Living on Plague Island

As we await the opening of bookings for those eligible for the free spring 2024 Covid booster (listed in the photo above), this blog summarises what the situation is regarding private vaccines this spring and discusses wider issues about access and equity and updates my earlier post.

Novavax

Early optimism about the potentially relatively low cost, possible low side effects novavax vaccine has waned in recent weeks.

It was previously thought that Novavax would be available at a cost of £45 or thereabouts would be available from early April.However, it is now clear that this date was wildly optimistic and it is not quite clear when the vaccine will be available in the UK – it may appear later this month or next month, possibly…

The second problem to emerge is that unlike the Pfizer vaccine, Novavax is to be delivered in packs containing 5 virals and once the pack is opened it has to be used within 24 hours. This means the circa £50 price tag will only apply if people organise 5 friends or family members to receive the vaccine at the same time. The latest information we have is that Pharmadoctor (the main provider of Novavax) charge £90 per person if there are only two people in a group, £65 each for 3 people and £50 for five people. This was discussed in the Guardian recently and raises significant issues, particularly for the clinically vulnerable and people who live alone. Commenting on the issue Lara Wong, founder of the Clinically Vulnerable Families group said:

“Coordinating group vaccinations to fully utilise each multidose vial presents a significant challenge, particularly for patients who, due to health vulnerabilities or logistical constraints, cannot easily organise themselves into groups. This could lead to higher individual costs for those unable to form groups. We are deeply concerned that this situation will introduce barriers to vaccination,” she said.

See the Guardian above

The third issue is that many people have not been able to have a vaccine to date because of certain medical conditions and allergies. Novavax offers new hope for these patients as discussed recently in the i. newspaper. However, it will not be available on the NHS even for people who have never had the vaccine to date – they are going to have to pay an estimated £90 plus as it is unlikely that there will be more than one person with this problem in the same household. This feels grossly unfair.

A fourth related issue is that there is no allocation system based on need. It seems only fair that when the novavax vaccine eventually appears those who are able to receive a vaccine for the first time should be given priority access. However, no such allocation system is planned and I fear we are going to see a free for all with no prioritisation based on need.

Pfizer vaccine

The second private vaccine on offer this spring is the Pfizer vaccine that was administered during the latter part of the Autumn booster campaign and found to be effective. This is now available at a cost of nearly £99 per dose in a very limited number of Boots stores. Pharmadoctor may be slightly cheaper in some locations on offer – but not significantly so.

Geographical Accessibility

A key issue to emerge is whether people are actually able to travel to one of the pharmacies that are offering the private vaccines. There are many locations in the UK which are not within a 60 mile radius of a private vaccination pharmacy, for example, there are no pharmacies offering private vaccines across the whole of Cornwall.

Equity

Related to this, the significant costs of the booster doses raises significant affordability and equity issues. For example, at this moment in time a couple with one child would have to pay nearly £300 to get vaccinated even before the potentially significant costs of travel to a pharmacy are factored in.

Commenting in a recent article in the Guardian Dr Marija Pantelic, of the University of Sussex said

“The most disadvantaged in society are most likely to be exposed to respiratory viruses due to things like poverty, intergenerational households and crowded workplaces. While they might be most in need of a seasonal vaccine, they will also be the least likely to afford £100 in the midst of a cost of living crisis,” 

In the same article Lara Wong, founder of the Clinically Vulnerable Families group said:

“The availability of private vaccines will disproportionately affect high-risk groups, including diabetics, who have accounted for a significant number of Covid deaths,”

Lara Wong see reference above

Lara continues:

“Despite being recently approved for antiviral treatments, these newly approved groups will not have access to them until 2025, and they are also not being offered the NHS spring boosters that they desperately need”.

Lara Wong – see above

Concluding Comments

It will be clear to readers that in my assessment the UK’s restrictive approach to vaccination against Covid is highly problematic and inequitable. As discussed in a previous blog – policy has gone seriously wrong compared to the heady days of early 2021 when everyone received a free vaccine, it was rolled out based on need, and we were unaware of the short time it takes for the effectiveness of vaccine doses to wane.

As discussed by Sheena Cruickshank and others, vaccines have the potential to limit the spread of Covid, and hence help to prevent the ever growing number of patients with Long Covid. This would help to reduce the pressures on the NHS and arrest the very significant economic and social problems, including the falls in labour market participation and high levels of sickness absence.

Despite all of this and the clear unfairness of where we are at present, the government clings to the very narrow, non transparent appraisal method for assessing entitlement to a free vaccine boost without any regard for the wider impact on the economy or society.

Meanwhile the spring booster programme is about to begin with little or no publicity which means that those who are entitled to a spring booster often have no idea that they are eligible since there has been no publicity campaign.

In addition, it is very unclear what is going to happen in the Autumn and whether the eligibility will be the same as or narrower than for last Autumns boost. I believe plans on this may be announced as soon as next month.

Watch this space ….