Recently the Joint Committee on Vaccines and Immunisations (JCVI), the body responsible for recommending which vaccines are appropriate for which individuals in the U.K., decided that healthy individuals under the age of 50 should no longer be offered the Covid vaccines. This decision appears to have been made based on a multitude of factors, including the facts that the vast majority of the population have now had Covid (so no need to provide them with the immune stimulation given by the vaccines) and that Omicron variants of Covid appear to be rather less likely to result in hospitalisation, compared with prior variants.
This decision could well be considered as being long overdue – indeed, I consider it rather alarming that this seemingly evidence-based decision was made in early November, yet the JCVI only bothered getting around to telling the population about its deliberations nearly three months later. There will have been many thousands of individuals, many considerably younger than 50, who were persuaded to get their booster vaccination after early November when even the JCVI thought there was very little need for them to receive this medical product. I consider this apparent laziness in keeping the population informed to be rather dubious from a medical ethics point of view.
Furthermore, I note that even though the JCVI’s own deliberations have resulted in the conclusion that the Covid vaccines will offer the healthy young very little in the way of benefit, the report’s authors nevertheless insist on mentioning how awful it is that some in the population have not received their primary course of vaccination – an inoculation that still targets the original Wuhan strain which has effectively been extinct for over two years at this point. “Appropriate and adequate communication should be provided… to optimise update among those who are eligible but have yet to receive the offer of vaccination,” they write.
What’s worse, I’ve even seen information from the Health Minister (a qualified solicitor with a degree in history) informing people that the time available to get their shot is running out and that they need to hurry to get jabbed.
This isn’t a limited-time offer like the marketing from an online sofa warehouse; the JCVI now considers that the vaccines don’t offer benefit to the non-vulnerable. It is thus inappropriate to encourage people to hurry to get their jab as if it’s a matter of ‘when they’re gone they’re gone’.
What is particularly interesting about this latest JCVI announcement is that it has included in an appendix to the main document some data, provided by the UKHSA, to support its decision in the form of a calculation of the number of vaccinations that are required to prevent each hospitalisation. The numbers-needed-to-vaccinate per hospitalisation prevented given in the appendix appear not particularly to support the use of the vaccines; this point has been covered in an excellent series of tweets by Dr. Clare Craig.
What worries me more is the data upon which the calculations were made. These data appear at first glance to be plausible, but I have several specific concerns about their quality.
Firstly, the authors have not declared the population estimate which they’ve used to move from raw hospitalisation data to the per-million rates that they’ve included in their table.
I’ve made this point numerous times previously, but in short there is no formal count of the number of unvaccinated individuals in the U.K. – this is calculated by subtracting the number of individuals that have received at least one dose of any Covid vaccine from the total number of individuals in the U.K. Unfortunately, the Government doesn’t have a good understanding of the actual numbers of people in the U.K. (which is astounding in itself), only various estimates of the population. The lowest population estimate is consistently that offered by the ONS. If they’re using the ONS population estimate – and the UKHSA does so like to use the ONS population estimate – then their calculations will suggest a higher hospitalisation rate in the unvaccinated compared with that reached using other population estimates. I estimate that a more realistic population estimate could easily remove any differences between unvaccinated and vaccinated in Table 1 or even result in the unvaccinated having lower admission rates. Note that they say they’re using NIMS as their data source, but that appears only to be used to identify the vaccination status of those in hospital – there still needs to be a population estimate to calculate the population rates and they do not state that they use the NIMS estimate for this purpose.
Secondly, they’re using July 2022 as their ‘example’ month, upon which their whole calculation of ‘numbers needed to vaccinate’ is based – this was a high month for hospitalisations in the U.K. and wasn’t representative of the average across the year. Their analysis appears to assume that the July hospitalisation rates were maintained across the year, thus using July’s hospitalisation numbers as their basis should result in a lower – or more favourable to the pro-vaccine position – estimate for numbers-needed-to-vaccinate to prevent each Covid hospitalisation.
Third, their ‘numbers needed to vaccinate’ table is based on vaccine effectiveness data from “other studies”. These appear to be mainly based on the Test-Negative Case-Control (TNCC) methodology – for the sake of the readers’ sanity I won’t delve into my criticisms of TNCC in this post, except to state that it can give misleading estimates of vaccine effectiveness if the vaccines also increase the risk of infection with other, similar, diseases (e.g., the ‘worst cold ever’).
Fourth, the JCVI release suggests that its vaccine effectiveness data were from when the Omicron variant was comprised of the BA.1 and BA.2 variants, which the bivalent booster doses supposedly targeted – thus it would be reasonable to imagine that the vaccines would have a worse performance against more recent variants, which have further escaped vaccine derived immunity.
Fifth, the JCVI states that the actual vaccine effectiveness data used in the calculation were from the UKHSA’s Vaccine Surveillance Report week 44 (November 4th 2021), but that VSR didn’t contain those figures – indeed, the Omicron variant hadn’t been identified at that point in 2021. Quite where the JCVI got the data to populate its table of vaccine effectiveness is unclear – I suspect that the vaccine effectiveness estimates were provided by the UKHSA, based on data contained in some of the references given in later Vaccine Surveillance Reports but not actually directly taken from these other sources. Whether its chosen vaccine effectiveness figures were corrupted by the UKHSA’s enthusiasm for the Covid vaccines remains open to question.
The situation outlined in the points above would have the effect of decreasing the numbers needed to be vaccinated to prevent each hospitalisation given in Table 3 and 4 of the JCVI appendix document.
That is to say, if the JCVI used a more realistic population estimate, had based its calculation on an ‘average month’ for hospitalisations and had used more realistic estimates of vaccine effectiveness then its estimate of the numbers-needed-to-vaccinate would have been even less supportive of the vaccines than the marginal (at best) estimates that it has calculated.
There’s also no consideration at all of the mismatch between the estimates of vaccine effectiveness in Table 2 and the real-world data in the first table.
The assumed vaccine effectiveness suggests that the injections are preventing a fair proportion of hospitalisations, particularly in the first six months after vaccination (which would have been most of 2022 for older people given the enthusiasm for vaccinations last year). However, the real world data given in Table 1 suggest that the vaccines aren’t performing this well. A normal data scientist would ask questions here, but they merely state their usual “do not use these data to estimate vaccine effectiveness”. The report also states that the unvaccinated were probably doing surprisingly well because of prior infection; surely if this were the case then it would be a very important factor and shouldn’t be simply explained away. As it stands I’d suggest that nearly everyone in the U.K. gained ‘prior immunity’ in 2022, regardless of vaccination status, and so this wouldn’t have been an advantage unique to the unvaccinated.
Beyond the criticism above relating to the numerical data in the JCVI document, I believe that there are additional shortcomings. Firstly, there is no consideration of the impact of the vaccines on Covid-disease below the hospitalisation threshold. My fear is that the vaccinated are getting frequent reinfections with ‘nuisance symptoms’ but not ending up in hospital (merely feeling miserable for a week or perhaps longer).
Secondly, there’s no consideration at all of side-effects, which appear to be a non-trivial risk. The JCVI should have been undertaking risk-benefit analyses for the vaccines, but instead it has only considered the supposed benefits. Even when ignoring the risks, it has still decided that the vaccines don’t offer any substantive benefit to the healthy young. One can only guess at how negative its recommendations would have been if it had included risks in its analysis. But, of course, it appears that official bodies are not allowed to even mention the slightest possibility of there being any risks associated with the vaccines, and when pushed will only begrudgingly accept that there is a very very small risk of very very rare side effects (but only myocarditis and thrombosis, and anyway most people have a complete recovery armed only with a paracetamol and a day off work).
To summarise: the recent JCVI document appears to fall short of what is required of our medical regulators. Once again, one of our official medical agencies has had the opportunity to be timely, open and transparent in its deliberations, but has instead offered a delayed response full of ‘science words’ but which is desperately short on providing actual scientific evidence and logical argument to support its position.