We should not rely on a vaccine to restore normal life

Rushing one through could end up shattering public confidence in our health system

Hold your breath till we get there. It’s just another six months. It’s only till there is a vaccine and that will be before spring, right? Then this whole annoying, ghastly illness can go away. Well, yes, maybe, except that it isn’t quite that simple. In fact, the intense expectation that a perfect vaccine will soon appear and that normal life cannot resume until that happens could end up being far more dangerous than Covid itself.

For one thing, we don’t know how effective any vaccine will be. Most vaccines we take have efficacy rates of over 90 per cent, meaning they block infection in 90 per cent of cases. The Covid vaccines now being trialled have a target efficacy rate of 50-60 per cent. That would, of course, still be huge progress and could also reduce the severity of the disease in those who do get it, but it is not quite the same as eradicating 90 per cent of cases.

This is particularly true if significant numbers of people are not actually willing to take a vaccine. The unavoidable backdrop to Covid-19 is that anti-vaccine sentiment is on the rise. Indeed, Western Europe is the most vaccine-sceptical region of the world, according to a 2018 survey by the Wellcome Global Monitor, which found that only 59 per cent agree “vaccines are safe”, versus 22 per cent who disagree. In North America, by contrast, the figures were 85 per cent versus under 5 per cent.

Contrary to its supposed “Brexit idiot” image, the UK is much less sceptical than our neighbours on the Continent. But we could be dealing with another factor by the time a vaccine is available: declining fear of the virus. A Yougov survey conducted twice, once in July and once in early October, found the proportion of people willing to take a Covid-19 vaccine fell from 71 per cent to 65 per cent. What will that figure be in March next year?

This reflects how I feel. In general, I would class myself as a fervent pro-vaxxer, if there is such a term. When mothers in baby groups say things like, “There are too many vaccines nowadays”, I think quietly that they ought to try a spell living in the slums of London in the early 1900s surrounded by polio and whooping cough. My feelings about the Andrew Wakefields of this world are not fit for print.

But if I were surveyed by Yougov, I am not sure how I would answer, for two reasons. Firstly, I am no longer scared of Covid. I think I have probably had it and even if I haven’t, all the data suggests my risk of a severe case is vanishingly small. Unless the vulnerable people around me are unable to be vaccinated, then getting immunised will not be a priority.

Secondly, at the risk of being labelled an irresponsible cave dweller, I must admit that I will not have the confidence in a Covid vaccine that I have in the MMR. There is an unprecedented amount of political and economic pressure on getting a vaccine across the line and regulatory bodies have been explicit: as soon as they deem it safe, they will issue “emergency” authorisations ahead of when they would normally do so. Longer term safety trials will continue as the vaccine is rolled out.

For an elderly person with diabetes or a heart condition, getting vaccinated as soon as possible makes obvious sense. Covid’s estimated infection fatality rate for those over 70 ranges from 1 to 5 per cent (and up to 10 per cent for the very elderly). That means it is well worth taking the small risk of adverse effects from a rushed vaccine to get normal life back. For healthcare workers too, whose fatality rates and exposure tend to be higher than most, vaccination is an urgent priority. But not only is it unnecessary to roll out a vaccine quickly to the general population; it is a very bad idea.

This is because it is much, much more important to protect the reputation of the medical system than it is to protect non-vulnerable people. The US provides a case study in what not to do. This year, the US Food and Drug Administration has twice issued “emergency use authorisations” that may have irreparably sullied its reputation.

In April, it authorised use of hydroxychloroquine to treat Covid, a decision that had to be revoked within two months after research concluded that the drug’s risks did not actually outweigh its wholly unproven benefits. In August, it authorised the use of convalescent plasma, a decision almost immediately followed by a statement from the US National Institute of Health that there was no evidence to support either its safety or efficacy. This is a reputational disaster.

There is also precedent on the vaccine front. In 2009, swine flu emerged in Mexico and quickly spread in North America. With lightning speed, work began on a vaccine, an indemnity was handed to drug makers and within a year, a jab was rushed into service. Several years later, a downside emerged. It turned out that in extremely rare cases – one in 55,000 – the vaccine caused debilitating narcolepsy. Its use was discontinued.

I mention these incidents not to fan the flames of anti-vaccine sentiment, though I will no doubt be accused of doing so, but for the opposite reason. Rushing treatments or a vaccine through the approvals process has potentially catastrophic consequences. The vaccine is not likely to be very risky, but any unforeseen side effect that later emerges, however mild, could shatter public confidence in vaccines and taint the reputation of those whose efficacy and safety has been proved beyond doubt over many years. If that were to happen, a Covid vaccine could end up killing many more people than it saves.

We are all sick of this pandemic and ready for it to be over. But we need to start planning on the basis that a vaccine is not some magical fix that will end it forever. The Government should be honest that it will be a partial solution whose protective benefits may be incomplete. It will, as the head of the Vaccine Taskforce recently stated, mainly be given to the vulnerable. The rest of us should expect to live with the risk of getting Covid for a very long time.

After all, the worst outcome is not that the world fails to find a vaccine. The worst outcome is that we find one and it winds up putting millions of people off vaccines for good.

Regulatory bodies have been explicit: as soon as they deem it safe, they will issue ‘emergency’ authorisations