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    In Praise of the UK’s Vaccine Rollout

    Dominic Enright argues that we should give credit where credit is due.

    Last month in an interview with the Times, Oxford’s own Regius professor of Medicine John Bell claimed that “The NHS has the theoretical capacity to immunise everybody in five days.” What was the doctor’s diagnosis for their inability to do this? Lack of motivation.

    Far be it for me, an undergraduate student (and a Classics BA, at that), to question the expert medical advice of a Professor – but five days seems a little bit ambitious. Leaving aside the fact the UK currently has neither the 48 million or so doses for the entire adult population, nor the certainty that everyone will decide to take the vaccine, it would be a logistical nightmare to vaccinate everyone in the UK in only five days; a feat that even a perfect healthcare system could never accomplish.

    “What about Israel?” Professor Bell might retort, “they have had a far more effective vaccine campaign than the UK.” While this claim is no doubt true, it would be disingenuous to say that it proves that the UK could vaccinate the adult population in less than a week. Firstly, although Israel has nearly vaccinated 59% of their population – not the entire adult population – and they have had more than five days to do so since the beginning of their programme on December 20th.

    Moreover, Israel is a special case regarding the vaccine roll-out, with the government having offered an increased sum to Pfizer. Furthermore, the country is smaller than the UK, both geographically and in terms of population size, meaning that fewer doses are required to vaccinate a greater percentage of the population. Israel’s particularly efficient public health system (with its strengths in health data and digitisation), is also accelerating the roll-out, making them the perfect frontrunner in the race for the vaccine distribution. Interestingly, the next-best vaccination schemes in the UAE and Bahrain have similar factors which make their per capita vaccination statistics dwarf most Western nations.

    To ground this back in the UK; what about the question of whether the NHS Bureaucracy is slowing Britain’s vaccine roll-out? To answer this, a distinction must be drawn between stifling over-regulation (or ‘red tape,’ as it is sometimes called) and bureaucracy. They are often linked, insofar that a bad bureaucracy will have unnecessary rules leading to high employment requirements and restrictive procedures which hinder important processes. Some restrictions, however, are imperative. Even though time is of the essence in the fight against the pandemic, to suggest that urgency means all regulation and employment checks should be waived would be lunacy. Whilst the idea that all vaccinators need to be bilingual, and go through a language learning course if not, would be an example of excessive red tape, even the staunchest anti-bureaucrat doesn’t want anyone off the street whacking needles in people’s arms.

    Public health in the UK is a notoriously bureaucratic system. But this is not as bad as it sounds. Counterintuitively, it actually leads to less red tape. The reason our health system must be classed as ‘bureaucratic’ is that there are more UK governmental health bodies than PPE students at Oxford. Firstly, there is the Department of Health, headed by everyone’s favourite, Matt Hancock, which oversees the budget and direction of other bodies. This body needs to be multiplied by four for the devolved administrations of Wales, England, Scotland, and Northern Ireland. There is also Public Health England, (or Scotland, Wales, Northern Ireland) which oversees the general health of the nation; the National Institute for Health and Care Excellence, which provides national guidance for Healthcare, and the Medicines and Healthcare Products Regulatory Agency, which focuses on regulating medications and similar products. Then, we arrive at the main organisation we think of when we hear “NHS”: the NHS Confederation. This consists of four executive bodies which run each nation’s healthcare trusts. Each trust runs a set of hospitals, but since the Health and Social Care Act of 2012, they were united under the Confederation, a separate body which represents the trusts to the NHS of the respective nation. The NHS, in turn, represents their interests back up the chain to the Department of Health at Whitehall. If that isn’t enough, there is also a separate body called ‘NHS Improvement’, created to make this process more efficient.

    From the outside, healthcare in the UK is complicated and opaque, the system seemingly clogged up with superfluous middle-managers. This can lead to outrageous cases of wastefulness, such as the disastrous NHS Test and Trace programme which, despite costing £10 billion, saw no real success. Such superfluity was also at fault for the PPE scandal earlier in the pandemic where £10.5 billion worth of personal protective equipment was bought without the correct competitive tender processes. With a reputation like this, surely we can assume that the UK health bureaucracy will be too slow to effectively roll-out the vaccine?

    I disagree, and in fact, I would go on to argue that the vaccine rollout has been one of the few British successes to quietly emerge from the pandemic, primarily as the government has taken a step back and left it to non-partisan public bodies to head the process. The problems of the UK Health Bureaucracy revolve around under-regulation and political cronyism as opposed to stifling red tape and bloated public organisations. The cause of the PPE scandal was the awarding of public contracts to Tory party donors rather than accredited providers. Indeed, a similar oversight led to the failure of NHS Test and Trace, the scheme headed by former McKinsey consultant Dido Harding who paid over £500,000 in consulting fees to her former company. In these cases, it is a lack of regulation that seems to be the problem, as opposed to over-regulation.

    In contrast to these missteps, our current vaccine programme has already delivered over ten million first doses of the vaccine, and is fourth in the world for vaccines delivered per head. Indeed, one of the aforementioned public health bodies, the Medicines and Healthcare Products Regulatory Agency, was the first to approve the use of a vaccine without ignoring any of the regulatory steps. Whilst I will not echo the tone of Gavin Williamson and turn the issues of vaccinations into a national competition, it must be emphasised that the UK has vaccinated more people than any nation in Europe and our average daily output is significantly higher than our Continental counterparts.   Another strong point of the UK vaccination programme is that it is done by age cohort, meaning that over-80s, frontline workers, and elderly care home workers have been prioritised. Given that Covid-19 death rates increase with age, it makes sense that these groups receive the vaccine first, unlike the in the USA, where wealthier individuals seem to be at the front of the queue.

    The NHS (trusts and main body) and the Vaccine task force have been crucial in enabling this huge programme. By creating new vaccination centres, adapting hospital hubs and using pharmacies, they have ensured that everyone is within ten miles of a testing centre. Furthermore, there is little regulation for patients wishing to receive the jab, requiring only a phone call to organise the appointment. This is a stark contrast to France, for example, where the receiver of the jab has to get a GP meeting five days before and must receive written consent.

    Professor Bell’s claim that the UK roll-out has been hindered by red tape was centred around the revelation that GPs were being forced to fill out 7 unnecessary forms in order to join the taskforce. Whilst this was a legitimate grievance, there has been no evidence of vaccination centres being understaffed, the NHS showing that it has the ability to deliver more vaccinations than are currently available. Indeed, the minor red tape of the 7-form requirement has now been slashed, and I suspect this was an earnest mistake as opposed to lack of motivation.

    Another sign of the UK health bureaucracy’s success is the PR management of the vaccine rollout and the effort against misinformation. Although certain state actors have endeavoured to spread disinformation about the effectiveness of the vaccines, a recent YouGov poll on the issue indicated that 68% of Britons have confidence in the jabs, with only 9% saying they are not confident at all. In fact, this trust increases amongst the over-60s, with 81% of this age group expressing confidence in the effectiveness of the vaccine. The government is behind this public trust, with effective steps including a specific inquiry into the cause of misinformation, and with the media coverage of the vaccinations of public figures including David Attenborough and the Queen. Furthermore, the government has cooperated with social media companies to filter any false information or questionable sources to scientific authorities including NHS England. Non-governmental actors also engaged in this effort, with Imams helping combat the recent spread of disinformation to members of the South Asian community in Britain by highlighting the dangers of dishonesty in their Friday sermons, many even informing their mosque-goers that the vaccine was halal. There seems to be collective (although sadly not universal) opposition to the disinformation on vaccines which could be a greater national obstacle to getting out of the pandemic. Of course, there is always room to improve, and events suggest that the roll-out will be slowed by pharmaceutical companies (what a surprise!), rather than NHS bureaucracy. However, I think in what has been a terrible year for all of us and especially governmental agencies, we should give credit where credit is due, rather than call them “lazy” for minor errors.

    Image credits: U.S. Secretary of Defense

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