Omicron and “Plan C” – how’s it going?

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Yesterday morning, I wrote about talk of a Plan C against COVID this winter. My view was that the Government would feel under significant pressure to implement this plan over the next few days.  I had always suspected that we’d be hearing very soon from the Prime Minister again and so it turned out with his statement on Sunday evening.

I’d also argued that on the assumption that a booster vaccine/third dose could be effective both against serious disease and against transmission then the priority for any plan c should not be implementing new lockdown type restrictions but stepping up with the booster campaign and opening up booking to all eligible over 18s.  My thinking behind that approach is

  1. There is a cost in terms of finances and political capital both for the vaccination programme and restrictions. I know where I’d prefer that capital to be spent if I were the Prime Minister.
  2. That if the majority of the most vulnerable are now protected with a third boost then the priority now is to try and dampen transmission to further reduce the risk of hospitalisations.  The best way to do this is to enable those who are the most mobile in society (younger people) to benefit from protection against transmission.

There is of course the caveat still that whilst there have been some encouraging reports, we are a long way off from certainty that the booster will deliver the 70-75% protection against infection suggested in one report. We need to see further confirmation of this combined with data regarding the efficacy of the booster against serious disease especially when combined with prior infection. 

So, when the Prime Minister’s announcement focused on a boost to the booster campaign last night, my reaction was on the whole positive.  This does look to be the right step forward in the circumstances.  There was one particularly negative sting in the announcement and that was the warning that in order to boost the vaccine campaign, other medical appointments will need to be cancelled. This will raise a great deal of anxiety amongst people, especially as we don’t know which appointments will be affected.  Nor is it simply the case that only those who were due to see a doctor in the next few weeks will be hit.  This could potentially have a significant impact as delays knock appointments planned for the New Year back further.  Additionally, even if only supposed minor and routine appointments are postponed this doesn’t mean that serious consequences are avoided. The loss of such “routine” activities may result in the failure to spot and treat issues that should have been minor but become more serious due to delay. So I hope that the Government will have another look at this and do everything they can to keep NHS services running as normal.

In terms of how the booster campaign is going, I think there’s a lot to be positive about.

Currently we have given the third jab to 23,124, 829 people or 40.2% of the over 12s population. This accounts for 33.8% of the total UK population. However, those numbers will be concentrated in those age demographics that are most vulnerable to COVID. If the third dose does prove effective at reducing transmission as well as serious disease then hopefully this means that primarily the disease will continue to be one affecting younger people for whom it is on the whole a much milder experience.  Indeed, if the campaign steps up a gear this week then I suspect that we would be hoping to see well over 60% of the adult population vaccinated by this time next week as we begin the run up to Christmas.

Whether this will be enough to get us through the Omicron wave remains to be seen. However, assuming it does (and I’m hopeful) this means there is one crucial question still needing answering.  It is likely that we are going to see more variants of concern and so the question is “can we simply respond by masking up, social distancing and adding boosters” every time there is one. It may be that we wait another year before we see a major mutation, but it is also possible that another will come along in a month or two. 

We need a conversation about what lies ahead. The mainstream view in the scientific community is that we are likely to see a move to endemicity. This means the virus will not be eliminated and we’ll have to live with it but not in pandemic conditions. It could still be very serious for some and it could still cost a lot of lives, especially in the short to medium term. However, the expectation appears to be that over time we’ll be exposed to the virus repeatedly so that as our immune systems get used to it we’ll experience it in a milder form not because the virus itself is less virulent or deadly but because our bodies are more used to it. Note that if this view is correct then it is part of the rationale for not vaccinating children whom we hope to build up their immunity by repeated exposure whilst the virus is not a serious risk to them. 

If this is right, then it should matter less and less as to whether or not future variants can escape the vaccine. This should mean that there is a reduction in the number of people required to be re-vaccinated over time.  However, we do need to have clarity about this and the assumptions and strategy need to be clearly articulated by those responsible for public health. The point being that if responding to an immediate pandemic is a sprint, there is still the marathon ahead of learning to live with and to subdue the virus.

Update – SAGE modelling is suggesting that 2 jabs offers around about 84% protection from serious disease whilst the booster brings it up to about 93% . It also is assuming that the booster brings protection against infection back up to around 68%.

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