Covid-19 Vaccinations

Baroness Brinton Excerpts

Monday 8th November 2021 Lords Chamber

[Baroness Thornton (Lab)]

I start by thanking the Minister for taking the Statement. I very much welcome the new antiviral, molnupiravir—another name we all have to learn—as a significant drug in our armoury in the fight against Covid. I think this might be my and the Minister’s first Covid Statement since he was appointed, though we have done several Questions. I thought it might be useful to remember the last 18 months for a moment, when his predecessor and the House dealt with, on average, two Statements and several Questions about Covid a week.

Let us be quite clear: the NHS and social care services have saved the country, and they continue to do so as we move into winter. I again place on record my gratitude from these Benches to the NHS, social care services and all the staff from the top to the bottom of our health service who have worked so hard to save lives, protect the vulnerable and roll out vaccines. But we should remind ourselves that 142,000 people have died from Covid in the UK so far, and 1,173 died last week. We have the highest, or one of the highest, infection rates in Europe. This is not over by a long way, and we are now moving into the winter. Frankly, one has to question whether the Government have a handle on Covid going into the busiest season for our NHS.

The Government must get a grip on the stalling vaccination programme. The Health Secretary, Sajid Javid, is calling on younger relatives to help their eligible parents and grandparents take up the offer of the booster and the flu vaccine. Older and vulnerable people have been urged to get their Covid-19 booster jabs as part of a “national mission” to help avoid a return to Covid restrictions over Christmas. The Health Secretary said:

“If we all come together and play our part”,


the country can

“avoid a return to restrictions, and enjoy Christmas.”

That is a bit late, and it is absolutely in line with this Government’s handling of the pandemic—about two to three weeks later than they need to be. It is a bit rich for the Secretary of State to line up who is to blame if we do need further restrictions at Christmas because the Government have failed to get everyone vaccinated who needs to be.

I ask the Minister specifically about immuno- compromised patients. In September, the JCVI recommended that severely immunosuppressed patients have a third primary dose prior to having their booster jab to maximise their protection. There has been a lack of clarity about whether and when this would happen, which has caused huge confusion among a very vulnerable group in our communities. It is estimated that between 400,000 and 500,000 people fall into this category and are entitled to both a third primary jab and a booster. These two things are not interchangeable. Can the Minister tell the House how many of this group have received a third primary jab, and how many are going on to have a booster? How many are missing out on potentially life-saving doses of Covid vaccines after confusion about who is eligible for a third dose followed by an additional booster jab?

The blood cancer charity Myeloma UK said its helpline has been inundated with hundreds of inquiries in recent months from patients who are struggling to book their third and fourth doses. To compound this challenge, patients like this cannot turn up at a walk-in or mass vaccination centre. What plans are there to ensure that the immunosuppressed receive the vaccinations they need?

More generally, local residents are contacting their MPs to say that they cannot get the boosters they so desperately want. One lady in her 70s with an underlying health condition went to her pharmacy and called 119, just to be told that she was not eligible for her booster—but she knew she was. She finally has one booked in December, but she had to rely on her daughter to book the appointment because she does not use the internet. The system simply is not working for many of those who need it most, because they do not have access to the internet or the new technology the Government want them to use to get their boosters.

Turning to care home residents and booster vaccinations, 1 November was the Government’s target for getting care home residents their booster jab. Could the Minister tell the House what proportion of care home residents have been vaccinated so far? My honourable friend Dr Allin-Khan said in the Commons on Thursday that only about a quarter of care home residents in Leicester have had their booster. The former Secretary of State is now calling for all NHS staff to be compulsorily vaccinated. Is this government policy? If so, what is the timetable? Is it wise to force this through right now when the NHS has a vacancy rate of 100,000?

Finally, plan B, which contains measures that we on these Benches already support, such as mask wearing and allowing working from home, is simply not enough on its own. Yes, we support it, but we must turbocharge vaccine boosters, fix sick pay, and improve ventilation. Does the Minister agree?

[Baroness Brinton (LD) [V]]

My Lords, from these Benches, we add our thanks to all those involved in the current delivery of vaccinations, whether they are GPs, nurses, healthcare assistants or volunteers at vaccination centres, and we thank more broadly our NHS and care-sector staff who are still working extremely hard to reduce the backlog of cases while coping with over 9,000 patients currently in hospital with Covid.

The Minister knows that the Delta variant and its subvariant, which is thought to be behind the growth of cases in the west country and Wales, remains highly transmissible. Doctors are reporting daily that double-jabbed patients are catching Covid and passing it on. Why have none of the mitigations in plan B been carried out? Many scientists, including some members of SAGE and Independent SAGE, believe that we should be operating them now to reduce the high numbers of cases and not be faced with a second Christmas being cancelled by the Prime Minister at short notice.

From these Benches, we have asked time and again for the wearing of facemasks inside and on public transport, as well as room ventilation in schools and other public venues, to be mandated, and for social distancing to remain. There are now, on average, 35,000 new cases daily, a shockingly high number. Professor Peter Openshaw, the chair of NERVTAG, said today that it was clear that immunity from the vaccines is waning. Yes, and vaccination is vital, but with cases at this level why are the Government not making mask mandates and social distancing formal?

Today, the Prime Minister once again reminded people to get their jab, whether first, second, third or booster, the ONS data showing that the risk of dying from Covid is 32 times greater in unvaccinated people. Can the Minister tell us why last week it was announced that vaccination centres are now closing at 6pm? Surely it should be easy for people to get vaccinated at a time that works for them, when they leave for work or get home from work?

The last time we spoke about Covid, I asked the Minister what the Government were doing to prevent some of the very unpleasant anti-vaxxer interventions at school gates and outside some vaccine centres. Has any action been taken on their disgraceful leaflets, which deliberately look like an NHS document but are full of direct lies and mistruths? It is important, because, by the Minister’s own numbers in this Statement, only 22% of 12 to 15-year olds have had their vaccination so far. I think Ministers now recognise that cases in this age group are driving cases in the older age groups, which is probably why hospital numbers are going up.

The noble Baroness, Lady Thornton, referred to the muddle between booster and third doses. The pandemic is far from over for immunocompromised and immunosuppressed people. I declare my interest as one of the clinically extremely vulnerable, as I have said before. I discovered by chance, reading something online, that I am now in the third-dose category. My GP did not know it and I certainly did not know it either. That is the problem. GPs and vaccination centres have not been told about the distinction. I have read the NHS guidance on the third dose, but many other clinically extremely vulnerable people are saying that their surgery or vaccination centre does not understand which category they fall into.

This is not helped by the problems with the online form which I asked the Minister about last week. Does the online form now specify the third dose, which is for around 800,000 people, according to current estimates, not for 400,000 people, as the noble Baroness, Lady Thornton, said, as distinct from the booster, which is for around 20 million? It is important, because the third-dose patients must have a booster in a further few months. If the system is not even recording the third dose, how will it know to call them back?

With the end of the shielding programme on 17 September, Sajid Javid wrote to all those on the patients’ list to inform them that it had finished, that the Government would no longer be offering specific advice and that we should go to our hospital clinicians. But many of us do not have an appointment in the diary, and there is not likely to be one because our clinicians are catching up with the backlog of cases, and those who are specialists in immune diseases are working on the Covid wards as well. So can the Minister say how on earth the clinically extremely vulnerable are meant to know what to do in the meantime?

Will the Minister ensure that the Government will work with patient organisations, clinicians and employer to produce clear and meaningful guidance that promotes safe working practices for this group and, in particular, let employers know that they have to help employees either to work from home or, if they have to go in, to make sure they do not have to go in by train or bus at peak hours? Please will the Government appoint a dedicated national lead to co-ordinate the support and guidance available to people in this group?

The news in the Statement of the approval of the Merck and Ridgeback antiviral Molnupiravir is also good news. I see that just under half a million courses of doses have been ordered. It was good to hear on Saturday of the success of the Pfizer clinical trials elsewhere, but I gather we are some way off from that being approved, because further trials of people who are clinically vulnerable are needed. Can the Minister tell the House the likely timescales of the actual delivery of both these different antivirals?

Finally, I am aware that I have asked some technical questions. If the Minister cannot answer them today, please will he write to me with the answers?

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

I thank the noble Baronesses for their questions and for raising some very important points, on which I and others have been in discussion not only with health professionals but with departments and other advisers. I will try to answer their questions in detail. The ones that I do not answer because of their technical nature—as the noble Baroness, Lady Brinton, acknowledges—I will try to answer later if I am unable to answer now.

First, I join the noble Baronesses, Lady Thornton and Lady Brinton, in praising our wonderful doctors, nurses and other healthcare staff. Also, we should not forget all the wonderful people who have supported them: the delivery staff who brought stuff to their homes and delivered food, and the local civil society projects. We saw a massive upsurge in voluntary work and volunteerism. Whatever our politics, whatever part of the spectrum we are on—whether we call it co-operative socialism, local libertarianism, community conservatism, or just humanity and people helping each other—I thought it was a wonderful expression of what we can do when we all pull together.

We also have to remember, as the noble Baronesses, Lady Thornton and Lady Brinton, reminded us, that this is not over. That is one of the reasons why the Secretary of State felt it was important to make this Statement and this point. There has been a level of complacency in encouraging people to come forward. We have not been strong enough, which is why we are pushing now and emphasising the fact that we want as many people as possible to come forward and get the booster. It was announced over the weekend that it is not necessary to wait for six months after the second dose; people can book from five months. In fact, today I tested the system and took advantage of it and was able to book my booster. I hope many others will be able to do so to.

I would ask noble Lords across the House that if anyone comes to them with experiences of not being able to use the service—we have had a couple of reports of a few technical hitches—please let me know so that I can pass them on to NHSX, so that we make sure that we are aware of problems as soon as possible. So far—I want to try to touch some wood somewhere—it seems to be working.

Let me now turn to some of the detailed questions that I was asked by the noble Baronesses. The JCVI has advised that people with severe immunosuppression at or around the time of their first or second vaccination receive a third primary dose as a precautionary measure. Some individuals who are severely immunosuppressed due to underlying health conditions or medical treatment may not achieve the same full immune response to the initial two-dose Covid-19 vaccine course. The third dose aims to bring them up to nearer the level of immunity. As with the vaccination of other at-risk individuals, eligible individuals will be identified and invited by the hospital where they receive care under a consultant and/or GPs.

If either of the noble Baronesses or any noble Lord here today is aware of that not happening, please let me know so that I can make sure that we push on this. I am told that the NHS is writing to all patients who may be eligible so that they can talk through their options with their GP or consultant if they have not done so already. Any patients who have not yet been contacted but think they may be eligible, for example because they have previously been advised to shield, can contact their consultant for an update. If noble Lords know of any problems or are aware of any issues, I hope that they will let me know as soon as possible so that I can chase on them.

On the booster, while there are many stories saying that we have not done that well, we have 12% booster vaccination. When we look at booster vaccination in other European countries, the highest is Israel with 45%, but Spain is at 2%, Italy is at 3%, France is at 4% and Germany is at 2%. This is why we are emphasising the importance of booster vaccinations. My right honourable friend the Secretary of State and others are keen to push people to make sure that they have their booster as soon as possible. It is the best defence against Covid and it is important, especially as protection wanes, that people are getting their boosters.

On plan B, I repeat what has been said previously: there is no set threshold. We consider a range of evidence and data, as we have done throughout the pandemic, to avoid the risk of placing unsustainable pressure on the NHS. For example, while the number of Covid-19 patients in hospitals is an important factor, the interaction with other indicators, such as the rate of increase of hospitalisations and the ratio of cases to hospitalisations, will also be vital.

The Government monitor and consider a wide range of Covid-19 health data. I shall go into some of them in a bit of detail. We look at cases, immunity, the ratio of cases to hospitalisations, the proportion of admissions due to infections, the rate of growth in cases and hospital admissions in the over-65s, vaccine efficacy and the global distribution and characteristics of variants of concern. We also look at the risk to the NHS. One of the issues, as many noble Lords will know, is about making sure that the NHS is not overwhelmed. In assessing the risks to the NHS, the key metrics include hospital occupancy for Covid-19 and non-Covid-19 patients, intensive care unit capacity, admissions in vaccinated individuals and the rate of growth in admissions. The Government also track the economic and societal impact of the virus to ensure that any response takes into account those wider effects.

On some of the measures that are being proposed in the potential plan B, clearly a number of people with other health conditions, including mental health conditions, would be incredibly concerned were we to go to some of the more severe measures under plan B. We always have to balance them up. As noble Lords will be aware, questions have been asked about those awaiting elective surgery and the unintended consequences of focusing on Covid-19, for example whether it has led to a disproportionate number of deaths from other diseases or conditions.

Covid booster jabs have been delivered or booked in almost nine in 10 care homes as the NHS vaccination programme accelerates ahead of winter. Around 6,000 care homes have already been visited, while a further 3,700 homes have visits scheduled in the coming days and weeks. The new figures also show that residents in more than half of care homes have received their booster jab. When I asked about the discrepancies in the small proportion that have not yet been booked or vaccinated, I was told that there may well be cases of Covid in those care homes and they are waiting for the delay after the positive test to ensure that it is safe to go there.

I was asked about the breakdown of different types of care home. Based on the latest CQC annual report on care, we can say that the CQC inspects a number of these care homes.

To answer some of the other questions, as I said, the NHS is writing to all patients who may be eligible so that they can talk through their options. On the issue of whether to make NHS staff take their vaccinations, we have consulted on vaccination as a condition of employment in wider health and social care; I am told that my right honourable friend the Secretary of State will set out the position very shortly. The important thing to remember is that we want people to take the booster, and we want to make sure that we reach those communities and demographics who have not had even their first or second vaccine yet.

I have had a number of conversations with noble Lords from across the House—I thank them for their advice and suggestions—about how to reach out to some of these communities. For example, I was in conversation with one right reverend Prelate about how we could work in conjunction with interfaith communities in local communities, for example in certain parts of London where there is a low uptake. Sometimes people may not be of faith, but they respect faith leaders—vicars, imams, priests et cetera. We are looking at how we can work on this, and I very much hope that we will be able to roll that programme out further. If any noble Lords are interested in or have any suggestions on that area, I would welcome them.

I apologise if there are technical questions that I have not answered; I will make sure that I write to noble Lords.