The hesitancy paradox of “data, not dates” and the government’s roadmap to unlocking

It’s a mistake for the government to be so opaque about the data they’ll use to guide our exit from lockdown, writes Andy Cowper

As schools return in England, the government’s roadmap to lifting covid-19 restrictions comes into sharper focus. There is, of course, a risk that the return of in-person education for all in schools (rather than just for vulnerable children or the children of key workers, as previously) will drive an increase in the transmission of covid-19.

The principle expounded by prime minister Boris Johnson at the roadmap’s launch was that the lifting of lockdown restrictions would be driven by “data, not dates.”

Inevitably, the four stages listed in this document (of which stage one is actually two separate stages: the 8 March “schools reopening” and the 29 March “rule of six/two families outdoors/outdoor sport”) were accompanied by indicative dates, albeit with an emphasis of “no earlier than” and a five week gap between each to assess the impacts of the last stage’s easing of restrictions. This five week gap provides the government with four weeks’ data to allow assessment of the last changes’ impact; followed by one week’s notice for businesses and communities to prepare.

To guide its assessment of progress, the government set itself four rules:

  1. The vaccine deployment programme continues successfully.
  2. Evidence shows vaccines are sufficiently effective in reducing hospitalisations and deaths in those vaccinated.
  3. Infection rates do not risk a surge in hospitalisations, which would put unsustainable pressure on the NHS.
  4. Our assessment of the risks is not fundamentally changed by new “variants of concern.”

That all seems quite sensible. What is more opaque, however, is the actual data and thresholds that will be used to guide their decision making. It is not obviously clear why this should not be clarified.

Given the levels of anxiety or paranoia among some parts of the community about covid-19 being a hoax (which, of course, it isn’t), and that research shows thatgender, education, and ethnicity were independently associated with vaccine hesitancy,” this feels like a mistake. Research has also shown that vaccine take-up is lower among ethnic minority NHS staff.

The hesitancy paradox

More than a mistake, the failure to release this information could actually become a paradox. To date, take-up of the vaccine has been high: the figures show well over 90% in the 65+ age groups targeted so far. This is unsurprising, as the most vulnerable groups have been first to be offered the vaccine: those at highest risk of serious illness can most see its importance to them. Analyst Duncan Robertson has offered pertinent analysis of the take-up data.

Yet given that vaccine hesitancy lies more in the populations yet to be vaccinated, it would obviously mitigate against the government’s first self-test if the lack of maximum transparency about the data and criteria to be used were to entrench these worries—however scientifically illiterate they may be.

We also need to bear in mind the legacy of public concern about the government’s handling of the pandemic so far. Research in December 2020 found that the majority of UK respondents distrusted the government’s handling of the pandemic: this distrust had doubled since the start of the pandemic. This study also found that nearly two thirds (64%) of respondents thought that the UK government had failed to prepare properly for a second wave of SARS-CoV-2 infections.

The vaccination programme and its procurement have been rare bright spots in the government’s pandemic response. For many, the refusal to take SAGE’s September 2020 advice for a circuit breaker lockdown, and the subsequent rising tide of infections (clashing with the government’s “save Christmas” narrative), brought us the dreadful toll of the second national wave over the past few months.

As health economist Professor John Appleby pointed out at the end of January 2021, “50% of all covid-19 deaths in the UK have happened over the last two and a half months.”

The covid-19 public inquiry is going to be a big event.


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

Competing interests: none declared.