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Vaccination Procrastination
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On Monday England was given an indication as to how it will eventually get out of lockdown. Gradually, and in very careful stages, seems to be the answer.

We are in our third lockdown, and have staggered through two false dawns. What is different now is that vaccinations have been completed on 17.7 million citizens (last weekend’s figures), which covers all the most vulnerable people. This should have a big impact on deaths and hospitalizations. The plan is to keep going till all adults have been vaccinated, probably by the end of July. We are now in a transition phase, and each stage will follow the next stage every 5 weeks, so long as four tests are met:

1 The vaccination program continues at the present pace.
2 Vaccinations continue to be effective in reducing hospitalisations and deaths.
3 The NHS can cope with the pressure of hospitalizations
4 No risky new variants arise.

So, not exactly a slam dunk, and plenty of wriggle room for the government, but there is a reasonable likelihood of progress towards the usual freedoms of life by midsummer.

Stage 1. Starting 8th March (those vaccinated will have reasonable protection) schools and colleges will open, and small outdoor meetings can commence, and by 29 March more people can meet outside, and outdoor sports can commence.

Stage 2. No earlier than 12 April, all shops allowed to open, restaurants and pubs can serve customers sitting outdoors, and gyms, hairdressers, zoos, theme parks, libraries and community centres can open.

Stage 3. No earlier than 17 May, groups of 30 can meet outdoors or for special events like weddings; but only 6 indoors. Outdoor theatres and cinemas, and hotels can open; international travel can begin, indoor sports, exercise classes and large events also, though subject to number restrictions.

Stage 4. No earlier than 21 June. Everything open.

As the English say: “Fair enough”. Snap polls show general support, with only 16% saying the pace is too slow. However, the chance of getting infected outdoors is very low, and always has been, so why not allow all outdoor activities immediately?

One reason is that although not many of the younger-than-70-years-of-age die, they account for half the patients in hospital. There are more people under 70 than above it, so the prospect of large numbers needing hospital beds is alarming. As always, when epidemics make people very ill, hospitals become a limiting factor. They are designed to deal with our everyday needs, plus a small buffer for winter, but are not well set up for widespread community infections which happen infrequently. Also, although deaths are coming down, they are not coming down quite as fast as hoped.

This is a trifecta: vaccinations are working (but need more time and to be given to more people); many are still getting infected and dying so some restrictions need to be applied; and people have had enough of lockdown and are bursting to get out. The government are looking at the junction point of increasing vaccinations and increasing infections, and trying to balance the effects of possible hospitalizations coming, say, two to three weeks later, and vaccine produced immunity coming four weeks after the first inoculation.

As always, there is a strong political dimension: the UK has one of the highest death rates, and also one of the fastest vaccination deployments. The latter is that rare thing, a moment when the public give grudging support to their leaders, and thankful lip service to Science. They respect lab workers in white overalls, but don’t want to pay them all that much. It is dull work, and requires brains, so is best left to someone else.

As the weeks have gone by the general news about vaccination has been uplifting. The Oxford/AstraZeneca vaccine is highly effective in England, but European citizens are avoiding it, because their leaders have told them to. Vaccines are going to waste, at a time when countries outside Europe would gratefully receive them.

The vaccinated quite understandably want some public recognition of their new status. They have taken a low risk, and are now far less likely to be hospitalized or to pass the virus on. They would like a Vaccination Passport so that they can go on holiday without compulsory quarantine, and also go to theatres, cinemas, or nightclubs. The Greek Government would like British tourists on their beaches, and in their nightclubs.

The government, not initially too happy with the passport idea, is now considering it, so a committee will study the issue, including whether such passports would be discriminatory against those who “for whatever reason” did not get vaccinated. This is an inversion of what was formerly meant by “discrimination” which was that discrimination was a positive attribute showing that a person could distinguish one thing from another, as in the case of fine wines. Persons of discrimination have done a risk calculus and got vaccinated so as to protect themselves and cause less trouble and burden to others, and now the concern is that those who haven’t bothered to take up the free vaccination will be inconvenienced in some way.

Vaccination data for England as at 2 February 2021 shows:

• 14.4% of white people vaccinated so far (7.02 million)
• 9.2% of Asian people vaccinated (411,000)
• 6.8% of Black people vaccinated (135,000)
• 4.7% of people from mixed ethnic groups vaccinated (62,000)

You may remember that the surveys of intention to accept vaccination showed that this was likely some months ago. The “hesitant” remain so, and are procrastinating. The government, aware that not all will be vaccinated, and that no vaccine provides perfect protection, and that more social mixing will generate more cases is also procrastinating, but in cautious stages.

The usual suspects for vaccine “hesitancy” have been rounded up by the Office for National Statistics:

perception of risk, low confidence in the vaccine, distrust, access barriers, inconvenience, socio-demographic context & lack of endorsement, lack of vaccine offer or lack of communication from trusted providers and community leaders. [High Confidence].

To overcome these barriers, multilingual, non-stigmatising communications should be produced and shared, including vaccine offers and endorsements from trusted sources to increase awareness and understanding and to address different religious and cultural concerns (such as whether the vaccine is compliant with the dietary practices of major faiths, or with their ethical positions around medical interventions). Communication should consider the “whole communication journey” for vaccine rollout. [medium confidence]

Community engagement is essential as health messages and vaccine distribution strategies must be sensitive to local communities. Community forums should include engagement with trusted sources such as healthcare workers, in particular GPs, and scientists from within the target community to respond to concerns about vaccine safety and efficacy [medium confidence]

All this is well and good, so scientists and politicians of the relevant races and religions have been photographed loyally getting vaccinated, the better to inspire their genetic and faith cohorts. In times of tribulation, tribes matter.

“Perception of risk” is an interesting one: at heart it is a maths problem. Maths is difficult. A simple solution is to place all numbery things into five bins. Instead of the full range of probabilities things get clumped together into manageable categories. (At a Royal Society lecture on risks one speaker made his points about motorcycle deaths by giving order of magnitude comparisons with other causes of deaths, which seemed second nature to him).

That means that even the very rare stuff gets inherently classified as 20% probable. Crude, but workable for people who are in a hurry. In this compressed range the side effects of vaccination may loom large, particularly as they are in the all-too-vivid present, while the gains are in the all-too-distant future, and hence improbable, and not one’s fault. A contributing cause may be the tendency of medical communications to give side effects in a list, without any precise measure of frequency. At a glance of the list, every medicine will have more side effects than the single desired main effect.

So the crocuses of Monday have given way to the wild winds of Wednesday, and in the scudding clouds only the most optimistic catch glances of sunshine.

• Category: Science • Tags: Britain, Coronavirus, Vaccines 
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