I am considering cancelling my second Covid-19 vaccination. I received my first jab in March, and at the time I happily booked the date for the second one in June, confident that by then we would be continuing to see a fall in infections.
But last week the story changed. The B.1.617.2 variant, first identified in India, could, according to Sage minutes, be 50 per cent more transmissible than the variant identified in Kent. Early numbers suggest we could be at the start of an exponential growth in infections. The lesson of the past year is that if you wait to act until you’re certain of the data, you’re too late in changing your plans. Here, therefore, are four areas to consider now.
In the race between vaccines and the virus, we are still constrained by supply, so wouldn’t it be better if people who, like me, have already had Covid cancelled our second jabs and waited for the planned autumn booster, thereby allowing others to have their first shot instead? While when infections were very low it made sense not to use the AstraZeneca shot for the under-thirties, this decision might need revisiting if infections rise. Should we tighten up the restrictions for those travelling from amber countries such as France where 10 per cent of infections in Paris are from the more vaccine-busting South African variant? And would face masks in schools now make sense? Let’s illustrate how the Indian variant might have shifted the balance by looking at the first of these.
The science in our understanding of vaccines is evolving, but recent US research has shown that those of us who suffered from Covid last year are at least as strongly protected after one jab as those who had not suffered from Covid are after two vaccine shots. The second jab seems less vital for those who have had Covid.
So what would be the impact of giving up my second shot and waiting about 16 weeks for the booster? Let’s look at some rough numbers. In spring last year, a 55-year-old had roughly a 200-in-a-million chance of dying from Covid in a 16-week period, according to research by David Spiegelhalter. These numbers will have improved given lower infection rates and better treatments, but they’re good enough for rough estimates. Research suggests that the level of immunity after two doses of the vaccine reduces the risk of death by a factor of around 30. So we can guess that for anyone who’s had the bug and one jab, it’s roughly the same, working out at a death rate of seven in a million (200 divided by 30) in a 16-week period for a 55-year-old. To put this in context, it’s about the same risk as a scuba dive or driving 1,700 miles.
Now let’s compare this with the death rate for a 35-year-old, the age range that would benefit if I gave up my second dose. Unvaccinated, the chance of death is -roughly 30 in a million in a 16-week period. A single dose of the vaccine reduces the death rate by around 80 per cent, so that would mean a reduction in the likelihood of death of around 24 in a million in a 16-week period. That’s more than three times more deaths avoided if those who have had Covid give up their second jabs — and that’s an underestimate as it assumes the second jab would give us total immunity.
Then there are the deaths avoided by reducing transmission. Despite the success of the overall vaccination programme, there are still more than two million of the at-risk 50-plus age group who have not been vaccinated. This problem is more acute among some ethnic groups, according to NHS data, with more than 30 per cent of the black over-fifties still unvaccinated. At current progress it’s going to take more than a year to vaccinate the higher-risk over-seventies black or South Asians, according to data from Oxford University’s OpenSAFELY analytics platform, though the Health Secretary has said uptake has increased. The higher transmission from the Indian variant will eventually cause more deaths as the virus ‘finds’ the at-risk individuals who have so far not taken up the vaccination, as we are already seeing in Bolton. Vaccinating a greater proportion of the population with first doses would reduce overall transmission, giving us time to encourage take-up among the hesitant.
In the UK, I estimate between ten and 15 million have had Covid. This number is, incidentally, much larger than the 4.5 million on the government’s website, as the government figure only includes those who have tested positive. Currently we are administering around 400,000 second doses a day. If half of those who have had Covid postponed their second jabs, this would free up roughly 40,000 doses a day, allowing a 20 per cent increase in first-dose vaccinations. This would be enough to vaccinate in the next month all those still unvaccinated who are likely to act as spreaders: the police, teachers, firefighters, railway staff, posties, checkout staff and delivery workers.
Now I realise that communications could be complex and it could cause confusion among the vaccine-hesitant. Eleanor Riley, professor of immunology and infectious disease at the University of Edinburgh, captured the challenge when she said (prior to the rise of the Indian variant) that while people who have had Covid may require only one dose of the vaccine, ‘incorporating this into a mass vaccination programme may be logistically complex and it may be safer, overall, to ensure that everyone gets two’.
But the rise of the Indian variant might have changed the balance here. Indeed, we could use those giving up their second jabs as part of a campaign for the unvaccinated to take up the vaccine. And isn’t our whole approach to unlocking meant to be about personal judgment on the balance of risk? We have the power to decide who we should hug, how far apart we should sit and whether to meet inside or outside. Why should this judgment not extend to whether I should take the risk of delaying my second jab?
So Boris Johnson, Matt Hancock, Patrick Vallance and Chris Whitty, as you requested, I am ready to take personal responsibility in the next phase of our response to Covid. I need to know from you if my maths is right, and if it is, I’d like others who have had Covid and one jab to consider joining me in giving up our second jabs, for the greater good.
This piece was written in a personal capacity.