I’m grateful to Will Jones and the Daily Sceptic for highlighting my article in Spiked on Dr. Ashley Croft’s report for the Scottish Covid Inquiry. You do, though, criticise me for saying that the vaccines had some benefit in 2021, suggesting that I’m being misled by a ‘Healthy Vaccinee Effect (i.e., that folk already near death are unlikely to be given a vaccine, creating the illusion that the vaccine has a survival benefit for those who did receive it).
I completely accept that a Healthy Vaccine Effect is a likely confounder of non-randomised vaccine cohort studies, particularly if the very elderly are included. I agree also with Prof Norman Fenton’s oft-made criticisms that cohort studies are distorted by counting the newly vaccinated and partially vaccinated among the unvaccinated and by the fact that the size of the UK’s unvaccinated population is grossly underestimated by the ONS. All these distortion lead to an over-estimation of vaccine efficacy.
However, my view of the vaccines’ benefit in 2021 is not based upon cohort studies. Rather, it is based on the changing death:case ratio, as illustrated below.
What I’ve done here is to take data for England and calculate a daily ratio of Deaths attributed at Day 20:Cases recorded on Day 1. Twenty days is a typical period from infection to death in a case that goes bad, and death peaks lag case peaks by around 20 days in epidemiological series. I have then smoothed the line by converting it to a 7-day moving average and, since I’m averaging ratios, I’ve preferred a geometric mean, not an arithmetic one. The dates on the X axis are the mid-point in each 7-day series: so ‘4/11/20’ is for Cases in the period 1-7/11/20 inclusive related to Deaths in the period 21-28/11/20 inclusive. I’ve kept case date rather than death date on the X axis because, obviously, cases drive deaths, not vice versa.
The graph shows a falling trend for the ratio from December 2020 to April 2021, indicating that – so long as case ascertainment and the attribution of death to Covid remained essentially unchanged – Covid became considerably less lethal through the tail of the Alpha wave, encompassing the period to April 2021.
This was precisely the period of major vaccine deployment; 2.3m doses had already been given by the data start date of Jan 10th 2021 and, by April, the vast majority of older citizens had been vaccinated (figure 2)
Notably, the Death:Case ratio remained low throughout the Delta wave of summer/early autumn 2021.
It is hard to think of a factor, other than vaccine deployment, that could cause the lowering of this ratio. There was no dramatic improvement in the care of severe cases that would have reduced the death rate; such changes, notably steroid use and avoiding ventilators where possible, came earlier. Delta, unlike later variants, was associated with substantial mortality so one can’t say that the ratio remained low because it was a mild strain.
Under-recording of cases would raise my ratio and may be a factor right at the start of the graph, so I’m not convinced that the drop is as large as 10-fold, but it is substantial. Moreover, the insanity that was mass testing was well underway by Jan/Feb 2021. I walked the two paths around London – the Capital Ring and London Loop – during that winter’s dismal third lockdown and vividly recall testing centres with snaking queues of people who looked perfectly well but had chosen to stand among the potentially infected. This testing madness really didn’t end until the omicron wave, which came after the period I’ve reviewed.
I suppose you might argue that all the most vulnerable had already succumbed by the late winter of 2020/21, so the ratio inevitably fell. This may be true to a degree; however, the majority of the population remained infection-naive until the later omicron waves, so I don’t think it can provide a substantial explanation.
So, I stand by my comments in Spiked on the vaccines’ achievements in 2021. But would add six further points, all underscoring vaccine limitations.
First, these are novel types of medicine, hurriedly developed. It was reckless to give them to groups, particularly healthy children, at zero risk of severe Covid. I consistently argued this case.
Secondly, the vaccines failed to stop infection and transmission. This weakness was apparent as early as the summer of 2021. That autumn’s coercion to be vaccinated ’to protect others’ was medically as well as morally unsound. This should have demolished the argument for vaccine passports, as I said in the Spiked article and many times previously. Yet vaccine passports were most extensively and severely imposed in that very autumn, both in Scotland and across much of the EU, where President Macron notably promised to “piss off the unvaccinated”.
Thirdly, by summer 2021 it also was clear that natural immunity confers more durable protection than vaccination. This further negated the case for vaccinating low-risk groups. It is particularly pertinent to healthcare workers. They’d better protect their patients by being infected and recovering rather than by being vaccinated. Yet care home workers in England were sacked for refusing vaccination and the same threat was held over NHS staff.
Fourth, the multi-dose boosters regimens deployed from autumn 2021 were never trialled, and ‘variant-updated’ vaccines have only been subjected to the most cursory human trials. The Cleveland Clinic’s study of its own staff suggests that repeated vaccination is associated with increased vulnerability to infection, and original antigenic sin makes it doubtful whether SARS-CoV2 vaccines can be repeatedly adapted to each emerging variant. In autumn 2021 the vaccine strategy’ departed from the last threads of evidence-based medicine.
Fifthly, there was and is a real and justifiable concern that use of vaccines targeting one highly variable part of SARS-CoV2 – its Spike protein – might become a major driver of variant evolution favouring ever-more-vaccine-evasive mutants. Natural immunity, involving a response to multiple virus proteins, should be harder to evade.
Sixth, and last, there is no justification for continuing extensive vaccination, given that circulating strains are associated with mild disease and that the great majority of us are now survivors of Covid infection, unlikely to succumb to a second attack. The JCVI seems to comprehend this, and is steadily rowing back on who should be boosted – now just the over-65s. This is in contrast to the U.S., which still advocates vaccination for anyone aged over six months.
The tragedy is that, had these vaccines been used narrowly and briefly in high-risk groups – as Kate Bingham argued – they’d be remembered well, for the achievement in 2021 that I’ve illustrated here.
Instead, for reasons that no one will yet admit the vaccination programme morphed into something very different. My expectation is it will come to be remembered badly, as the vaccine-harmed pile up for no discernible further benefit.
And my fear is that this will have a knock-on effect, leading people to eschew other and far better vaccines against more dangerous diseases.
Dr. David Livermore is a retired Professor of Medical Microbiology at the University of East Anglia.