Andy Cowper: Hope of a covid-19 vaccine is good news, but comes with many uncertainties

The announcement on Monday of a covid-19 vaccine candidate feels as if it has changed the game in dealing with covid-19. According to a press release of the Phase III study, the vaccine shows 90% effectiveness in preventing covid-19 in participants without evidence of prior infection. The study enrolled 43,538 participants.

Of course, it does and it doesn’t change the game. What it shows us is that production of an effective covid-19 vaccine is possible, and Phase III trial results for other vaccines are likely to follow shortly. That is all provisionally good news.

Alongside it come a range of uncertainties. Some of these are obvious clinical issues, which writers with clinical expertise will cover for The BMJ: safety in a wider and more diverse (in age and health status) patient population; are there differences in response by sex; do these vaccines offer only protection, or prevent spread; how long does the immunity conferred by these vaccines last? These will be best left to the consideration of clinical experts, one of which I am not. The Joint Committee on Vaccination and Immunisation’s prioritisation outline plans are here. 

However, the logistical and practical challenges of how these vaccine(s) will be delivered deserve some thought. 

News reports suggest that this Pfizer/BioNTech RNA vaccine must be kept at temperatures below -70 degrees centigrade, and given in two doses. This creates some logistical challenges, if the plan had been to deliver this through GP surgeries: the cold chain storage technology is currently not in place in those premises.

This suggests the likelihood that for its delivery, a range of regional vaccination centres will be set up, with extensive use of insulated packages delivered by courier and packed in dry ice. News coverage on Reuters and the Wall Street Journal notes that Pfizer has already developed a storage and delivery plan in 1,000-5,000 dose containers.

The Reuters coverage also observes that other candidate vaccines may not need to be stored at such low temperatures. This brings in the issue of public, political, and media pressure for vaccination.

Vaccine hesitancy

While there has been a fringe “anti-lockdown’ movement in the UK—as in many countries—the majority of opinion polls in the UK have suggested that participants report that they strongly support the lockdown measures introduced to slow the spread of covid-19.

This support appears to have increased as the second wave of covid-19 has grown. Using examples from more respected polling firms, Ipsos MORI research in late September found that less than half of the representative sample polled favoured a second national lockdown. Just six weeks later, polling by YouGov at the end of October found that two-thirds (67%) of respondents would be in favour of this decision, with a quarter (26%) opposed

This suggests that, as Sky News and Times correspondent Ed Conway observed, the evidence base for widespread “vaccine hesitancy” is also not terribly convincing, out with fringe self-radicalising online communities. Conway points to this article in the journal Vaccine, from July this year. 

Behavioural expert and “Nudge” author Cass Sunstein wrote this interesting piece for Bloomberg on things to consider to reduce friction for those who may tend to be less willing to be vaccinated.

Indeed, the problem that may arise will be that the court of public opinion, hungry for a return to normality, wants the vaccine more quickly than logistics will easily allow.

If this is so, that presents the UK’s healthcare industry with both an opportunity and a threat. The opportunity is to explain and celebrate the science that has brought us nearer to tackling this potentially fatal respiratory global pandemic; also, to use any new chain of national vaccination centres to take any and all available opportunities to do catch-up and prioritisation-focused diagnostics and screening. It could even be used for health education for the population who lost out on access to NHS services during the near-total shutdown caused by the pressures of the first wave of covid-19.

We also need to give ethical and logistical consideration to having covid-19 vaccine “passports”, to enable more of the economy and society to open back up once it is safe to do so.

The threat would be around arguments over funding for local primary care delivery, and high-handed communication and incompetent delivery. On all these grounds, we must hope that Test And Trace boss Dido Harding is kept very far away from the vaccination logistics programme.


Andy Cowper is a freelance journalist and editor of Health Policy Insight.

Competing interests: None declared.