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Views And Reviews The Bottom Line

Partha Kar: The end of the tunnel, and the bumps on the way

BMJ 2021; 372 doi: (Published 19 January 2021) Cite this as: BMJ 2021;372:n128

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  1. Partha Kar, consultant in diabetes and endocrinology
  1. Portsmouth Hospitals NHS Trust
  1. drparthakar{at}
    Follow Partha on Twitter: @parthaskar

At the start of this new year, even as we’re buffeted by the unwelcome news of a more infective strain of covid, it feels at times as if we’re nearing the end of a long tunnel, with light just around the corner. Vaccines are being approved, and the health service is ramping up systems to ensure that vulnerable groups are protected.

The ongoing controversy around who is prioritised for covid vaccinations was probably to be expected, given all of the opinions, vested interests, politics, and stupidity surrounding discussion of the pandemic. The uproar is understandable given the inexplicable resistance to prioritising healthcare staff, especially in the face of a new variant. While we dithered, weighed up evidence, and debated, more healthcare professionals lost their lives.

What’s surprised me is the reluctance of many organisations to highlight this issue until quite recently. Any modelling should have shown the risk to hospitals, especially as the main thing the health and social care systems could ill afford to lose in a pandemic was staff. Yet, nearly a month or so after the fanfare of being the first in the world to administer the vaccine, the NHS still doesn’t have its staff fully covered. (Excuse the war analogy, but how do you send your troops out to battle without an adequate flak jacket? Memories from the PPE experience still fester—and in one decision process, the chance to uplift morale in a struggling workforce was seemingly squandered.)

Another tricky area has been prioritising people from ethnic minority backgrounds, whether healthcare staff or the population at large. Casual comments that the disproportionate impact of covid among ethnic minorities was simply linked to deprivation brought back memories of April, when data started emerging about increased risk to this population group. Many people wonder what “white privilege” is. In this instance, it’s a national committee making recommendations for vaccine prioritisation that make only a cursory mention of ethnicity (and even then not in criteria for prioritisation) and a system believing that this would suffice; that ethnicity would be taken into account anyway, even if it’s not highlighted specifically in national recommendations.

The absence of a national steer always opens things up to variation from local leadership. And, sure as clockwork, we now have variation in vaccination rates, depending on local leaders’ willingness to recognise ethnicity as a risk factor. When we know about the increased risk to people from ethnic minority backgrounds, and the lack of senior healthcare workers from those backgrounds represented in the media or indeed the committee, the silence from many, yet again, has been deafening. There’s much talk of improving care in the ethnic minority population, but it’s lacking at the crunch.

Add in the conundrum of Public Health England deciding to space out one vaccine’s dosing schedule on the basis of data from another vaccine, and any nervousness about such decisions is understandable. After all, the science underpinning PHE’s decision makes the scheduling change look like the kind of bold call that in American football is termed a “Hail Mary pass” (undertaken with great hope, given the chances of success). Undoubtedly, constraints on vaccine supply in the face of an out-of-control pandemic have forced these decisions. But this is still a decision that could either turn out to be a masterstroke, in a pandemic blighted by missteps, or a tumble of epic proportions.

And, yet, for all of the annoyance, there’s a palpable sense of hope and pride in how the NHS continues to step up, whether it be the camaraderie across specialties to bond together and help anywhere as needed or the determination of primary care—too often an unsung part of the NHS—to get the vaccination programme done.

There is hope that, come springtime, we may be in a significantly stronger position. However tough it appears now, there’s a belief that this could indeed be the last haul. For everyone involved in the fight against covid, the past year has been an effort and a half, and we’re due a big party to celebrate. Let’s hope it’s just a whisker away.