vaccine rollout because people need to understand what they are being asked to do and why. And behind each question lie several ethical dilemmas and practical issues. The first is the question many fitters and young people ask themselves. Why, if they are extremely likely to survive Covid, should they be vaccinated when they are unaware of the risk of vaccination? This argument is attractive, but it ignores both the danger of pandemics and the value of vaccinations. The vaccine is an act of collective defense: by being vaccinated, we protect others as well as ourselves, allowing us to live freely and enjoy the benefits of our collective existence, including the security of a health system that was not overwhelmed.

Then there are the anti-vaxxers. Social media is teeming with misinformation and scary stories, most of which are produced by hostile foreign governments, about the supposed dangers of vaccines. Ministers are discussing with intelligence agencies how to counter the threat, but the risk is that it will only get worse. Normally, after clinical trials, vaccines and drugs are started slowly to watch for side effects. It will be the fastest and largest vaccine deployment in history, and the first beneficiaries will be the elderly. When they experience symptoms after vaccination, which is common, and some die, such as for reasons other than Covid, many inevitably will, online speculation will compromise adherence.

Then there is the question of who gets which vaccines. Prior to the release of the trial results, some epidemiologists argued that with a limited supply of vaccines, it was best to target the most vulnerable first, but with a larger supply, it was better to protect them indirectly. by targeting the issuers: the working-age population. and children. But they had not expected to have several vaccines with different levels of effectiveness.

The AstraZeneca vaccine can be as effective as 90%, depending on the dosage, but due to the way its trial worked, we don’t know if it will be as effective for anyone over 55. So it might make sense to give the seemingly superior Pfizer vaccine to the elderly and vulnerable and use the AstraZeneca vaccine for the younger and fitter. It’s a sensitive call, but deciding who is vulnerable and therefore a priority – ethnic minorities and low-skilled workers, for example, have higher Covid death rates – is even more sensitive.

And so does the dilemma the government has constantly struggled with. If ministers decide there is no point in rushing to reopen economic and social life before we have vaccinated most of the public, lockdowns will continue until we reach critical mass of vaccinations. If they conclude that we can reopen as soon as only the most vulnerable are vaccinated, they will have to perform regular mass testing – a logistical challenge at least as great as rolling out the vaccine – and a “free pass” system to let us leave on our lives safe.

In other words, it’s not over yet. This happy day, when we can live our life in freedom and security, is still far away.



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