06 Apr The conversation we need to have before the next pandemic
Last Christmas Boris Johnson hinted there may come a time when a ‘national conversation’ about mandatory COVID-19 jabs might be necessary.
That feels in the distant past now. But today is World Health Day and I’d contend the Prime Minister’s words foreshadowed a conversation we must have ahead of the next pandemic – whenever that may be.
Vaccinations became a deeply divisive issue over the past two years, with families of unvaccinated people who died from Covid shunned for their loved one’s ‘anti-vax’ beliefs[1]. But who exactly were the Covid-19 unvaccinated? By answering this question, policymakers could gain valuable insight to address gaping health inequalities that have plagued this country for decades – enabling them to plan more effectively for a future virus entering our shores.
In the government’s Levelling Up white paper, launched in February, narrowing the healthy life expectancy (HLE) between local areas was a key priority and a White Paper will be published later this year setting out an ambition to reduce gaps in health outcomes.
Gaining (and sharing) a better understanding of who the group of unvaccinated people were during Covid-19, and crucially why they made that decision, could help address structural, systemic, and other underlying factors that lead to health disparities. This, in turn, would ease pressure on the NHS at a time (where the number one political focus is the backlog), improved patient safety and huge cost-savings.
It is, of course, a complex picture to decode. This is partly because the data needed to paint an accurate picture is held by all kinds of agencies – from the UK Health Security Agency (UKSHA) to NHS England, the Office for National Statistics and individual Trusts. Conversely, the US managed to deliver a fairly accurate portrait of ‘who’ this group is via the Centers for Disease Control and Prevention.
At the peak of the Omicron wave, approximately 60% of beds in London were occupied by those without any vaccination at all. And a separate study by the UKSHA[2] showed that, while the unvaccinated made up a small segment of the population, they accounted for 27% of admitted hospital patients with a confirmed case of Omnicron.
So, should Boris Johnson have followed in the footsteps of Emmanuel Macron by threatening to ‘piss off’ [3]the unvaccinated in a bid to future proof the population from the next variant or pandemic when it comes?
No. Not when the unvaccinated in hospital with COVID-19 in England a few months were also 1.6-1.8 times more likely to die of something unrelated to coronavirus[4]. The unvaccinated are sometimes (not always) in the ‘hard to reach groups’. Some are from black and ethnic minority backgrounds and lower income households who are more mistrustful of government[5]. Indeed, just 1,200 of the 270,000 who signed up to take part in Covid-19 clinical trials were from the black community[6].
All of this means we don’t (and never did) need a national conversation about mandatory vaccinations in the run-up to the next pandemic. Instead we should be having a conversation about levelling-up health[7]. Knowing the unvaccinated is the gateway to that conversation.
I would hope the upcoming white paper on health disparities will address some of the issues outlined above, but that wouldn’t be the whole solution. If we want real change we need to incentivise the NHS to tackle health disparities as business as usual, building it into the way services are commissioned.
We have some good data, but it took Covid-19 to show us that there are still gaps. We have time before the next pandemic to put this right so let’s not waste a moment more.
Jenny Ousbey, CEO & Founder, OVID Health
[1] https://www.theatlantic.com/family/archive/2022/01/unvaccinated-covid-deaths-secret-grief/621269/
[2] https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1045619/Technical-Briefing-31-Dec-2021-Omicron_severity_update.pdf
[3] https://www.connexionfrance.com/French-news/Covid-19/Who-are-France-s-five-million-unvaccinated-and-what-are-the-reasons
[4] https://www.dannydorling.org/?page_id=8711
[5] https://pmj.bmj.com/content/early/2021/03/28/postgradmedj-2021-139957
[6] https://www.standard.co.uk/insider/london-unvaccinated-covid-vaccine-jab-omicron-plan-b-b976103.html
[7] https://www.rcplondon.ac.uk/projects/outputs/rcp-view-health-inequalities-case-cross-government-strategy