by David Livermore
Vaccine passports or certificates – an idea we thought dead – have, regrettably, just been sleeping. With no little sense of irony, the Government is busy resurrecting them in time for “Freedom Day”.
To be clear, I won’t be too put out if an immigration officer demands a SARS-CoV-2 vaccination certificate in future, especially if I’m travelling to a low-Covid country, like Taiwan. I doubt it will protect them in the long term, but I’m happy to be vaccinated and it doesn’t upset me any more than having to obtain a yellow fever vaccine and certificate.
The issue is with using vaccine passports internally, to restrict access to large events and maybe even pubs and restaurants.
Certificates will be used to discriminate against the unvaccinated, not all of whom belong to the awkward squad. They include the young, not yet offered vaccination, as well as those who can’t be vaccinated. But, set aside the ethical. Others have written extensively.
What concerns me is the practical.
Certificates are touted on the basis that ‘They will make concert-goers feel safe.’ Really? Perhaps the concert-goers should while away one of Wagner’s tedious half hours counting the odds.
Suppose a concert is attended by 1,000 people, 900 vaccinated and 100 unvaccinated, which is about the current split. Assume also that vaccines confer around 80% protection – 95% for Pfizer and Moderna and 63-76% for AZ, and that 20% of the unvaccinated are immune through prior infection.
On that basis, the audience will include 80 unvaccinated ‘vulnerables’ and 180 potential vaccine failures. In other words, unvaccinated ‘hazards’ are outnumbered 2:1 by the vaccinated ‘hazards’. ZOE app data, showing that infections in the (large) vaccinated population are beginning to outnumber those in the (small and diminishing) unvaccinated population illustrate how, nationally, we are on track to reach such ratios.
In these circumstances, excluding the vaccinated won’t dramatically alter the risk to the audience. Rather, the good news is that 740 of the 1000 attendees ([80% x 900]+[20% x 100]) are protected by successful vaccination or prior infection and this proportion, replicated across the population outside, should give sufficient herd immunity to prevent the virus regaining traction. Moreover, it’s generally accepted that vaccination gives better than 80% protection against severe infection, meaning that the vaccinated vulnerables aren’t at much risk.
As for the 80 unvaccinated vulnerables, have we not reached the point where it is their business if they choose to hazard more severe infection? They may also smoke or drink excessively. Or, despite limited mountaineering experience, join a commercial climb of Mt Everest, as promoted by this Everest Expedition service, whose blurb includes the wonderful encouragement: “If you want to experience what it feels like to be on the highest point on the planet and have strong economic background to compensate for your old age and your fear of risks, you can sign up for the VVIP Mount Everest Expedition Service.”
Next, there is the question of ‘Which vaccine and when’?
We know little about the longevity of protection. We do know that serum antibody titres fall over time, but that immune memory and T cell activity persist. We also know that SARS-CoV-2 mutates and that some mutations reduce antibody binding, also that common cold coronaviruses alter sufficiently to allow immune escape, with repeat infections every few years.
But, of the detail for SARS-CoV-2 we remain very ignorant.
So, for how long should a Covid passport remain valid, and should this depend on the particular vaccine and the individual? Will certificates be revoked when a new variant circulates?
One trial suggests the AZ vaccine failed to protect against the South African (beta) variant, though caution is needed both because it was small and there were no severe infections in either arm. Pfizer say that their vaccine remains 91% effective against the beta variant which anyway is now being outcompeted everywhere by the delta variant, even in its home territory of South Africa. NovoVax – whose vaccine is yet to be licensed – achieved 55% efficacy among HIV-negative vaccinees in South Africa when the beta variant dominated, though protection was reduced in those with HIV.
Presently it might be possible to set a certificate’s terms according to which vaccine you’ve had. But, it won’t remain so in a ‘long war’. Suppose I’ve had two shots of AZ and a NovoVax booster; you’ve had two shots of Pfizer classic and one of ‘second-generation’ Pfizer. Who is better protected? And, whilst I might have had a ‘better’ cocktail, you might mount a stronger response.
Who then should be allowed into that concert? Anyone suggesting HIV status should be considered is advised to buy a tin hat.
What, moreover, to do about those who’ve had vaccines that are not licensed here? Russia’s Sputnik is used in 60 countries, including Hungary. It receives sniffy UK coverage but achieved 91% efficacy in trials and employs similar technology to AZ’s product; whatever one’s views about the Putin regime the evidence says that it is ‘Fit for purpose.’ There is much less clarity or publication about the inactivated-whole-virus vaccines from China’s SinoPharm and SinoVac, which are dissimilar to any vaccine used here.
We have already had a foretaste of the chaos to come from these aspects, with an unfortunate British couple turned away from Malta because their AZ vaccine was manufactured in India. Other ‘unfortunates’ (or not) were excluded from a Bruce Springsteen concert in the US because they’d had the AZ jab, which isn’t licensed there.
In short, one doesn’t have to delve very deep to see an evolving mess and realise that herd immunity – not individual certification – is the guarantor of safety. Instead of certification the Government needs to accept what Chris Whitty has recognised in one of his more candid moments – that Covid will be with us for the foreseeable, that vaccines can reduce its burden to that of flu and that if we accept this, we can return to a ‘Whole life’.
A whole life is not one where “Papers!” are demanded for simple pleasures.
David Livermore is Professor of Medical Microbiology at the University of East Anglia, a member of HART and a contributor to Collateral Global.
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