‘If you sail a massive liner across the Atlantic, you are going to have to make at least one course correction.’ This was the analogy used by professor Jonathan Van-Tam, the UK’s deputy chief medical officer, when explaining why the UK has opted to change its approach to vaccinating healthy 18 to 29-year-olds. For this group, officials argue, there is no point in taking any risk whatsoever, no matter how negligible, and that instead they should be offered the Pfizer-BioNTech or Moderna vaccines instead of Oxford-AstraZeneca.
On the one hand, from a clinical perspective, this seems very reasonable — why take any risks if there is a better choice available? But managing pandemics isn’t just about making course corrections to navigate around the currents of clinical risk. It’s also about understanding how to strategically work with the public, to build trust that motivates them, and to foresee how their perceptions might impact upon their choices. This is what distinguishes the public health approach to pandemic management from the clinical approach. In this case, I fear that the public health perspective might have been overlooked.
When professor Wei Shen Lim, chair of the Joint Committee on Vaccination and Immunisation’s Covid response, said the decision had been made out of the ‘utmost caution’. But what about being cautious of the impact this choice might have upon the public’s confidence towards Covid-19 vaccines? Vaccine hesitancy presents a far greater danger and risk to public health than the negligible risk of developing a cerebral blood clot — a hypothesised side effect that still cannot be confidently connected to the vaccine. Indeed, recent research by Imperial College London has estimated that vaccine hesitancy could lead to an additional 236 deaths per million population. This is far higher than the estimated 18 fatal cases of blood clots identified among 25 million Europeans who have had the jab.
What we need now is urgent action to re-vitalise vaccine confidence, especially towards AstraZeneca and other similar vaccines (such as Johnson & Johnson). This will be particularly crucial for those aged just above the 18 to 29 threshold, many of whom are likely to be left wondering why authorities think AstraZeneca is good enough for them but not for their slightly younger counterparts. Efforts have to also be re-doubled in those groups who we already know are most hesitant towards vaccination, namely younger people in general, parents living with a young dependent child, those in socially deprived areas and some ethnic minority communities.
Ultimately, professor Van-Tam’s analogy was accurate — the UK’s Covid-19 vaccination rollout is like sailing a massive liner across an open ocean. A careful eye on the dangers of new currents is needed for making reasonable course adjustments, but we also need an eye on our destination too, in this case the elimination of Covid-19. Our best bet for achieving this is through a vaccination programme that has very high uptake across all groups. So efforts to boost vaccine confidence should be the central priority.