Following the approval of the first Covid-19 vaccine last week came the announcement that the government will be rolling out a vaccination programme for the Pfizer/BioNTech vaccine to care home residents and healthcare workers first, followed by tiers according to age and vulnerability.
Mass vaccination roll outs are intended to get the pandemic under control, prevent deaths, hospitalisations and infections. But each of these come with trade-offs in terms of who is vaccinated first, so which should be prioritised when considering public health vaccination strategies?
Currently, the government is signalling that it’s starting with “prevent deaths”. Care home residents are extraordinarily vulnerable to Covid-19 infections, and it’s well documented that the subsequent risk of dying significantly increases with both age and the presence of other conditions.
But this strategy doesn’t necessarily help to control the pandemic. Care home residents themselves don’t sustain infection rates in our communities. While they’re vulnerable to care staff and visitors bringing the infection to the care home, residents aren’t regularly going to schools, gigs, and pubs where they might pass the infection on to the general public.
Given this, it’s not clear that vaccinating according to age as opposed to other characteristics will have a meaningful impact on overall infection rates. In fact, this approach may not even be effective at minimising mortality in the long term, if it leaves transmission rates high in younger groups.
Instead, in choosing to vaccinate care home residents and the elderly first, the government is leaving large numbers of frontline workers - transport staff, retail workers, teachers, and hospitality staff - vulnerable. People in these roles interact with a higher than average number of strangers during the course of the day, and can act as a significant point of transmission if they’re infected.
While it’s true that age correlates with the likelihood of death from Covid-19, cases such as that of Belly Mujinga, a transport worker who died of Covid-19 after being spat at by a passenger, and the thousands of people experiencing “long Covid” symptoms for months after their initial infection, show that this infection can be life-changing, no matter your age.
Vaccinating frontline workers as a priority could not only save the lives of people vaccinated, but also reduce the risk of onward spread by these workers to the public, including vulnerable individuals. Even if the vaccines don’t completely prevent infection, study data has shown that they reduce symptomatic infection, and separate studies have also demonstrated that asymptomatic people are less infectious, slowing transmission.
Choosing not to vaccinate people according to their relative likelihood of infection and transmission means that it may be some time before we see the impact of vaccination on rates of infections in the UK. Restrictions on socialising and daily life are expected to continue well into the spring to keep infection rates low. So, while care homes first may be a sensible strategy to prevent deaths and NHS overwhelm in the short term, in the mid-term it means the pandemic will likely smoulder on, and may even get worse if people get fed up with winter restrictions and are lulled into a false sense of security by the availability of a vaccine.
Vaccination strategies are not straightforward. There are plenty of other factors public health officials will have considered such as the unknown long-term safety of the available mRNA vaccines, the need for booster shots in the future, and the logistical issues caused by the looming Brexit deadline. There are no simple answers.
But at the very least, frontline workers should be much further up the priority list than they currently are, if the government really wants to both “control the virus” and “save lives”.
