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Professor Alan Whiteside recently received his second dose of the AstraZeneca Covid-19 vaccine, in what he describes as a vaccination campaign of military precision in the UK. The professor describes his recent experience in the country’s evolving healthcare system as amazing but warns that people will increasingly be expected to take responsibility for their own health under the conservative government. With controversy swirling around the AstraZeneca jab, many countries have delayed the rollout of the AstraZeneca-Oxford vaccine. Norway was the first to raise alarm over a possible link between the inoculation and fatal blood clots when elderly patients succumbed shortly after receiving a dose. Denmark, Italy and Thailand joined Norway in delaying rollouts of the vaccine. European regulators have repeatedly voiced their support for the use of the vaccine, calling the clots ‘common’ and suggesting that they might have been coincidental. Professor Whiteside makes an assessment of Covid-19 infections and rollouts and the availability of vaccines in an ‘unequal world’. – Melani Nathan
Update on vaccinations 24th March 2021
By Prof. Alan Whiteside
I received my first Covid-19 vaccination on 12th March. The NHS team have taken over the food court in one of the malls in Norwich. They are operating with military precision, with appointments every five minutes. I entered the mostly deserted mall for my appointment at 18h05. Numerous people were on hand to guide the patients up to the area where the shots are being administered. It was extremely efficient. My name was checked off the list, I waited in socially-distanced seating, and was taken forward for questions to establish I was healthy and did not have any critical allergies. I then went to a nurse, bared my upper arm, was given the immunisation, and sent on my way.
The vaccination programme has been an astonishing success in the United Kingdom. By Tuesday there had been 27,997,976 people given their first dose and 2,281,384 had received both. It gives us hope that the planned relaxation in the lockdown can begin. However, supply issues may delay this.
The hernia repair I described in my last letter is healing slowly. Having to self-inject the blood thinner was horrible, but that is now over. This experience, combined with the vaccination roll out, confirms the UKs health service is amazing. But it is increasingly clear one of the results of the pandemic is people will be expected to take more responsibility for their health. The self-administration of the post-operative blood thinner is one example. Self-testing for Covid-19 is another. Education staff, teachers and ancillary workers are expected to test themselves three times a week. Self-isolation is, as the name suggests, something one must take one’s own responsibly for.
Access to the health system is constrained and responsibility for gatekeeping is being devolved. I am not sure what the role of the General Practitioner will be post-Covid-19. An additional problem is that this transformation is taking place in the UK under a conservative government, and they are not a compassionate people’s government. There are calls for an inquiry into the pandemic’s handling. So, let us begin by looking at what is going on around the world. First, there is an anniversary, yesterday it was a year since the UK went into lockdown. There is a growing restlessness and civil disobedience. Second, I have been writing communiques for over a year.
Globally the number of new cases is rising slightly, with about 125,000,000 recorded since the beginning of the epidemic. The largest numbers are in the USA, about 30,000,000: a quarter of global cases! The numbers fell from the peak of just over a quarter of a million cases per day in February to about 50,000 now, the seven-day average on the 22nd March shows a slight increase.
In presenting data on the countries, I use bold to indicate rising numbers and italics to indicate where they are falling. The USA is followed by Brazil 11,998,233; India 11,646,081; then a gap to Russia 4,416,226; the United Kingdom 4,310,195; France 4,277,796; Italy 3,376,376; Spain 3,212,332 and Turkey 3,013,122. The countries with between two and three million cases are Germany, Colombia, Argentina, Mexico and Poland. In my final two countries: South Africa has just over 1.5 million cases and Canada about 950,000, and the numbers seem static.
The Economist’s daily chart for 19th March shows: “Covid-19 cases are rising again in much of the world: More transmissible variants, rather than changes in behaviour, are largely to blame”. Some countries, such as Ukraine and Poland, are facing exponential increases. The Economist notes: “The recent rise in global cases is worrying. They fell by half between January 11th and February 20th, but have since risen by 30% from that low point. Cases are currently highest in Europe, particularly in eastern Europe. Both Estonia and the Czech Republic are recording more than 100 new cases per 100,000 people a day. In the EU as a whole, that rate is 31 per 100,000, not far below the mid-January peak. Hospitals beds in the worst-affected places are full.”
The Telegraph notes: “Europe is bracing for a third wave of coronavirus forcing Italy to ban holiday travel, France into lockdown and Germany to consider breaking away from the EU’s vaccination program to buy Russian vaccines. Germany was expected to extend its shutdown as highly contagious variants of the virus took hold and wiped-out last month’s progress in containing the pandemic in the EU’s largest and richest country. Meanwhile, Emmanuel Macron was under fire after France imposed a month-long shutdown …”. In London Johnson warned the effects of a third wave of coronavirus will “wash up on our shores” from Europe. “The PM said the UK should be “under no illusion” we will “feel effects” of growing cases on the continent.”
Cases in Latin America are up by a third since February. Brazil is particularly badly hit. The situation in much of Asia seems to be stable with small numbers of cases, the exception is India where numbers have risen. Africa continues to baffle me. There have been many high-profile deaths – most recently John Magufuli, President of Tanzania who died in hospital in Nairobi: “We have lost our courageous leader … who has died from a heart illness.” He claimed Tanzania was Covid-free, “discouraged the use of face masks and advised his people to pray and undergo steam therapy to safeguard their health. While most of the rest of the world clamored to access vaccines, his administration eschewed them and said it was working on developing alternative natural remedies.” Tanzania has not published infection data since April 2020. Congo Brazzaville opposition leader Guy Brice Parfait Kolelas died while being evacuated to France for Covid treatment.
This is the issue dominating the headlines and discussions in Europe and the UK. In summary (on 23rd March 2021) there are three vaccines currently available in the UK and Europe. These are:
- Pfizer and BioNTech was the first vaccine. It costs £15 and must be stored at -70°C.
- Oxford University and AstraZeneca. This is the cheapest available so far at £3 per dose and can be stored in a fridge.
- The Moderna vaccine is the most expensive at £28 and it must be stored at -20°C.
There will probably be vaccines from Novavax (£12 per dose) and Johnson & Johnson (£7 per dose) available very soon. Both can be stored in a fridge and in the case of J&J only one dose is required. These are being assessed in the UK by the Medicines and Healthcare products Regulatory Agency (MHRA). The vaccines used in Europe have to be approved by the European Medicines Agency (EMA). When the UK left the European Union, they took complete control of the vaccine regulatory process. This may be the one Brexit blessing. The UK was able to take independent, rapid decisions!
There is a shortage of doses and consequently a war of words concerning, in particular, the Oxford/AstraZeneca vaccine. It was suggested it caused blood clots, but the EMA cleared it, so individual countries were deciding not to use it. In addition, and slightly bizarrely, the EU argues that they are not receiving the number of doses agreed with the company. They suggest the UK is being better treated and, in retaliation that other vaccines made in Europe (the Pfizer/BioNTech in particular), might not be exported to the UK. This has led to reports that Germany is seeking the Sputnik vaccine developed by Russia’s Gamaleya National Centre of Epidemiology and Microbiology. As can be seen from the Our World in Data graph the UK leads members of the OECD in vaccination.
The discussion about supply that is dominating the airwaves in Europe and the UK, is in my view, an unhelpful political distraction. There are unused stocks in Europe and the issue of vaccine hesitancy has not been addressed. Data suggests that this is highest in France and lowest in the UK. It also raises the thorny question of whether certain categories of employees (health and care workers for example) could be required to be immunised as a condition of employment. There are many unknowns with regard to the vaccine (which must be seen as a huge success in the UK and USA). How long will the protection last, how often will we need vaccination campaigns? Do we need to vaccinate everyone in a society? Who will pay where there is no national health service?
Sunday 21st March was census day in England. We were required to go on online, enter a code that was unique for each household and complete the form. Censuses are one of those geeky things that give me pleasure, indeed I remember the first census in Swaziland in 1966. The data gathered on these occasions is important for planning for counties and the country at large, so I was delighted to do this. At the same time, I am aware of the danger that information can be misused. There have been riots in the UK at lockdown protests thanks to a minority of demonstrators seeking conflict and overzealous policing. Similar incidents have been reported from the Netherlands, France and Poland.
A year ago, I began writing this blog ‘in order to give my friends and colleagues the information I thought they needed’. That was in a world overloaded with information, today there is even more but there are also more things we can be certain about. There are numerous places where data can be accessed. Many are easy to use and easily accessible. Over the year I have pointed to a number of these in the blog. Many countries have statistics offices and in the UK the Office of National Statistics (ONS) is a great resource.
Daniel Halperin defies easy classification, his PhD according to his CV is in Medical/Cultural Anthropology; Public Health/Epidemiology. I have known him for more years than either of us cares to admit. His publication ‘Facing COVID without Panic: 12 Common Myths and 12 Lesser Known Facts about the Pandemic Clearly Explained by an Epidemiologist’ is well worth getting hold of. One example of a myth is “Myth 7: “Social distancing” of at least six feet is always necessary”. What is most relevant is distance between people’s faces not their bodies – something to note on a crowded bus or tube. The fact – “Fact 10: The economic collapse and other outcomes of prolonged shutdowns have resulted in unprecedented consequences”, he notes, as of May 2020, 27 million Americans had lost their employee-based health insurance. I highly recommend this short, lucid and informative publication, and please do buy it, it is not expensive.
Peter Piot writing in the Telegraph says: “As for Covid, I think the most likely scenario a year from now is some seasonal outbreaks – just as we have for the flu – and endemic low grade coronavirus infections, but with much lower mortality thanks to vaccination. The future trajectory will also depend on the severity of unavoidable new variants and whether people will accept vaccines. I think a successful vaccination roll-out should also involve children otherwise they will be continuous reservoirs of infection. As for the idea of pursuing a ‘zero Covid’ strategy’ – I think that is an illusion. There is only one human virus that has ever been eradicated and that is smallpox.” This is a depressing conclusion. I don’t think the full implications of the pandemic are appreciated. We are going to have to fundamentally change the way we live and travel.
Book: Daniel T Halperin, ‘Facing COVID without Panic: 12 Common Myths and 12 Lesser Known Facts about the Pandemic Clearly Explained by an Epidemiologist’, Gillings School of Global Public Health University of North Carolina, Chapel Hill. https://www.amazon.com/Facing-COVID-Without-Panic-Epidemiologist-ebook/dp/B08D25GQX6
Article: up to the minute on AstraZeneca Heidi Larson, Want to Restore Trust in the AstraZeneca Vaccine? Start Here. Countries should know that a successful rollout is not just about delivery. https://www.nytimes.com/2021/03/22/opinion/astrazeneca-vaccine-trust.html (MUST READ)
 https://www.dailymaverick.co.za/article/2021-03-17-john-magufuli-tanzanian-leader-who-scoffed-at-covid-dies-at-61 – the italic is mine as this is not widely believed.
- Professor Alan Whiteside, OBE, is Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus at the University of KwaZulu-Natal.
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