The Government’s vaccines advisory panel last week set out a priority list of who should be first in line for the Covid vaccine.
This sets 11 categories — with top priority given to care home residents and staff. Those under 50 without known health problems come last. The guidance makes clear the pecking order “could change if the first available vaccines were not considered suitable for, or effective in, older adults”.
Q: Will the vaccines work in everybody?
Probably not. However, according to Dr Nuria Martinez-Alier, a consultant in children’s infectious disease and immunology at Guy’s and St Thomas’ NHS trust, the “efficacy” of any vaccine — or how well it works — should be at least 50 per cent before it is rolled out.
Speaking to the Standard in a personal capacity, she said: “If you go into the doctor’s and get the vaccine, you have got a one in two chance of it working, which is quite good. There is a good chance within 18 months that there will be a first generation vaccine, with hopefully better than 50 per cent efficacy for those at high risk. It would be fantastic if we have a vaccine that prevents infection and therefore interrupts transmission. If the first generation vaccine doesn’t give sterile immunity, as it’s called, but can attenuate or reduce the disease, that should be good enough. If what you prevent is hospitalisation, then that is very positive.
“It’s like an orchestra. We might have a conductor and we might have violins and a few drums to start with, but that doesn’t really make Beethoven’s Fifth Symphony. If we’re aiming for a fantastic system, then we will be waiting for many years. If we can have a vaccine that at least starts playing a tune, then that is a good start.”
The Government has six vaccine candidates in its portfolio being worked on, including the one produced by AstraZeneca and Oxford University.
Q: Is there good scientific evidence for prioritising the elderly?
“Yes, old age is the single most important risk factor for severe disease in this pandemic. It’s true that currently in the UK, and in many countries, where the elderly and at-risk population is effectively shielding, the virus is transmitted among the younger circulating pool of the population – particularly those who are mingling more, the 18-25 year-olds or teenagers struggling not to meet their friends.
“But we do not have it as a fact yet that they are the lead transmitters within the Covid pandemic. For other diseases, for example pneumococcal disease, when we first introduced pneumococcal vaccine, and we immunised infants, that had a significant impact reducing disease in the elderly population.
“So, for pneumococcal vaccine, knowing that it was infants and toddlers that are at high risk of severe disease and were the main transmitters of infection, it makes sense to first vaccinate that age group.
“We target flu vaccination to the under-fives and to the over 65s and high-risk groups. If resources were infinite and vaccine uptake were enthusiastic, it may be that we should vaccinate the whole population against flu.
“Recommendations are driven by science, and in part a question of resources while keeping the population on board with what the purpose of vaccination is, while at the same time targeting the highest risk group.”
Q: Why not vaccinate the entire population, from all infectious diseases?
“It may that, within our lifetime, we will have a regime of cradle to grave vaccination, where everybody is vaccinated at several time-points to keep the population healthy,” Dr Martinez-Alier said.
“For somebody who has seen the terrible effects of a lack of vaccination in Africa, it’s a terribly attractive proposition – prevention rather than cure.
“But in the context of vaccine hesitancy and conspiracy theories and all sorts of anti-vaxx sentiment against the vaccines that we do have, if we start to walk in with the concept of cradle to grave, which means infants all the way to the very elderly, it may backfire.”
Q: Is it correct that older people are more at risk from Covid?
“In terms of Covid, from age 50 the risk of serious disease rapidly rises, with co-morbidities adding additional risk.
“It’s a scientific and logistical decision [on who to vaccinate], not so much a political decision.”
Q: Is a vaccine worth using if it works in less than 50 per cent of people?
“There is a pilot malaria vaccine implementation trial in Africa with a vaccine that has a reported efficacy around 40 per cent. It’s the first generation malaria vaccine, the best we have at the moment, despite decades of research.
“Much like malaria, the first vaccines we will have in Covid will may not be 95 per cent efficacious. We could be lucky… nobody has totally extinguished the glimmer of hope of something amazing.”
Q: Are there risks with vaccinating everybody against Covid?
“If the first generation vaccines have less than 98% efficacy and do not provide sterile immunity and then in six months or 12 months we have a more efficacious vaccine and then maybe everybody is vaccinated again, and then in three years’ time we have an even more effective vaccine and everybody’s vaccinated again, people would say: ‘Your vaccines don’t work. Why do they keep getting us all to get vaccinated again?’ There is also the huge logistical and financial investment.”
Q: How hopeful are you of a Covid vaccine being available soon?
“I’m being cautious. It’s not as simple with Covid as preventing infection – it’s about preventing disease. The triggers for disease, now that we understand the immunology better, are so much more complex than just infection.
“On an optimistic note, we have never had as many vaccine platforms as we have.
“I think it’s worth being optimistic, but rolling out the vaccine needs to be managed very carefully. The expectations have to be realistic. If there ever was a chance, this is it, but I think it may be some time still.”