Getting an effective covid vaccine is just the first step

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We have been warned about the logistical problems we will face when the transition period ends on 31 December and we formally leave the EU single market and customs union. We know there will be supply chain problems affecting imported goods, including food and medicine. But the logistical nightmare doesn’t stop there and covid vaccine distribution will add yet another complication.

The biggest challenge for Covid-19 vaccines is the cold supply chain, where temperatures need to be as low as -80c over extended periods. Deutsche Post DHL has already stated that easy access to any vaccine will elude anyone in the world where it is impossible to store it at freezing temperatures. Apart from the health consequences, the implication is that getting access to the vaccine will be complicated and costly.

UPS has started building storage facilities larger than football fields in the US, and Venlo in the Netherlands. The idea is that ‘freezer farms’ will store millions of doses in two-metre tall fridges set to -80c and send the vaccines out when and where needed. The vaccines from some manufacturers can be kept unfrozen for one day at 2–8c and a maximum of two hours at room temperature. Any failure in the cold supply chain will potentially be disastrous.

While the vaccine developed with the University of Oxford by AstraZeneca and Sanofi-GSK may be shipped unfrozen, its shelf life is unclear. In August 2020, the EU Commission signed a first contract for 300 million doses with AstraZeneca on behalf of the member states, with a further 100 million doses being distributed on a population-based pro-rata basis. Advanced purchase agreements are used to buy the vaccines under the EU’s Emergency Support Instrument, and according to the EU Vaccines Strategy, it is expected that from around summer next year, high-quality, safe, effective and affordable vaccines will be available.

In the meantime, eyes are focused on averting impending tragedy. Ahead of the EU’s covid summit, the European Council president Charles Michel this week urged member states to adopt covid tests, common rules on virus management and steps to avert vaccine ‘chaos’. These steps include defining criteria for distributing vaccines among the various countries, a refrigeration infrastructure, identifying priority groups for vaccination and getting a clear picture of what is going on across the continent, including the UK. In this scenario, banging on about national sovereignty is plain crazy. Coordination is vital to save lives.

Here in the UK, similar conclusions have been reached by the all-party parliamentary group on coronavirus, which has been taking evidence from experts and members of the public over the summer, in order to learn lessons from the first wave and put in place an effective strategy. On Tuesday, the cross-party group of MPs published a detailed Covid-Secure UK exit strategy that it says the UK should adopt, in order to avoid continuous lockdowns ahead of a viable vaccine or other protective remedy being available.

It calls for a three-step plan:

  • Control – bring the reproduction rate down and control community transmission
  • Suppress – minimise transmission within the UK by combating infection across borders
  • Eliminate – through a nationwide vaccine rollout once available.

The strategy relies on local public health organisations managing the response to flare-ups with national funding, rather than central government playing local governments off against each other. So public health directors need access to the appropriate data, resources and authorities to scale-up and mobilise as necessary, and at pace. Moreover, unless there is clear communication with the public, we will all be left wondering what the rules are.

Among other things, the Covid-Secure strategy recommends that national broadcasters should do local covid updates alongside weather bulletins and online; daily covid briefings should be reinstated; home working should be encouraged and face masks made mandatory for those working indoors and in close proximity to others. There must be financial support to ensure that those having to self-isolate or on zero-hours contracts get a decent living wage.

But combating transmission also needs effective quarantine rules and enforcement, and screening programmes outside health and care homes, to include public transport and public spaces. Border testing for international travel needs to be mandatory. Heathrow airport started departure testing this month, because some countries (Hong Kong and Italy, for example) require negative test certificates from arrivals. Other UK airports may soon follow suit, but airports elsewhere have been doing this for some time, such as Paris Charles de Gaulle, which has now overtaken Heathrow as Europe’s busiest airport.

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Of course, those with enough money can already access various forms of testing. Several companies, including Superdrug, offer tests that show if you’ve previously had Covid-19 (and therefore have some antibodies), with costs varying from £85 to £130. If you want to know if you currently have covid, but are symptom free, you can get a test from Boots for £120. And if you have symptoms of course, you can be tested for free via the government’s ‘NHS’ testing programme which has been outsourced to Serco.

So what will happen when it comes to rolling out a vaccine and will this also be dependent on a person’s income? What ethical reflection has taken place in the UK to balance and assess the needs of priority groups? It is widely thought that when vaccines become available, frontline healthcare workers will be immunised first, and then maybe the most vulnerable in care or hospital settings, which are hotbeds of infection in many western countries.

But access to these vaccines will also depend on availability, and in the UK Brexit is likely to aggravate cold supply chain disruption. This is, of course, entirely avoidable given political will; but that doesn’t currently exist. So we face a very uncertain future where we can expect a lot more bluster, rhetoric, and untold damage to our collective health.

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