Robert Peston Robert Peston

The difficult vaccine debate we’ve shied away from

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The Prime Minister only has himself to blame for the public outcry over 70-year-olds being vaccinated when there are still many over 80-year-olds waiting even to be invited to be vaccinated. What I mean by this is that there was a perfectly good argument for vaccinating 70-to-80 year olds before the more elderly, or at the same time. But Boris Johnson eliminated all debate about that when he ordered the Joint Committee on Vaccination and Immunisation to organise the vaccination programme so that deaths from or with Covid-19 should be cut as rapidly as possible.

As Professor Lim Wei Shen, chair of immunisation at the JCVI, told Jeremy Hunt’s health committee last week, it was this instruction from the PM and the health secretary that meant residents in care homes, with their carers, and those over 80 would be vaccinated before anyone else. If those priorities aren’t being met, it’s by definition a government failure. But, as ministers concede to me, it would have been rational and humane for the PM to have issued different instructions for who gets the vaccine first, rather than his simple order to cut the number of death certificates mentioning Covid-19.

The brutal point is that a 70-year-old is likely to have more good quality years ahead of them – what are called ‘quality adjusted life years’ – than a 90-year-old. Saving one 70-year-old from a Covid-19 death is likely to preserve more ‘quality adjusted life years’ than saving one 90-year-old. So although vaccinating 85-year-olds before 70-year-olds will probably reduce the number of deaths directly caused by Covid-19 fastest, simply because the mortality rate from Covid-19 rises so fast with age, that prioritisation does not necessarily maximise the preservation of ‘quality adjusted life years’. 

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