Covid-19: UK’s pandemic inquiry prepares to hear from witnesses
BMJ 2023; 381 doi: https://doi.org/10.1136/bmj.p1314 (Published 08 June 2023) Cite this as: BMJ 2023;381:p1314Read our Covid Inquiry series
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Dear Editor
The COVID-19 inquiry and the benefit of hindsight
The covid inquiry might generate an opportunity to receive the benefit of hindsight in order to resolve the paradox of the outcome of the rapid rollout of the United Kingdom vaccination strategy.
Briefly, the UK initiated its vaccination rollout on the 8th December 2020 with the express aim of prioritising vaccination of older citizens. In order to expedite vaccination of the greatest number of subjects, the interval between the first dose and the second dose was increased from the recommended 3-4 weeks to 12 weeks. As a consequence, by the 26th January 2021, "more than 6.8 million people in the United Kingdom had received the first of two doses of coronavirus vaccine-either Pfizer-BionTech or the homegrown Oxford-AstraZeneca jab-and 472,000 others [had] gotten(sic) the second booster shot[1].
In other words, by the time the alpha variant had become the predominant strain, vastly more vaccinees had received only one dose of vaccine.
France, with comparable population size of approximately 68 million , initiated its own vaccination rollout on the 29th December 2020[2]. According to Castillo et al, a single dose of either the AstraZeneca vaccine or one of the mRNA vaccines was administered only to prospective vaccinees with evidence of previous Covid-19 infection. The rest of the prospective vaccinees of either of those vaccines received 2 full doses within the time frame recommended by the vaccine manufacturers[3].
By the 20th January 2021, the UK had far outstripped France in the number of recipients of any of the COVID-19 vaccines.
Surprisingly, however, by that date, the UK had recorded 1,354 Covid-associated deaths per million of its population, as opposed to France, with 1,057 deaths per million of its population[4].
Why did the UK not benefit as much as France, from its rapid vaccination rollout even though both countries had comparable population size?
The answer might lie in the dynamics of infection-induced immunity and its crucial role in generating hybrid immunity(ie immunity generated by vaccination of previously infected people).. In their study of COVID-19 seroprevalence among American blood donors during the second quarter of 2021 Jones et al showed that subjects aged 65 or more had significantly lower prevalence of hybrid immunity(and , by inference, lower prevalence of infection-induced immunity) than subjects aged 16-29, namely, 36.9%(95% CI=35.8%-38.1%) versus 59.6%(95% CI=56.7%-62.3%). Given the fact that hybrid immunity(ie immunity generated by vaccination of previously infected subjects) is more protective against severe disease or hospitalisation than vaccination of previously uninfected subjects[6], younger subjects would be the ones most likely to benefit from single-dose vaccination because they have greater prevalence of infection-induced immunity. By contrast the elderly would have to rely more on optimisation and timeliness of the two-dose vaccination strategy in order to mitigate the risk of severe disease or hospitalisation. Correspondingly, within the two-dose strategy, the elderly would reap the greatest benefit from optimisation of the use of vaccines with the highest evidence-based efficacy.
If both preconditions had prevailed the UK rollout strategy might have generated a more favourable outcome.
I have no funding and no conflict of interest
PS
In due course both the UK and France had comparable numbers of fully vaccinated individuals. Nevertheless, during the period June 2021-March 2022 excess all-cause mortality amounted to 59 per 10,000 in the UK versus 42.2 per 10,000 in France[7].
References
[1] Booth W., Adam K
The UK., facing a seary coronavirus strain, is running a high-stakes, real-world vaccine experiment
The Washington Post
January 26th, 2021
[2] Wikipedia
COVID-19 vaccination in France
https://en.wikipedia.org.wiki/COVID-19_vaccination_in_France
[3] Castillo MS., Khaoua H., Courtejoie N
Vaccine effectiveness and duration of protection against symptomatic infections and sever COVID-19 outcomes in adults aged 50 years and over.
France, January to mid-December 2021
Global Epidemiology 2022;4:100076
[4] COVID19 Daily Dashboard
January 20, 2021
https://dgalerts.docguide.com/covid-19-daily-dashboard-207?overlay=2&nl ref=newslw=etter&pk campaign
Source: John Hopkins University CSSE
[5]Jones JM., Manrique IM., Stone MS et al
Estimates of SARS-CoV-2 seroprevalence and incidence of primary SARS-CoV-2 infections among blood donors, by COVID-19 vaccination status-United States April 2021-September 2022
MMWR 2023;72:601-605
[6] Hall V., Foulkes S., Insalata P et al
Protection against SARS-CoV-2 after Covid 19 vaccination and previous infection
N Engl J Med 2022;386:1207-1220
[7]Bilinski A., Thompson K., Emanuel E
COVID-19 and excess all-cause mortality in the US and 20 comparison countries
June 2021-March 2022
JAMA published on line November 18 , 2022
https://jamanetwork.com/on 11/23/2022
Competing interests: No competing interests
Re: Covid-19: UK’s pandemic inquiry repares to hear from witnesses
Dear Editor
Clarification of my rapid response
In my rapid response entitled "The covid-19 inquiry and the benefit of hindsight", I omitted to mention the pre-vaccination COVID-associated mortality statistics for the United Kingdom and France, respectively.
For the UK, the closest I could get to the prevaccination mortality statistics was the figure for the 9th December 2020, which was the day after the administration of the first dose of vaccine. On that date the cumulative total for deaths per million population was 934 deaths per million population[1].
On that date (9th December 2020) France had not started vaccinating its population, and the cumulative total for deaths per million population was 843 deaths per million population[1].
As shown in my Rapid Response, cumulative deaths per million population had increased to 1,354 per million and 1,057 per million for the UK and France, respectively, by the 20th January 2021 [2].
I have no conflict of interest
References
[1] COVID-19 Daily Dashboard
December 9, 2020.
Reference: https://coronavirus.jhu.edu/map.html
Source: Johns Hopkins University CSSE
[2] COVID-19 Daily Dashboard
Reference: https://coronavirus.jhu.edu/map.html
SOURCE: Johns Hopkins University CSSE
Competing interests: No competing interests