‘We are so much further on than we were at the beginning with vaccines’
The woman in charge of Wales’ vaccination programme, Dr Gill Richardson, and her colleagues would rather be in the background, but the pandemic has propelled them to the forefront of public awareness. Political editor Ruth Mosalski reports
IT WAS more than 30 years ago that a GP travelled to north Africa as part of her training.
When Dr Gill Richardson describes the time there, the words “antibodies”, “mass vaccination” and “eradicate” come up. That all sounds scarily familiar, I say.
“Yes,” she laughs. “It does.”
She went to north Africa in 1987 and visited a hospital where an orthopaedic surgeon told her he was still operating on cases of polio – a completely preventable disease.
When she returned to the UK, she says, she couldn’t get it out of her mind, so worked with that surgeon on a bid to evaluate the antibody levels in children to see if the vaccine was working.
In that time Unicef had approached the government of the country she had visited to see if they could run a mass vaccination programme and Dr Richardson became part of it – looking at the antibody levels before and after the campaign in different types of areas, roping in some friends and colleagues from the UK.
She had also arranged for support for processing all the antibody samples from the National Institute for Biological Standards and Controls (NIBSC).
“So I had developed an interest in vaccines and I guess some expertise in looking at the technology, and then it was a very successful campaign and in fact, two years afterwards, polio was declared as eradicated in that country.
“My involvement probably lasted about seven years and during that time I had decided that much as I loved general practice, actually, public health was where I should be.”
Dr Richardson trained as a public health consultant and her CV gives a hint of just how varied that career has been. She has published on waterborne infectious disease outbreaks, blood-borne viruses, cardiovascular health and inequity, cancer inequities, climate change, refugee and asylumseeker health, and health literacy for all. She has worked for the World Health Organisation, been on Gold Command for the Celtic Manor Nato summit, and been a director of public health.
She is, her biography says, “passionate about tackling health inequity and promoting mental health resilience”.
Dr Richardson had been working on an international project when news of Covid-19 filtered out of China.
Now her role as Wales’ deputy chief medical officer for vaccines puts her front and centre in the campaign to get people vaccinated.
The reality of what was coming hit her when she realised the speed at which it was travelling.
“This was completely new. We did not have a template for this disease, apart from the common cold, which had never done anything like this, apart from Sars, which had burned itself out.
“There had been Mers (Middle East Respiratory Disease) but that was a zoonotic disease – a disease coming when animals and humans are in contact. So this was completely new and incredibly fast-moving.
“I was worried, and then within days there were cases in Europe and when we heard that we realised that actually with the modern transportation and travel .... the world is so connected you can no longer have a localised outbreak,” she said.
Did she realise then how big this would be?
“In public health, the NHS, and in local government and our local resilience fora, we rehearse for pandemics.
“Every rehearsal we had done had been for a disease for which there was a test and for which there was an antidote of some type, be it an antivi- ral or vaccine. We had not really appreciated that we might have a completely novel virus that there was not even a test for at the beginning.”
She describes the realisation of the reality of Covid-19 as being “sheer panic”.
“I think it was just sheer panic, to be honest, and the desire and the need to read as much as possible and look at the reports from elsewhere.
“I think when it got to Italy and started to overwhelm the health service, we had just never appreciated that health and care staff would actually be at personal risk to such an extent that the PPE that they were using may not protect them; that we needed to have far more increased standards for that so that we needed to nurse our Covid-positive patients in a very different way, and the separation of those Covid-positive patients became really important because of the spread within hospitals.
“We’d never had these situations where somebody may have just been together in a waiting-room and then suddenly they would all go down because of one case and it became really very, very concerning.
“So when there was a test that was a huge breakthrough, and the test made in Cardiff was a game-changer for the UK,” she said. Her job has been relentless during the pandemic, but in late spring both years there has been a point where she’s questioned “can we relax a little now?” as the period was, as she describes, a “steady state”.
In spring 2020 her thoughts were on a vaccine.
“As soon as we got to a steady state my thoughts turned to the vaccination programme because one was going to be needed. While we didn’t have a vaccine yet, 10 or more are being developed with no idea which one will be first out of the stocks. We need to prepare because whatever vaccine it’s going to be, the way that we’re going to have to do this at pace and scale is going to require a mass vaccination campaign model. So certainly all my very earlier experience became very relevant.”
Those involved in public health would, she says, happily get on with their jobs in the background.
“We would much prefer for all threats to be handled in the background and for the public to not know that all of these protections are being made all the time for their benefit. Nobody now asks, ‘What is public health?’” she says.
During the first peak she recalls the wait for a vaccine being approved as being the hardest point.
“We were waiting and waiting for the vaccine and were preparing, testing and getting plans from everybody how they were going to do the nursing homes and the mass vaccination campaigns, but we still didn’t have a vaccine yet and time was running out.
We did not have a template for this disease, apart from Sars, which had burned itself out
Dr Gill Richardson
“I’d see the figures of deaths, but it really hit home when the British Medical Journal did a photo-montage of all the medics that had died, the nurses and care workers who died, and it really struck me how this was ravaging through my colleagues who were trying to help on the frontline.”
Every day she would make herself read the figures about how many people had died – something she still does today.
“If you didn’t read it then you don’t really grasp why you’re doing something. You have to carry on reminding yourself that every single one of those has a family and that death was not expected and that death was usually premature.”
Dr Richardson takes the positives where she can.
“One benefit now is that the profile of vaccination as a protective measure has now, I suppose, been more appreciated.”
The other is the way the NHS has responded.
“Our NHS staff are used to being able to turn things around very, very quickly. It’s not easy and it means that, obviously, some things might suffer while you’re in that acute response.
“It’s not something you want forever, but as a surge response they are incredible, absolutely incredible.
“I think sometimes you do pinch yourself. When I visited the first mass vaccination centre and I realised just how quickly things had been put together, I did.”
That teamwork was brought home to her when she was working at the mass vaccination centre. From across the busy room someone shouted her name and was waving at her.
The other person, almost entirely covered in their scrubs and mask, was vaccinating a patient.
Dr Richardson, working elsewhere, couldn’t quite place who the covered person waving at her was.
During a break they found each other. It was her goddaughter, a physiotherapist.
“It was so lovely we were there together,” she said.
She also remembers the vaccine being given to Mary, a care home resident in Llandeilo, Carmarthenshire, and feeling “fantastic” that the process had started. But on the flipside there are people still refusing their vaccination.
How does she feel then when she hears people criticising vaccination or refusing to take up the offer?
“There are a lot of people that are very scared. They’ve lost their constancies, they’ve lost their anchors.
“If you think about young people growing up and their lives have been paused, they’ve either had to postpone weddings, they’ve not gone on holiday abroad, they’ve not gone to university or colleges, their careers have perhaps suffered.
“People have been at home, which if you’re middle-class and you live in a home with a garden, maybe that’s acceptable – but it’s difficult with children, isn’t it?
“But if you are a single person and you’re on your own, or if you’re a family living in high-rise and you cannot get out with your children, these things are really difficult.
“So I think some of the anti-vaccination sentiment is to do with people’s frustration, turmoil, at the way that their lives have been impacted by the pandemic.
“We have to try and understand – ‘How can we help you to see that the vaccination is actually our way out of this?’ That’s to do with trust, isn’t it? And if we don’t have trust in those that are telling us these messages, then we will reject the message if we don’t trust the messenger.
“So this is something we’re finding with pregnant ladies that we really need to use our midwives, who are trusted voices, to give their personal advice to that individual woman.”
The impact pregnant women not taking up the jab has on her in particular is clear when she speaks for this interview, as well as in pleas she has made in press conferences.
“At the beginning of the campaign we were being extra-careful, but now, if we don’t advise you to have this vaccine, you could be one of those most intensive ITU patients.
“When we looked at figures in England of the women on this horrific, intensive treatment called ECMO and the fact that one in six are unvaccinated pregnant women... Those women were trying to do the very best for themselves and their baby and they were cautious and that’s why they haven’t had the vaccine, but then their family is now missing them.
“And their newborn baby may survive without them and that’s just, you know, that’s heartbreaking, isn’t it? And it’s a preventable death.”
There are reasons to be optimistic, Dr Richardson insists, despite Omicron and fears over what that will mean for people and the wider health service too.
“We are so much further on than we were at the beginning. We have a raft of vaccines in use and we now know that we can create new vaccines for new variants.
“So just as when Spanish flu swept through the world and then eventually we have vaccines and eventually the vaccines got better, now the vaccines are tweaked every year and it’s a bespoke vaccine every year.
“We’ll be in that place with coronavirus.
“It may take us a couple of years to get there, but we will definitely be there. So eventually we will settle into a rhythm with this disease of knowing who needs to be protected and what interval and, for most of us, hopefully it’s not going to be any more frequent than annual, but for some, the more vulnerable, it might be more frequent just at the beginning until we’ve all got immunity.
“The other thing that happens with viruses – and this is what happened with Sars – is that viruses can burn themselves out also and become less virulent.
“The last thing that actually a virus wants is to kill every person that it impacts because actually what it really wants is to not compromise its host too much and be able to circulate.
“Some can go the other way, obviously, but usually we have got clues and we can see we are now tracking the genetics of coronavirus across the world, really, that Covid-19 virus is really something we know a lot more about.
“We’ve got antivirals now that are coming down the line – some of which can be given in the community so people wouldn’t even need to be in hospital to have something which was a trial drug, you know, just 10 months ago.”
And, she says, when that happens, she and her public health colleagues will happily return to the background.
“Most of us will be very happy to go back to having entertainment other than Downing Street addresses and press conferences,” she laughs.