Beware of the perpetual cycle of Covid vaccines for all
The vaccine roll-out of 2021 was a great success, representing an extraordinary marriage of bureaucratic coordination and scientific expertise. To date, almost half the world’s population has had two doses of a vaccine designed to prevent severe outcomes from Covid-19. Over eight billion doses have been delivered – I’ve had three of them. The vaccines have done a good job in relieving the Covid burden on our health services, even when cases are running at high levels, allowing those in need of care access to it.
It was in part thanks to vaccines that over the summer and autumn we had a glimpse of what a future post-Covid world might look like – where life resumes some of its pre-crisis patterns, children have meaningful access to education and livelihoods are no longer held to be conditional on NHS capacity.
We seemed to be moving to a new consensus, learning to live with Covid by balancing medical risks with the desire to avoid inflicting serious social harm.
Eventually, we will accept that we might well catch Covid once, twice, three or four times in our lifetimes, much like the dozens of respiratory viruses that circulate in the human population. We will also accept that one of those viruses might end up killing us when we are geriatric if we are lucky to live to a distinguished age. For those who live with serious medical conditions and vulnerabilities, annual booster shots will become the norm, much like they are with seasonal flu, a historically important driver of mortality in the winter months.
The arrival of the omicron variant on these shores has now disrupted that fragile consensus. It has lent increased moral currency to an alternative view, rooted in dangerous assumptions that the Covid “state of exception” is here to stay forever.
In this view, the government and our medical authorities are always behind the curve and too late in taking action. There must always be more action on a safety first basis.
Britain’s booster campaign has been a “shambles”, the thinking goes – far too slow. Now Israel is recommending a fourth dose of a Covid-19 vaccine to over-60s, the cry goes up, why aren’t we? Alex Wickham, in this morning’s Politico Playbook email, commented: “There will be questions for the JCVI on when it will approve a fourth dose for general use in the UK.” Over the summer, the JCVI hummed and hawed about licensing Covid vaccines to children before eventually doing so. Critics deemed it far too slow, again.
There is a lot of magical thinking going on here. In the summer and early autumn, the NHS had barely finished rolling out first and second doses to the whole population. Our booster campaign is speedy in comparison to other western countries. There were a few hiccups, of course, when clinically vulnerable patients found access tricky. But by the time the Omicron variant had emerged, the portion of the population that accounts for most of the mortality from Covid had been given a third shot.
Can the NHS sustain a never-ending booster campaign alongside all the other post-crisis pressures on our health services? It seems doubtful and isn’t desirable when there are many other conditions that need treating.
The case for vaccines for children and teenagers remains a highly contentious topic where the harms and benefits are finely balanced. Indeed, until we have a vaccine that produces sterilising immunity (meaning we can no longer pass the virus on) and has no safety issues, reasonable people will continue to disagree over the relative benefits of giving vaccines to the segments of the population least at risk from the direct harms of the virus.
The vaccines are a wonderful tool and have allowed the health service precious time to recuperate while elements of normality have returned. But we should be very wary of the more ambitious claims made for the vaccine roll-outs – that without future vaccine roll-outs, efficiently executed and covering the entire population, livelihoods must be held forever contingent on rising Covid case numbers.
Getting locked into this cycle of living by endless vaccination would be a mistake.
The reasoning of those demanding it is a highly seductive addition to a long century of myth-making about the role of the biomedical sciences. Following advances in the leading medical centres in Europe and America in the first decades of the 20thcentury, doctors began to acquire immense professional status. Long gone were the quacks and apothecaries of the 19th century when medicine had a more limited role – to alleviate symptoms of common maladies, rather than to cure them.
What followed was an almighty coming together of the worlds of medicine and marketing. We live with its potent legacy.
For a glimpse of what can go wrong, read New Yorker journalist Patrick Radden Keefe’s history of the Sackler dynasty, Empire of Pain, published this year. It shows what went wrong when the world of advertising cottoned onto the potentially limitless market for new drugs prescribed to the public by trusted practitioners of the medical profession.
Idealistic admen, like Arthur Sackler who made his fortune in marketing Valium as a cure-all for “psychic tension,” believed they were doing God’s work. “In describing an ideal patient, a typical ad for Valium read, ’35, single and psychoneurotic’,” writes Radden Keefe. No wonder then that drug became popularly known as “penicillin for the blues.”
A near-magical partnership of advertising and scientific expertise, as Sackler saw it, would allow pharmaceutical companies to roll-out new therapies to the mass market in double-quick style, saving countless lives in the process. As a result of this virtuous cycle of scientific advances and efficient marketing, he believed that mankind would eventually “thwart the inevitability of death”.
But life is messier than that and drugs cannot beat the blues on their own. In fact, Sackler’s idealism about drugs and marketing would eventually contribute to America’s worst public health disaster in living memory, the ongoing opioid crisis.
By contrast, the Covid vaccines are safe and effective. They have been associated with a few direct harms, such as the clotting issue with the AZ vaccine. No medicine is 100 per cent effective and devoid of side effects.
But however efficiently they are executed, perpetual vaccine roll-outs have downsides and will not always come to the rescue. And there will always be an uncomfortable minority who refuse to take them, for whatever reason.
Vaccines do not liberate us from the fundamental questions posed to us by the return of infectious disease after decades of relative abeyance in the West – not only questions about the relative merits of our health systems but our appetite for risk and how far we weigh our own mortality in the balance.