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A Sky News report from Saturday showed the interaction between the consultant anaesthetist and the Health and Social Care Secretary, Sajid Javid
Dr Peter English, Retired Consultant in Communicable Disease Control, Former Editor of Vaccines in Practice, past Chair of the BMA Public Health Medicine Committee, said:
“The consultant making these comments seems to be confused about the efficacy of vaccination. He seemed to be arguing that vaccination does not prevent infection and transmission, and was therefore useless for this purpose. Since mandatory vaccination of healthcare staff is primarily to protect their patients – so they don’t transmit the infection to vulnerable patients (and secondarily to reduce staff absenteeism due to being ill with or testing positive for Covid-19), and given that (in his opinion) it is useless for this purpose, it should not be mandated.
“There is a kernel of truth in this; but overall it does not stand up to scrutiny. It is true that, even with earlier variants, efficacy against infection and transmission was lower than it was against severe disease; and it is true that such efficacy is even lower against the omicron variant.
“However, that doesn’t mean that vaccination is ineffective against preventing infection and transmission. UKHSA publishes regular reports on vaccine efficacy. The most recent one was published on 31 Dec 2021.[1] It is still early to be clear about the efficacy of vaccination against infection and transmission, and, as with previous variants, such efficacy is likely to decrease over time. A third dose of vaccine (which I do not consider to be a “booster” dose, by the way) gives most people a considerable increase in their circulating antibodies, multiplying them to levels that will take some time to fall below protective levels.
“There is a logical fallacy sometimes referred to as the Nirvana fallacy – that if something is not totally effective, it is useless and not worth using.[2] This is a trope common to anti-science and antivaccine advocates. It seems to be his primary argument. Even if vaccination only halves the likelihood that a healthcare worker will be infected and infect others, that is very valuable.
“And the efficacy against serious illness is much higher than it is against infection and transmission. If anybody – healthcare worker or otherwise – gets ill and blocks a hospital or ICU bed for weeks, because they declined vaccination, they deny treatment to many other people, given that the NHS has far-too limited resources. This is irresponsible.
“Whether mandating vaccination of healthcare workers will increase vaccine uptake, or have the opposite effect of increasing vaccine resistance and decreasing uptake; and whether there will be a large exodus of healthcare staff when and if the mandate comes in or whether, as was seen in the New York Police Department, most people will comply before the mandate remain to be seen.[3] I would guess the effect will be more like the NYPD. If a small number of people who are strongly opposed to a valuable public health measure choose to quit, that may not be such a bad thing.
“Efficacy against infection and transmission does fall over time. How quickly antibody levels fall to levels that fail to provide protection depends in part how high they were to start off with. They will be much higher after a third dose than after two doses of vaccine, so they will take longer to drop down below protective levels.
“The “eight weeks” comment does not seem to be evidence-based: he seems to suggest that after 8 weeks there is no efficacy against infection and transmission. The most recent UKHSA update focuses on Omicron, and was published too soon to observe a drop in efficacy, especially after three doses.
“Another publication (which, oddly, contained no metadata – no date, no authors, no institution… but there is a link to it at the UKHSA website) stated that “There was minimal or no effect against mild disease with the Omicron variant from 20 weeks after the second dose of either a ChAdOx1-S or BNT162b2 primary course.”[4] Note that this is after 20 weeks (not 8); and it is after only two doses – a third dose will push antibody levels much higher than after two doses, so it is likely to take considerably longer for efficacy to drop below protective levels.”
All our previous output on this subject can be seen at this weblink:
www.sciencemediacentre.org/tag/covid-19
Declared interests
Dr Peter English: “Dr English is on the editorial board of Vaccines Today: an unpaid, voluntary, position. While he is also a member of the BMA’s Public Health Medicine Committee (and its chair until Oct 2020), this comment is made in a personal capacity. Dr English sometimes receives honoraria for acting as a consultant to various vaccine manufacturers, most recently to Seqirus.”