Covid vaccine: Who will be given it first in the UK?

Since the start of the pandemic, the Covid-19 vaccine has been placed on a pedestal as marking the end of the coronavirus and the best hope of returning us to our pre-virus lives, without the need for continued social distancing and lockdown measures.

There are now more than 170 official vaccine trials being tracked globally by the World Health Organisation, with the Imperial College and Oxford University teams representing the British efforts. But most of the international trials are still in the preclinical stages of testing (meaning they have not yet been given the green light to test on humans).

On 23 November, Oxford University announced results of its trial which found the vaccine stops 70 per cent of people developing Covid symptoms. 

This follows the announcement by Pfizer that its vaccine had been found to be 90 per cent effective in preventing people from getting the virus. Only 94 of 43,538 participants in the trial developed coronavirus and no serious safety concerns were reported.

Previously experts have warned that despite optimism about the jab’s prospects, the timeline will be longer than we might hope. On 22 August, Professor Chris Witty said he would be “surprised” if it was available before the end of winter, estimating 12 months from now would be more reasonable. Although by no means a guarantee. 

Writing for The Lancet last month, Kate Bingham, head of the vaccine task force, herself cautioned against “over-optimism” and hinted that there’s also a possibility that any vaccine “might not work for everyone”. 

But when the vaccine is rolled out, will it be available to everyone right away or will some people face a much longer wait to return to normal life?

Given a vaccine has been framed as a society-wide solution; that many polls have asked people if they would have it (1 in 6 would refuse); and building up herd immunity through vaccination requires large uptake, it is logical you would conclude everyone will be given the vaccine.

But Bingham said in October that it is “misguided” to presume everyone will be vaccinated.

She told the Financial Times  (FT) that only half of the 67 million people in Britain will get it. “People keep talking about time to vaccinate the whole population but that is misguided,” she said. “We’re not fundamentally using the vaccine to create population immunity.” 

Instead, Bingham said, the vaccine will be for people over the age of 50, focusing on “health workers, care home workers and the vulnerable,” she said. And it will definitely be adult only, with no one under the age of 18 getting the vaccine. 

On 6 October, Mr Johnson corroborated Bingham’s comments, telling reporters: “Clearly the priority for a vaccine will be those who are the most vulnerable groups...that’s how you would start.” 

Downing Street also confirmed it would follow advice from the independent Joint Committee on Vaccination and Immunisation (JCVI) on which groups should be given the vaccine first.

In a document published on 25 September, the JCVI laid out “interim advice” to facilitate the planning of a proposed vaccine rollout, whenever that might happen. It devised a priority list of demographics that could be used to assess who would need the vaccine earliest in a multi-stage deployment over months, or even years. Although it did caveat the list was subject to change.

It said: “This advice assumes availability of a vaccine which is safe and effective in all age groups and has a moderate impact on transmission.” And said they had agreed that a simple age-based programme would be easiest to deliver and better uptake.

The JCVI says as more evidence emerges this list could change, and order of priority could shift.

“Any programme will need to ensure every effort is made to get good coverage in black, Asian and minority ethnic (BAME) groups, in areas of higher socio-economic deprivation, and in areas with outbreaks or high levels of community transmission,” it adds.

Not only did Bingham say that the vaccine needed to be prioritised for older people, but she went further and said giving it to younger, healthy people, who have less severe outcomes from Covid-19, could “cause them freak harm”, potentially tipping the scales towards greater risk than benefit from doing so.

David Nabarro, special envoy to the World Health Organisation on Covid-19, also told the FT: “We’re not fundamentally using the vaccine to create population immunity, we’re just changing the likelihood people will get harmed or hurt. It will be strategic.”

If the vaccine is proved to be highly effective, then Bingham says, it will make sense to vaccinate more widely at a later date. But younger, healthier people will certainly not be a priority.

There has been no suggestion that a coronavirus vaccine would be compulsory in England, although Boris Johnson has previously said anti-vaxxers are “nuts”. In July he told medical staff: “There’s all these anti-vaxxers now. They are nuts, they are nuts.”

In Wales, on 22 September, health minister Vaughan Gething, told ITV that he “wouldn’t rule out” mandated vaccines but did say it was “the most extreme end and the most unlikely”. But first minister Mark Drakeford clarified saying: "There is no such programme, there never has been such a programme, there is no proposal to have such a programme.”

The Public Health (Control of Disease) Act 1984, which applies in England and Wales, says that regulations cannot require a person to undertake medical treatment, including vaccination. This was extended to Scotland and Northern Ireland under the Coronavirus Act 2020.

While we wait for a vaccine, people are however being encouraged to get a flu vaccination this winter, in much larger numbers than normal, to protect the NHS against a double threat of rising influenza numbers and Covid-19. You can find out if you are eligible here.