Baroness Brinton (LD) [V]
My Lords, I start by congratulating everyone working in the vaccine sector: the scientists, still working behind the scenes to ensure that there are vaccines that will be effective against the South African and Manaus variants; those involved in the manufacture and supply chain; and all those on the front line, making sure that the vaccines are delivered into arms safely and swiftly by clinicians, with administrators, staff, the military and volunteers helping. A notable reason why the UK has been able to manage this so well has been the expertise of Professor Chris Whitty and our vaccine research community, which has so many years’ experience in epidemics, including the Ebola outbreak in west Africa.
The Joint Committee on Vaccination and Immunisation has also kept our focus on who should be protected first, and the government delivery group, led by Kate Bingham, has also done well. The numbers vaccinated in the top four priority group continues to grow and I, for one, hope that the target for next week will be achieved.
The Statement says:
“We … visited every eligible care home possible with older residents in England and offered vaccinations to all their residents and staff. That means we are currently on track to meet our target of offering a vaccine to the four most vulnerable groups by mid-February.”
However, I still cannot find the actual number and percentage of social care staff vaccinated, whether those working in care homes or domiciliary care staff providing essential support to keep people living in their own homes, so please can the Minister provide the number and percentage of social care staff who have now had their first dose of vaccine? Once again I ask: why are care staff not disaggregated from NHS staff in the published data?
The target of “offering” a vaccine to those in or working in homes is, frankly, no target at all. We know that, after Christmas, an alarming number of cases were diagnosed in care homes, which has resulted in residents and staff being refused vaccine until all cases are over in those homes. With very limited visits by families, the only way that Covid could have come in is, unfortunately, via staff, who probably picked it up from others over the Christmas break. Today, the ONS has said that one-third of all Covid cases in hospital during this pandemic have been over the past month. That is truly shocking.
Was the Prime Minister’s bold statement last year that Christmas should not be cancelled and his encouragement to allow people to mix, against all the expert advice from SAGE and alternative SAGE, worth it? How many deaths will have resulted from those cases, which could have been avoided if that expert advice had been followed earlier?
There are reports of some surgery teams arriving at care homes with enough vaccine only for residents and staff being redirected to large hubs, many miles away. This is unhelpful when staff work shifts and are on low wages, with no access to the transport needed to get to a hub. What is planned to ensure that all care home staff can be vaccinated at their place of work by their local vaccination teams?
Another bit of ONS data this week has shown that there were more than 30,000 Covid-related deaths of disabled people between mid-January and mid-November last year, representing 60% of all Covid-related deaths in that period. I remain concerned that many of those under 70 who are disabled or learning disabled and live in homes are still not on a priority list. We know that those requiring close personal care are at very high risk. The ONS data proves that. When will the Government add them to the top four priority lists?
The opening of large hubs is welcome, but they must not replace very local access to vaccines, whether through GP surgeries or local pharmacies. Worrying reports are emerging of GPs running out of supplies and being told that the large vaccine hubs are being prioritised over them. I thank the Minister for the excellent briefing that MPs and Peers had earlier this week on vaccines and possible treatments for Covid-19. The Statement says:
“This trial will look at whether different vaccines can be safely used for a two-dose regime in the future to support a more flexible programme of immunisation.”
It goes on:
“I want to reinforce that this is a year-long study, and there are no current plans to change our existing vaccination programme, which will continue to use the same doses.”
However, the green book on the vaccination programmes states:
“For individuals who started the schedule and who attend for a vaccination at a site where the same vaccine is not available … it is reasonable … to offer a single dose of the locally available product”
to complete the schedule. If safety has not yet been established, why does the green book say that potentially unsafe dosing regimes can go ahead?
The Minister is correct to say that no one is safe until the whole world is safe, and it is good that the UK has made a commitment of £548 million to COVAX with match funding to provide 1 billion doses of vaccine this year to developing countries. I hope that the Prime Minister will use his chairing of the G7 to encourage other countries to donate their share to make this happen. The examples of the South African and Manaus variants are a wake-up call to all of us that we must work as a global community to protect all people and the world’s economies from Covid-19.
Lord Bethell (Con)
My Lords, I am enormously grateful for the thoughtful questions from the noble Baronesses. They are entirely right to applaud the progress of the vaccine. I start by sharing some pretty formidable statistics on that. An absolutely remarkable 95.6% of those aged 75 to 79 have received their first dose. I have never seen a government statistic quite like that. It is an astonishing figure. Such a very large proportion of a target population have come forward, have been efficiently vaccinated and are now protected from the worse effects of this awful disease. It is an enormous success story. Of those over 80 years old, 91.3% have received their first dose and 74% of 70 to 74 year-olds have received their first dose. Up to 9 February, an astonishing 13,580,298 people received their vaccine. These are extraordinary figures. It will have a huge impact not just on the personal lives of those who have been vaccinated and their families but on the workings of the entire NHS. It is a massive game-changer and will dramatically reduce the amount of hospitalisation for and deaths from Covid. We are determined to take full advantage as a country of this enormous success story.
We are enormously pleased with the WHO readout on the AstraZeneca vaccine. It is exactly what we hoped for and what we understood from the clinical trials of the vaccine, and it is pleasing to see worldwide recognition that a 12-week gap between the two doses is the right approach and that the AstraZeneca vaccine is good for over 65 year-olds. I greatly thank those at the WHO who have done that. We are completely committed to the vaccine rollout and we will not take our foot off the pedal in any way.
I completely understand the point of those who are concerned about the impact of the lockdown. The noble Baroness alluded to the words of Charles Walker, who is entirely right that the lockdown has a huge impact on the economy, the public mood and particularly on those who cannot make it to school. However, the approach we are taking—a slow and steady approach of not rushing into anything—is exactly the one that will pay the greatest dividends for the economy. It is hugely supported by the general public and it will mean that, when we release the lockdown and return children to school, we can do it with the confidence that we will not have to go back again.
We are concerned about the lag in take up, particularly in black African communities. There are clearly, among the really good stories of take up, one or two areas where we are concerned. The work of the communications team on anti-vaxxers’ stories and the support we have got from social media firms has been really good across the board, but this is one area where we are enormously focused. The data is not always crystal clear, and we have not published it all yet, but this is one area where the noble Baroness is entirely right and we are very concerned.
The noble Baroness asked for reassurance on the second dose: will everyone get a second dose, and are there enough supplies in the warehouses for everyone? I reassure her and all noble Lords who may be concerned on that point that we are absolutely committed to the second dose. Everyone will get it, and they will get it on time. The supplies are in place.
The noble Baroness, Lady Brinton, asked about whether it was our policy to give a difference second dose to the first. I will be crystal clear: this is not our policy. If you are given a dose of “A” then your first dose will be “A” and your second dose will be “A” as well, and not “B.” We are looking into clinical trials that seek to understand whether an “AB” combination might be safe and may even be better. There are examples in other spheres where mixing two different vaccines can have a benign effect on the body and can stimulate a greater antibody response. We are looking at this very carefully. The COM COV clinical trial has been given £7 million to look into this. It is a long-term clinical trial and we are not expecting a readout any time soon but, if there are benefits, we will chase those down.
I completely agree with the noble Baronesses, Lady Thornton and Lady Brinton, on variants of concern. We have all been alerted to the grave danger that a mutation might have enhanced transmissibility, increased severity and escapology. Should such a variant emerge that could somehow jeopardise the Ming vase of our massive vaccination success story, we would be extremely concerned to address it. We are shortly having a debate on borders, and I shall save my comments for that debate, but I completely endorse the concerns of both noble Baronesses.
The noble Baroness, Lady Brinton, mentioned Professor Chris Whitty. To all those who missed it, I mention the presentation he gave yesterday on the investment in therapeutic drugs and antivirals, which was unbelievably impressive. We are enormously lucky to have someone like Chris as our Chief Medical Officer. Indeed, the Deputy Chief Medical Officers, Jonathan Van-Tam and the others, have all served us extremely well. I also praise others who have stepped up to public life in our time of need, including Kate Bingham and the noble Baroness, Lady Harding. They have both done an enormous public service and deserve enormous praise.
The noble Baroness, Lady Brinton, asked about disabled people. She is entirely right: there are those who are disabled or who have learning difficulties, and we are concerned about the impact of Covid on them. Many who are clinically extremely vulnerable are already in the priority level 4 and will already be in the prioritisation list. Others will be in prioritisation level 6. We are looking at whether we should change the prioritisation system in any way, and the JCVI keeps a running watch on this. I reassure the noble Baroness that all those in a high-risk group will be prioritised in a reasonable fashion. We will be reaching prioritisation level 6 very soon indeed.
The noble Baroness, Lady Brinton, talked about the importance of sharing vaccine with other countries. Tedros is absolutely right: we are not safe until everyone is safe. Britain has taken leadership role in CEPI, Gavi and ACT; we continue to support the global distribution of vaccines through our contribution of IP, our massive financial contribution and our diplomatic leadership. We remain committed to that, and we will continue to use our chairmanship of the G7 to influence other nations to step up to their responsibilities.
The Deputy Speaker (Lord Bates) (Con)
My Lords, we now come to the 20 minutes allocated for Back-Bench questions. I ask that questions and answers be brief so that I can call the maximum number of speakers.
Lord Hamilton of Epsom (Con)
My Lords, I congratulate the Government on the vaccine programme. After a pretty disastrous war against Covid, it looks as though the Government may be winning the last battle, which is the one that counts. What happens to people who have received the jab and are registered under the test and trace system? Will they be forced to isolate, despite inoculation making it very unlikely that they will catch the disease or transmit it to others?
Lord Bethell (Con)
My Lords, I am afraid that is not the view of the scientists at the moment. I am extremely glad about all those who have had their first jab, but the very strong recommendation is that everyone has to abide by the lockdown rules at the moment. The transmissibility is still there: a person who has had the jab can still, and often may well, be infected by the disease, carry it and communicate it to someone who has not had the jab. They remain a danger to the community and, until a very large number of the population have had the jabs, those protocols will remain in place.
Baroness Hayman (CB) [V]
My Lords, I will first follow up on an earlier question. I am not sure that the Minister managed to reply on the issue of when and if we are expecting evidence on the interval levels between doses on the Pfizer, rather than the AstraZeneca, vaccine?
My main question is about how, given the impressive and successful vaccine programme, we have to recognise that it has mobilised enormous effort and resources. There is growing evidence that Covid will be with us long-term, so it is not a one-off exercise. Can the Minister share government thinking on the sustainability of the programme—for example, the potential for future programmes to be combined with the annual flu vaccination drive or for a single bivalent vaccine against both diseases?
Lord Bethell (Con)
My Lords, I reassure the noble Baroness that the interval protocols for the Pfizer vaccine have been completely endorsed by the JCVI, the CMO and the MHRA. They are extremely clearly endorsed by the British authorities, and she should feel enormous confidence in our approach to that.
However, the noble Baroness is right: I do not know, and cannot say for certain, what the long-term prognosis is. We do not know what the transmissibility of the disease will be with the current vaccine. We are working on new versions of it that should address the South African variant, but we do not know for sure whether that will prove dominant in the UK. It is the view of the CMO, Jon Van-Tam, that it will not beat either Covid classic or Covid Kent—but it is not certain whether that is the case right now.
We do not know whether there will be a rolling programme of mutations that roll on to the shore and require us to update the vaccine regularly—or whether we will have to hold our borders as they are now until we have the kind of vaccine development programme that can turn around refreshed vaccines within, say, 100 days. Those are all possibilities; we are putting in place the necessary plans in case that should be required, but it is my confident hope that the current vaccine will have a massive impact on Covid and that we can return to something that approaches normal in the very near future.
The Lord Bishop of St Albans
I too add my congratulations to Her Majesty’s Government on an extraordinarily rollout of the vaccines. I pay tribute to all those involved, not least one group not often mentioned —the practice managers, who often work through the night. Can the Minister comment on the community champions scheme? Faith leaders across Hertfordshire and Bedfordshire, where I live, have been waiting to use our huge, extensive network of people on the ground to communicate with hard-to-reach groups, such as ethnic minorities and so on. Only now are we being brought into that opportunity. Will the Government commit to working with us, since we are keen to use all our resources to help get those messages out to those hard-to-reach groups?
Lord Bethell (Con)
I am enormously grateful to the right reverend Prelate for mentioning practice managers. Managers in the NHS are sometimes given a bit of a hard time and are too often overlooked. But, my goodness, if the vaccine deployment has been a success and been run smoothly—and if the constant reports I get of two-minute turnarounds, accurate invitations and appointments made briskly and accurately are correct—it is because of those managers. The NHS practice managers are running a tight ship and delivering huge value for the NHS. They are too often overlooked but, boy oh boy, have they delivered on this occasion.
The right reverend Prelate is entirely right to raise the issue of not only community champions but volunteering overall. It has been one of the toughest aspects of our response to Covid to make use of the hundreds of thousands of people who have stepped forward in various schemes to help with it. There are returning practitioners from healthcare; there are community champions, which he rightly described, along with the faith groups; there is also St John Ambulance and the vaccinating volunteers. Quite often, hygiene protocols and the necessity to put in place measures to avoid transmission of the disease have meant that it has been difficult to mobilise the army of volunteers. One thing that we should look back at, when we do our post-mortem, is how we as a country can deploy civic society more effectively.
Regarding the faith groups the right reverend Prelate specifically mentioned, I pay tribute to their role in the vaccine deployment. The sight of vaccines being given out in synagogues, mosques, gurdwaras and temples up and down the country surely has a huge part to play in their successful deployment among many difficult-to-reach groups.
Baroness Massey of Darwen (Lab) [V]
My Lords, may I press the Minister once more on care homes, as mentioned by the noble Baronesses, Lady Brinton and Lady Thornton? The progress on vaccinating residents is indeed impressive. Are there now plans to also vaccinate as a priority, with encouragement if necessary, the staff who work in care homes and to offer the vaccine to relatives who wish to visit, so that family life of some sort can be re-established?
Lord Bethell (Con)
My Lords, we have done an enormous amount to prioritise care home staff, for the entirely pragmatic reason that it would make no sense at all for vulnerable care home residents to be infected by the staff who come and serve them. It is not always possible to put care home staff in exactly the same queue as those residents, sometimes because they are the ones delivering the vaccines. There is in fact a hugely sophisticated NHS route for care home staff to get their vaccine. However, I hear loud and clearly the concerns of noble Lords on this area. Let me please look at it more closely and I will correspond with the noble Baroness, Lady Massey, if I can provide her with any more details that would be helpful.
Lord Scriven (LD) [V]
My Lords, some GPs in Sheffield have told me today that their hubs have a zero supply of vaccine and have been closed for over a week. However, they have not yet vaccinated all of their high priority patients. Those patients are now being directed to travel by bus up to 10 miles to the mass vaccination centre, but the most nervous and vulnerable say that they will not go there. What can the Minister say to GPs who are waiting and able to vaccinate patients but have no vaccine because it has all gone to the distant mass vaccination centre?
Lord Bethell (Con)
My Lords, I have heard the noble Lord’s concerns about this matter when he has brought them up previously, but I simply do not recognise the story he is telling. I would remind him that 95.6% of those aged 75 to 79 have had the vaccine. This is not the story of people who are concerned about going to mass vaccination centres. There are GP centres up and down the country that are closed because they do not have supplies, and it is supply that is undoubtedly the rate-limiting factor. That is because, as he knows, the supply comes in large boxes. If GPs do not have enough people to use up a large box, we have to prioritise those who have longer lists.
Lord Lansley (Con) [V]
My Lords, I want to ask my noble friend about the Moderna vaccine. I understand that we have 17 million doses on order, the first batches of which are likely to arrive in the spring—let us say, in May. Where will the vaccine be used? It seems that with a trial taking place in America of its use among 12 to 17 year-olds, there is an argument for it to be reserved for use in vulnerable younger people or, indeed, given its relative significant effectiveness, to be reserved for use later in the year as a booster vaccine for the most vulnerable groups. Can he tell us the Government’s thinking about the use of this vaccine?
Lord Bethell (Con)
As ever, my noble friend is extremely perceptive in his insight. The Moderna vaccine is indeed an interesting one that may well prove to be a useful complement to the Pfizer and AstraZeneca vaccines, which are the bulwarks of our vaccination deployment at the moment. As he probably knows, the MHRA has already sanctioned the use of existing vaccines in some children where there may be a strong clinical need, and under the advice of their clinicians. However, it is our aspiration to spread the vaccines as widely as possible. Unfortunately, children are a vector of infection and it may be that there are strong arguments for vaccinating not just vulnerable children, but perhaps a large number of children. We will look at various different vaccines for that, and Moderna may possibly be a candidate for the kind of A-B double-dose vaccine that I alluded to earlier.
Baroness Scott of Needham Market (LD) [V]
My Lords, as we move towards group six, we are getting into a rather complex situation where vaccination is not determined only by age but by health conditions and their severity. Can the Minister say something about how we will communicate to the public the kind of conditions and the level at which they have them that will lead them to be vaccinated so that people have a clear understanding and GP practices are not inundated by the task of having to give that information out?
Lord Bethell (Con)
The noble Baroness is entirely right. We are entering a different phase of the rollout where definitions are not based so clearly on age and where more choices have to be made. Noble Lords have raised special groups and interests for which they have made a good case for them to be prioritised. We are reaching the moment when that communication will be made more clearly. I cannot say for certain what it will be because I do not yet have the information in my gift. However, I reassure the noble Baroness that, when that moment comes, the communication will be done very clearly and all the arguments that have been made in this Chamber will be listened to.
Lord Singh of Wimbledon (CB) [V]
My Lords, I have two concerns about a generally impressive vaccine rollout. The first is the advice not to book a summer holiday. Even if it is cancelled later, planning for a break can have an important therapeutic effect on people at a very difficult time. The second is the policy of not allowing visits to relatives in care homes until all staff and residents have been vaccinated. However, I am reliably told that the vaccination take-up among staff in some homes is as low as 20%. Does the Minister agree that a policy which bars vaccinated relatives while giving unvaccinated staff unrestricted access needs to be revisited urgently?
Lord Bethell (Con)
My Lords, the noble Lord touches on one very positive subject: summer holidays. I entirely agree with him on the therapeutic effect of planning one’s holiday. I spend far too much time looking at Scottish cottages and the North Coast 500 to inspire me about the months ahead.
The noble Lord touches on the very difficult subject of care homes. I do not avoid the fact that this is one of the most awkward and regretful circumstances of the moment we are in. The bottom line is that care homes have many residents of different ages. A care home epidemic is unbelievably difficult to control and leads to mortality and sickness. I do not recognise the 20% figure that he articulated, but he is right that in many homes it is not the case that 100% of residents have been vaccinated. It is certainly not the case that everybody who would wish to visit one has been vaccinated. We are in a strange lacuna where visits are not possible—at least not indoor visits, only outdoor ones. I hope that we can end this awkward and difficult moment with the swift and emphatic deployment of the vaccine.
Lord Wigley (PC) [V]
My Lords, will the Minister join me in welcoming the fact that Wales had become the first of the UK nations to have vaccinated more than 20% of its population? Will he confirm that the availability of vaccine supplies for all four homes nations has been co-ordinated by the NHS centrally? That being so, can he reassure me that adequate supplies will consistently be made available to the NHS in Wales to keep up this rate of vaccination, and to enable it to give to all those who have had their first jab their second follow-up jab within 12 weeks?
Lord Bethell (Con)
My Lords, I pay tribute to the Welsh for hitting that remarkable number. I thank the noble Lord very much indeed for bringing it to the House’s attention. I absolutely assure him that distribution of the vaccines is done in very close concert between the four nations. These numbers are assessed and gone through in great detail on a weekly call on Thursday evenings between the Secretary of the State and his opposite numbers. The JCVI and Emily Lawson, who is running the vaccination programme, are in close contact with their DA counterparts. The figures I have seen suggest that the supply to the nations is more than the target numbers that we had originally planned.
Lord Haselhurst (Con) [V]
My Lords, is it not the case that, however brilliantly successful the vaccine rollout has so far been, we still know too little about transmissibility for it to be wise to switch at a stroke from lockdown to the previous normality? While this uncertainty persists, will the Government put caution before risk in their approach to the lifting of restrictions?
Lord Bethell (Con)
My Lords, my noble friend is entirely right that there are many mysteries of immunity that we do not fully understand. While we have some strong evidence on the transmissibility of the disease after vaccination, it is not crystal clear. The evidence we have is that it reduces infection by two-thirds, but that still means that a third of people who have the vaccine might get the disease and be able to pass it on. That is an extremely serious risk when the vast majority of the population have not been vaccinated at all. We do not want a situation where a small minority of the population might be spared sickness and death, but a very large amount of the population become infected with a disease that might hospitalise them or lead to other infections. That is why we are cautious. We are also conscious of variants of concern, which remain a potent threat as long as the vaccine has not been rolled out.
Baroness Tyler of Enfield (LD) [V]
My Lords, I will press the Minister a little further on the low take-up of the vaccine by some care home staff, which has already been raised by other noble Lords. Recent research from the National Care Forum has shown that some of the significant factors accounting for this low take-up include vaccinators coming to homes with enough vaccines only for residents, and staff being expected to travel to vaccination centres if they are not vaccinated in the home, but not being given time off. Those not on shift when vaccinators come, such as night shift staff, are missed, and some fear having to take unpaid time off if they develop a reaction to the vaccine. Could the Minister say what steps the Government are considering taking to tackle these very specific barriers?
Lord Bethell (Con)
My Lords, I do hear the noble Baroness and I would be happy to look into this matter further. However, my understanding is that the vaccination rates among care home staff are much higher than she describes. It is not unusual for care home staff to have their health provided for by the local NHS, and for them to be required to travel to receive that support. That is quite normal for anyone getting a vaccine, even if they work in social care. It is entirely in our interests to make sure that social care staff are vaccinated, so there is no way that there is any kind of policy or deliberate effort to avoid vaccinating care home staff. However, I will be glad to look into this further and, if I may, I will copy the noble Baroness into the correspondence that will clearly result from this debate.
Lord Farmer (Con) [V]
My Lords, having vaccinated the vulnerable tiers, at what level do we revert to normal, bearing in mind, first, that the remaining population is highly unlikely to require hospitalisation or to die from Covid; and, secondly, the mental health stresses which are starting to unravel our social fabric? On that note, do any members of SAGE have recognised expertise in mental health, so that their advice is weighted to this consideration as well as to others?
Lord Bethell (Con)
My Lords, the honest truth is that I cannot lay out a timetable for my noble friend. That will happen in the week of 22 February and the Prime Minister has made that clear. He is entirely right that the vaccine dramatically reduces hospitalisation and death. Target groups 1 to 4 account for nearly 90% of the deaths, so this is a dramatically improved situation. However, it does not remove the threat of Covid altogether. At the moment we have an infection rate of around 2% in the country. Were we to open up tomorrow, that infection rate might lead to a much higher rate: 10% or 20%. If we ran at a rate of 20% we would have a very large number of young people who would end up in hospital one way or the other, and who might experience long-standing damage from the Covid disease. We would also increase the rate of mutations in our own country and we would have a great displacement of that effect on the rest of the NHS system.
So this is not a binary game in which we have suddenly hit the moment where we can lift everything. We have to tread cautiously on that. However, I agree with my noble friend that the mental health impact of the lockdown is intense. I reassure him that two members of the SAGE subgroup SPI-B are members of the British Psychological Society. SPI-B presents the independent expert behavioural science to advise the top SAGE—the Scientific Advisory Group for Emergencies—and it brings to the debate a very clear insight on mental health and brings to our awareness the impact of lockdown, which, as my noble friend quite rightly points out, is immense.
The Deputy Speaker (Lord Bates) (Con)
My Lords, the time allowed for Back-Bench questions on this Statement has now elapsed. I apologise to those whom I was unable to call. There will now be a short pause to allow for some changes before taking the second Statement.