A special episode of my East End Ears podcast is now available and this one is so important that I've also made a video recording of the interview available.
In the episode, I’m joined by Dr Philippa Whitford - SNP Health Spokesperson and Chair of the APPG on Vaccinations - to draw upon her expert knowledge and answer common Covid-19 vaccine questions.
The video can be viewed below, but if you'd prefer to listen to the podcast, visit the East End Ears page to find out how to subscribe and stream the episode. To make the content as accessible as possible, a full transcription of the episode is also available below the video.
Remember also that there's also a dedicated vaccines page on the site with lots of answers to common questions.
Enjoy the show!
David: Okay, so this week I’m joined for a special episode of East End Ears - which we’re also putting on Facebook this week – and I’m joined by Dr Philippa Whitford who is the SNP Spokesperson for Health at Westminster, but also Chair of the All-Party Parliamentary Group on Vaccinations. So, vaccines have been hugely topical over the last couple of months particularly as we move to the rollout of the Covid-19 vaccine. I know that many of you have had lots and lots of questions about this so my hope is that for the next twenty minutes or so, we can draw upon Dr Whitford’s very good knowledge on this. So Philippa, thanks very much for joining us. We’ll just dive straight in with the first question if that’s okay? So, we’ve got three different vaccines approved. That’s Pfizer, AstraZeneca and Moderna. They’ve all been approved in Scotland and the rest of the UK with more to come on stream. What does this mean for the fight against the pandemic and based on these three vaccines is there any chance that we’ll return to what we would consider normal this year, i.e. 2021?
Philippa: The vaccines are obviously a huge weapon in the fight against Covid and particularly in protecting the most vulnerable. All the vaccines seem to protect the recipient from severe disease and thereby hopefully protecting them from death. So that’s really important. What we don’t yet know about these vaccines is whether they prevent transmission to someone else or whether you could still carry Covid but you’re not sick yourself and that means you don’t know you’re spreading it to other people and the danger is the more spread you have of virus, the more mutations you get. Coronaviruses mutate all the time and therefore the risk of a future variant that is not protected by the vaccine. So it’s part of the fight but the idea that it’s a magic wand is not quite there. It will make a huge difference but we have to reduce the spread of the virus, that’s still critical. We need to do it on a global basis and many countries don’t have any vaccine at all yet.
David: Yeah, absolutely. And one of the other questions a number of constituents will ask regularly is on the issue of care homes, particularly we’ve seen a huge roll-out of the first dose of the vaccine for care homes and a lot of people wondering for example if they work in the NHS, and their mum or dad is in a care home, so they’ve both had their first dose, why it would be that they couldn’t visit their parent in a care home. Can you talk a bit about why there are still restrictions on that?
Philippa: Well obviously we know it takes about three weeks for people to actually develop the immunity. You’re not immune when you walk out of the centre, which some people think. So your immune system has to react to the vaccine, has to develop that protection. So it takes a good three weeks for that to be in place. Certainly Jeane Freeman, our Cabinet Secretary, is talking about, now that Scotland has finished the care home roll-out, to be looking at how to get visiting going. That’s still likely to be with PPE because you couldn’t just say, well we’re only going to let NHS staff visit their relatives. That would be very unequal. It’s more about once the care home residents are protected, we could start to look at that. And I think that will happen on the basis of the first dose, which already provides substantial protection even though it’ll be combined with PPE and other measures at the same time.
David: Great, super. And on that theme of the roll-out of the vaccine. Obviously Scotland, England, Wales and Northern Ireland are all having a relatively similar approach, but because of devolution, some decisions are being taken differently. Can you just touch upon the strategy that Scotland’s taking in terms of rolling out the vaccine and how that differs to other parts of the UK?
Philippa: Well the Joint Committee on Vaccination and Immunisation, or JCVI, were very clear that vaccination should happen in the order of vulnerability. So the people most at risk of severe disease or death should be vaccinated first and that’s care home residents. In December, when vaccinations started, we only had the Pfizer vaccine. The AstraZeneca one only became available in early January. Now, because it needed to be kept in a freezer at -70 and had to be very carefully managed, all the way from that freezer to the patient, the regulator - the UK regulator - said that all had to be one legal body that would take responsibility for it. That meant that in Scotland, because we still have a single NHS, we still have integration of health and social care, that was possible. So health boards were able to already start delivering to care home residents on 8th December. In England, they couldn’t because every hospital trust, every area, is a separate legal body, and so they weren’t able so easily to get on with care home residents and they started with over-80s instead. So we have worked through the JCVI recommendations exactly in that order but of course it takes a lot longer to go into a care home with a whole team and vaccinate and explain and reassure very elderly people, maybe residents with dementia, and getting them to accept the vaccine, than just lining up a lot of fit 70-year-olds or NHS staff or whatever in a big mass vaccination centre. So that’s why our start, actually our start in December, was quicker, because we were able to use Pfizer and then earlier this month looked slower because we were focussing on getting the care home residents finished.
David: So much of the debate I think, particularly here at Westminster, has become about this idea of the economy versus public health and I’ve seen these suggestions that what you should do is vaccinate office workers first to try and get them back and get the economy moving. But I’ve seen some figures recently that suggest that if you vaccinate someone in a care home, you save many more lives. Can you talk a bit about the numbers and how that would compare to, say, the comparison between vaccinating me, a fit 30-year-old guy, versus somebody who is in a care home?
Philippa: No, there is often a little bit of discussion about what the numbers are but certainly roughly you only have to vaccinate somewhere between 20 and 40 people in a care home to save a life. For the likes of me it would probably be three or four hundred, maybe five hundred. For you, it would probably be thousands to save one life. So that’s the reason that the JCVI came out with their recommendation because the task they were set was how do we cut deaths from Covid. Now, the idea of vaccinating public sector workers, police, teachers - particularly people in transport or supermarkets - is absolutely a viable one. But for that you really need to know that the vaccine is preventing transmission and therefore that’s what these groups encourage, they encourage spread of the virus, and if you know the vaccine prevents that or if we get a vaccine that will prevent that, then that would be the vaccine you would want to use for younger people. But we don’t have proof of that from any of the vaccines as yet.
David: I think the suggestion is that sometime in the spring, the hope is that we’ll have vaccinated the majority of those people who are at risk of mortality and of hospitalisation. So would it be the case that once you’ve done that, that you can just lift restrictions and let Covid kind of rip amongst the younger generation? If so, what would be the impact of Long Covid on that and more generally, if you do get to a stage in the spring where you’ve managed to vaccinate those at risk of mortality, is there room for lifting some restrictions and how much room for manoeuvre do you have there from a public health point of view?
Philippa: I think obviously once you have vaccinated the most vulnerable, you will ease out of where we are now which is a kind of hard lockdown. You’ve almost answered your own question David, in that Long Covid is something that should not be overlooked and that does affect young people, even young people in the first wave who weren’t sick enough to go to hospital. But yet here we are, six months, nine months later, they’re still struggling. And the thought of leaving a lot of young people with a chronic fatigue syndrome or a disability or lung or kidney damage - these are things that you just can’t accept that. So there is still the need to look at how you protect everybody. You mention this economy versus public health and the problem in the UK is that the UK Government have simply ping-ponged backwards and forwards between the two. If it’s a public health emergency we lock down, and then suddenly we’re pushing the economy. And it’s a false dichotomy. If you look at the countries that were very strict from the beginning, had very tight border controls, and then drove down and eliminated community spread, their domestic economies are up and running. Look at the Australian Open. Crowds of people attending tennis games. So, they have actually had the least economic impact. We’re now seeing the UK Government finally talking about border controls because of the threat of the South Africa variant actually being resistant to vaccine immunity and there is some evidence to suggest that. But they’re only still talking about putting in the minimum protection, so quarantining people from countries where we actually have a travel ban instead of actually saying everyone who comes into the UK, we need to make sure they’re not bringing in a new variant. We saw in Scotland last summer, we had got down to elimination levels. Genomics shows that Scotland had eliminated over 300 strains that had been running in the first wave. And then everyone felt they had a God-given right to go on holiday and we imported a whole new set of strains and we can’t afford to make that same mistake again. So even with the vaccine, the best way to be protecting everyone is you still have to look at how you minimise the risk of cases coming in, but it’s also things like ventilation, air quality, wearing face coverings at the right time, washing our hands, etc.
David: Yeah, absolutely. The final question would be, we've seen an awful lot of stuff online, quite a lot of nonsense actually from what would be considered as anti-vaxxers, questioning the legitimacy of the vaccine, particularly the timescale of how quickly it was developed. Can you talk about some of the process for developing that vaccine and how we should actually have confidence in taking this vaccine, and when we get the opportunity why we should go forward and take it?
Philippa: Well I think the number of people who are outright anti-vaccination is actually quite small. There’s a much larger group of people that might be called ‘vaccine hesitant’, or they’re anxious about it and to be honest, with a new vaccine, that’s totally understandable. The aim should be answering their questions rather than shutting any of these people down. And as you say, people are anxious about, well how have you managed to do this in a year when normally it might take four or five years? And the thing is, the four or five year timescale is not that people are running trials or working in a lab for four or five years. A huge amount of that was bureaucracy because each step of the trials, and there are three main stages to any trial, happened one after the other with often quite a long gap in between. And then all the data would go to the regulator at the end, who would often take ages to make a decision. And then the vaccine producer, the pharmaceutical company, had to decide whether they thought it was profitable to produce. What’s happened here is because of the enormous scientific collaboration. The three trial stages have actually all been on an overlapping basis with the data sent to the UK regulator as it’s been running. So they’ve been also working in parallel. And the companies, often with government support, made the decision to take the risk right at the beginning and invest in their vaccine and build up production. So it is simply that we’ve taken the five or six years and we’ve done all the stages almost at the same time in parallel. It’s not that any corners have been cut. It’s not that the safety work hasn’t been carried out. And when you look at the threat of Covid, particularly for our older relatives, family in care homes or over-60, over-70, the risk to them is so high, they should absolutely be taking the vaccine. We will learn more about the vaccines. There are things like people with severe allergies and so on, but the basic safety work has all been done and it’s been done on thousands and thousands. These trials have been run on twenty/thirty thousand people. Normally some of these trials are only run on three or four thousand people. So actually, the safety work has been very intense and it’s because of collaboration, better organisation, and just cutting out the bureaucracy. That's why we've got where we are. So people should feel confident and should take the vaccine once it's offered to them.
David: And just one other question that comes to mind, particularly on the issue of timescales, there's been a lot of debate recently about the gap that should be left between having these vaccines. Most of these vaccines so far are suggesting we've got to get two doses. Another suggestion that one of them you’ll be able to do as a one-off. But given the debate that's been ongoing about whether it should be 3 weeks or whether it should be 12 weeks, could you explain a little bit of the thinking behind that and why there’s a bit of confusion amongst the public and perhaps even academics on this?
Philippa: Well the AstraZeneca vaccine, they included data in their trial that looked at the different gaps. Now this came about accidentally because there was a death in, I think in South America, that had to be looked into. It was nothing to do with the vaccine, but of course during that time, the immunisation stopped. So they then had lots of different groups who had a different gap and what they found was actually for their vaccine, the longer gap resulted in a better and stronger response to the booster dose. And actually, that's quite a recognised thing. Now Pfizer didn’t do any of that work, nor did they have an accidental stop, so they only looked at three weeks. It’s not that they have evidence that a longer gap would be a problem, they just don’t have any evidence. But it is normal for vaccines that if you leave a longer gap for the whole immune system to have finished its reaction to the first dose, and then you put it through its paces again from beginning to end after a longer gap, you get a better response. Most experts feel that there’s no reason to think that would be any different for Pfizer. And if you go back to the trial data, which JCVI and the regulator did, you saw was that actually after the two weeks it took to get any protection, you had about 90% protection on that first dose. And therefore the decision was made, with limited supplies, it made more sense to get 90% protection with Pfizer to more people than 95% protection to a much smaller group. Obviously we still have to make sure that we get those second doses out within the 12 weeks. But they did publish the data, JCVI and the health regulator, and when you look at the data most experts were convinced and were happy to accept that.
David: Great. And one final question Philippa, I mean we’re recording this on 1st February, we’re in I guess the height of this third wave. What are the chances that there could be a fourth wave and what do people need to do to try and avoid that happening?
Philippa: Well I think the key thing is to recognise that in the UK, this oscillating between a health priority or an economic priority is part of what has led to these waves and obviously the problem for us in Scotland is we don't control our borders and we didn't control the finances. So the UK Government really needs to keep this lockdown until they have driven the virus down in the community to elimination levels. They still need to go for that. They then need to ease the lockdown very slowly as we did in Scotland last year, and they need to deal with the border. They have to set up a system for any visitor from outside the UK, preferably even working with the Republic of Ireland to make the whole common travel area Covid-secure and then we could actually do what New Zealand, Taiwan, South Korea and others have done and actually eliminate it in the community. The biggest danger is that the Prime Minster Boris Johnson is being pushed by his backbenchers to promise a quick opening up and that would be a disaster. Vaccine or no vaccine, until you have vaccinated almost 80% of the population you would still see yet another wave and if we got a fourth wave we would end up with a fourth lockdown and I think that really would be negligent.
David: Dr Philippa Whitford, thank you very much indeed.
Philippa: You’re welcome.