Vaccines offer hope, but the route back to a normal life is far from straightforward

Paul Nuki
·6-min read
London coronavirus
London coronavirus
Coronavirus Article Bar with counter ..
Coronavirus Article Bar with counter ..

In the words of the song, freedom's just another word for nothing left to lose.

There was more than a hint of this in the decision in early summer to quickly wind down social distancing measures across Europe. With economies tanking and no obvious hope on the horizon, politicians could be tempted to gamble even though the rules of contagion were stacked against them.

Now with two vaccines illuminating the end of the tunnel, the political calculus has fundamentally changed. Today the question political leaders face is not, will we return to normal? But when will we get there - and who will get there first?

Sir John Bell, regius chair of medicine at the University of Oxford and a member of the UK vaccine task force, spelt it out bluntly in the Commons last week: the new vaccines offer a “70 to 80 percent chance of normality post-Easter… provided they don't screw up the distribution”.

If vaccines are the road back to normality, there are major hurdles ahead, notably in the areas of licencing, supply and distribution. The nation’s behaviour over Christmas could also be decisive, according to some.

On the positive side, the NHS is good at vaccinations. Every year it efficiently vaccinates some 15 million older people against seasonal flu in three months over autumn.

By comparison, the Government’s draft priority list for coronavirus vaccination stretches to nearly 25 million people. Much of the vaccine will need to be supercooled and people will require two shots three weeks apart, not one, but even so, the task at hand is not a moonshot. 

The dates pencilled in for starting to vaccinate each group
The dates pencilled in for starting to vaccinate each group

If - and it’s a big if - everything goes to plan it is plausible that all those most vulnerable to Covid in the UK could be inoculated against it by the end of April, say officials.

Richard Hatchett, chief executive of the Coalition for Epidemic Preparedness Innovations (Cepi), says the benefit of protecting the vulnerable with a vaccine should not be underestimated, in either human or economic terms.

“It would remove the biggest threat - of health services being overwhelmed”, he said. “It would allow social distancing measures to be relaxed and a gradual return to normal”.

Licencing may not be straightforward

For the next few days, probably weeks, all eyes will be on the regulators. Pfizer handed over its trial data to the US Food and Drug Administration (FDA) on Friday. The same information will be sent to the European Medicines Agency (EMA) in Amsterdam and the Medicines and Healthcare products Regulatory Agency (MHRA) in London very shortly.

Publicly, most experts are bullish on this process, perhaps conscious of fueling vaccine hesitancy if they air doubts. Others, however, say it would be wise to anticipate surprises.

All the limited phase three trial data published to date has been distributed by press release and regulators - always conscious of confirmation bias - will want to go through it with a tooth comb. They will have in the back of their minds unforeseen problems with previous vaccines that were licenced in a hurry, notably the 1976 US swine flu vaccine.

Did the five per cent who caught Covid after having the Pfizer and Moderna shots, all cluster towards the end of the trial period, suggesting its protection fades quickly? Was efficacy in older groups spread evenly between those aged 65 to 85 and is there data enough to know? Were side effects better tolerated by some than others? Is two months safety data enough for an mRNA vaccine that has never been used before? How safe are the manufacturing processes?

These are just some of the many vital questions regulators will ask.

It is also unclear if, and how, the FDA, EMA and MHRA will cooperate in their decision making. Two months ago the MRHA cleared the Oxford vaccine trial to continue after a serious adverse event was reported but the FDA dug its heels in and paused the US wing of the trial for more than a month.

It was not a good look and if stark differences emerge between regulators on licencing of the new vaccines public trust could take a serious hit.

Nick Jackson, head of programmes and innovative technology at Cepi, said medicines regulators had “strived to coordinate” from the start of the pandemic. However, he added that they may still come to different conclusions because “each must make their own risk-benefit assessment”. Nuances between countries such as health care capacity, age profiles and the incidence of co-morbidities will all influence each regulator’s final judgment.

Supply issues could stop a quick rollout

If and when the vaccines are given approval, supply issues could also prove tricky. The government has struck deals to secure 355 million doses of seven vaccines to date but the contracts are not publicly available and delivery times remain horribly vague.

For example, 10 million doses of the Pfizer vaccine - enough for five million people - are said to be “expected” before Christmas but the delivery date on the remaining 30 million ordered is “some time next year”. 

On the supply side, experts say much hangs on the trial results of the Oxford AstraZeneca jab, which are not yet known to anyone, including the Oxford team. 

Only four million doses of this vaccine have so far been delivered but as a home grown product, the UK is at the front of the queue for the first 100 million vials. It is also easier to manufacture and distribute as similar products have been made in the past and it does not need to be supercooled.

“Everyone has everything crossed for the Oxford candidate”, said a health official who asked not to be named. “If it comes good, everyone will breathe easier”. 

A third wave could disrupt NHS distribution

Responsibility for vaccine distribution has been handed to the NHS, and on Friday draft plans, dated November 13, were leaked to the Health Service Journal. They envisaged every adult in the country - some 52 million people - being offered a vaccine by May 1.

“These earlier draft slides are no longer up to date relative to the latest information from companies on likely supply schedules,” a spokesman for NHS England said.

The NHS is right to be cautious, not just because of supply chains but because so much depends on our collective behaviour as a nation. Of all the things that could derail the efficient distribution of a vaccine, a third wave of the virus sparked by an overly merry Christmas is what planners fear most.

The Covid vaccination strategy involves the same core personnel - GPs, nurses and pharmacists - as the annual flu vaccine, noted one well placed observer. If they are all locked down and fighting a new wave of Covid, things will not run smoothly.

It is this calculation, perhaps more than any other, that points to a quiet Christmas 2020. Isolating for a second time in his Downing Street flat, the Prime Minister is unlikely to take the same gamble when the current lockdown ends on December 2 as he did in July.

It is not simply a case of once bitten twice shy, but that his escape route - the country’s escape route - is now so tantalisingly close. In short, there is now everything to lose.

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