The general news about how Covid-19 has hit Britain so far this year has been relatively positive: while we have still had many hospital admissions and deaths from Covid and flu, the numbers in England and Wales, Scotland and Northern Ireland lower than in England and Wales, Scotland and Northern Ireland. with the same period last year. News is also coming in about the next few rounds of Covid vaccine boosters. It appears that while countries such as the US and France have made vaccines available to anyone who wants them, Britain is likely to continue restricting free access to certain groups, and may restrict access even further in the future.
The spring booster campaign will, as expected, be more limited than the recent fall campaigns – aimed at adults aged 75 and over, elderly people in care homes and immunosuppressed children and adults. The Joint Committee on Vaccination and Immunization (JCVI), which makes recommendations to the government, says it is using a “bespoke, non-standard cost-effectiveness assessment methodology” to inform priorities going forward, but full details of its analysis are not available yet (the JCVI said material for its spring campaign will be published “in due course”). Looking ahead to the upcoming rollout, and reading between the lines, it seems likely that the number of groups offered boosters will continue to shrink.
When rolled out in autumn 2023, the supply was already much smaller than in previous years, and the JCVI notes that autumn 2024 will likely be even smaller. If you read through the latest JCVI statement, the main focus seems to be on the risk of hospital admission due to serious infection or death. Clearly, serious illness is an important consideration, but should other factors be taken into account? For example, children are less likely to develop a serious disease, but there are major benefits to vaccinating them.
A recent study in four Scandinavian countries found that vaccines reduced hospital admissions among children aged 12 to 17 by more than 70%. And of course, children can also suffer long-term consequences even from a mild Covid-19 infection. Despite this, vaccines for children in Britain have been in limited supply and are no longer widely available (unless clinically vulnerable), and it seems likely that this position will persist. This makes Britain an outlier, as many other wealthy countries recommend vaccination for children. In England, almost 90% of five to 11 year olds have not been vaccinated.
The JCVI analysis takes into account the consequences of hospital admissions, but does not include the consequences of long-term Covid-19 in the calculations. It is estimated that around 65 million people worldwide suffer from a long bout of Covid-19 (symptoms lasting four or more weeks), and the condition often presents with severe symptoms that can affect many different organs, causing cardiovascular, respiratory and neurological problems. We know that vaccination helps protect against long-term Covid-19, but we are still seeing new cases, so it is uncertain how long protection lasts after previous vaccinations.
In Britain, an estimated 80,000 people have left their jobs as a result of the long Covid-19 crisis, and the cost of healthcare for those with long Covid-19 is high and only increasing over time to. Despite the obvious social and economic costs, it seems that living with long Covid-19, nor its effect on the economy, will not be taken into account.
There is also little point in continuing to limit the number of people offered vaccines in Britain, as the government was already negotiating the purchase of millions of doses of Covid vaccines, which would be delivered in phases between 2021 and 2024. The vaccines were purchased under this agreement on the understanding that there would be sufficient coverage for people over 50 years of age and other clinically vulnerable groups. With vaccine supply shrinking and uptake in certain groups low, there is a surplus of unused vaccines that will soon expire. The UK Health Security Agency estimates that it expects to write off £229 million worth of vaccines that we want to buy, or already have in our possession, that will ultimately not be used.
It is unknown whether the value of these vaccines, versus the cost of delivery and rollout, has been taken into consideration when determining which age groups vaccines should be offered to in 2023 and 2024. The pre-purchase approach has tied us to certain makers and types of vaccines. and it is not clear whether there is a long-term plan to develop vaccines that may provide longer-lasting protection. But if we’re going to throw away vaccines, why not expand the age groups that are eligible right now?
There is good news for those in England and Scotland who want Covid-19 vaccines as they can finally buy doses privately. Unlike the flu vaccine, which costs around £20, the price per dose is likely to be £45. The costs of vaccinating an entire family can therefore quickly add up to hundreds of euros. We are in a cost of living crisis, with many struggling to eat or heat their homes. People who are poorer tend to have more precarious employment and are at greatest risk of contracting Covid-19 at work, so would benefit significantly from vaccination.
There are already many barriers to vaccination campaigns, including low trust and easy access to vaccines – and costs should not be added to that. The latest boosters in the US and many European countries have been free for all, but Britain is already moving towards a place where vaccines are reserved for those who are richest.
Britain’s initial commitments to vaccinate everyone against Covid-19 have had variable reach depending on age and demographics, but have still prevented untold amounts of death and suffering. At the moment, most adults in Britain under the age of 65 will be one or more years away from their last booster treatment. I do not mean to downplay the important volunteer work the JCVI does, or the budgetary constraints it faces in relation to the vaccine rollout, but it is vital that it provides much greater transparency around its cost calculations, so that a public discussion can take place about it. how to best use the vaccines we have, and what lies ahead in the future.