by Andy Alaszewski
9th March 2021

In early 2020, COVID-19 started to spread from human to human. It travelled in its human hosts from its epicentre in China to large cities around the world. At the start, no-one knew how risky the new virus was. Countries in the western Pacific rim with experience of SARS and a historic distrust of Chinese officials, Taiwan, Vietnam, South Korea and Mongolia, framed COVID-19 as a SARS-like disease, contagious and lethal, and focussed on preventing the virus entering and spreading. They either closed their borders or closely monitored travellers and tracked and controlled the virus if it broke through these defences. This worked well, there have been some localised outbreaks but these have been contained and overall infection and death rates have been minimal.

Countries in Europe and the Americas had good contingency plans for a flu epidemic and framed COVID-19 as a form of flu, highly contagious but lethal only for the vulnerable people. Rather than focussing on controlling the virus, they concentrated on protecting vulnerable people allowing the virus to spread through the rest of the population creating herd immunity. Initially, there was little or no attempt in the UK or Europe to control or monitor travellers or to restrict travel. In February 2020, British holiday makers went on half-term skiing holidays in the Alps and brought back the virus. By the end of March, the virus was out of control. In the UK, over the next three months, more than 40,000 mainly vulnerable people died. There was no single Patient Zero in the UK, rather there were more than 1,000 Patients Zero seeding the virus in the various regions. There was some attempt in the UK in February 2020 to track and control the virus and monitor travellers. But as evidence of community transmission emerged, the UK abandoned these attempts and resorted to lockdown.

In the Summer of 2020, the UK government repeated its mistakes. With little or no restriction on travel and little monitoring of the virus, British holiday makers were again free to visit virus hotspots such as Spain and brought back a mutation of the virus which rapidly became the dominant variant in the UK. The Chancellor’s ‘Eat Out to Help Out’ scheme encouraged people to mix in crowded poorly ventilated spaces, another good way of spreading the virus. By the Autumn of 2020, with the reopening of schools and universities, conditions were ideal for the virus to start spreading again. In late Autumn the government tried applying the brakes to the spread first with a tier system of regional restrictions and then with a pre-Christmas lockdown. As infection and death rates continued rising after Christmas so the government had to reimpose a third and full lockdown.

In December 2020, the approval of COVID-19 vaccines offered governments in Europe and North America a way out of the pandemic. The vaccines are a public good, manufactured for and distributed by the state. The state decides who will be offered the vaccine and the protection it provides. In the short-term government are likely to fund vaccination programme by borrowing but in the long-term tax payers will fund and repay this borrowing.

There are two related issues, who should get the vaccine first and why and how was this decision is made. In the UK, the committee advising the government identified three possible strategies, breaking the chain of transmission, maximising social justice versus protecting the most vulnerable.

Some countries have chosen to concentrate on interrupting the transmission of the virus and restarting economic activity as quickly as possible.  They are prioritising younger economically active people who were the most likely to be infected and spread the virus. Russia is concentrating on vaccinating frontline, health, social care and education workers. Indonesia has also decided to prioritise individuals aged 18-59 as this age group has the highest infection rate and is the most economically active.

Most of Europe and North America has chosen to vaccinate the most vulnerable and those who care for them, first. This approach is relatively straightforward to implement, is popular especially amongst older and vulnerable people and should reduce infections, hospitalisations and deaths.

This approach does raise the issue of social justice, particularly between generations. Welfare systems in countries such as the UK depend on intergenerational solidarity with younger healthier adults contributing to the support of less healthy older people. In those countries which had to adopt lockdown policies, the COVID-19 pandemic highlighted this intergenerational divide. In lockdowns, children and younger people had their education, economic and social lives put on hold to protect the lives of older and other vulnerable people. In the long-term the younger generations will become the tax payers that have to pay for the cost of a vaccination programme that they were excluded from.  It has not escaped the attention of Generations Y and Z that many Boomers, having gained the protection of the vaccine are now booking their summer holidays.

The vaccine strategy raises questions about how choices about who benefits from publicly funded programmes are made. In the UK, the choices about vaccination were made by a committee of government appointed experts, the Joint Committee on Vaccination and Immunisation (JCVI). Most of the committee members are experts in respiratory diseases, virology or vaccine development but they are not experts in social ethics or social justice.  The committee justified its recommendation to prioritise the vulnerable and those who cared for them on pragmatic grounds as the quickest way of delivering the vaccine. These decisions were made behind ‘closed doors’. There has been some public campaigning to change priorities, a radio DJ, Jo Wiley, who led a successful campaign to ensure that her sister and other individuals with learning disabilities were prioritised. There has been an unsuccessful campaign to prioritise vaccinating key workers such as teachers and police officers.

At the start of pandemic, countries such as the UK and US, made the mistake of treating COVID-19 as if it was seasonal flu. There is a danger that the UK will repeat this mistake with the vaccination strategy that misses opportunities to break the chain of COVID-19 transmission.

Andy Alaszewski is Emeritus Professor of Health Studies at the University of Kent. He is a social scientist who has specialised in the study of health risk and society, and is the founding Editor of the International Journal ‘Health, Risk and Society’.


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Image credit: Daniel Schludi on Unsplash (does not depict the actual vaccine)