Statement from the Chair, The Rt Hon the Baroness Hallett DBE
Today I publish the fourth Report of the UK Covid-19 Inquiry. It covers the development and deployment of vaccines and therapeutics in the UK during the Covid-19 pandemic.
In many ways the development, manufacture and distribution of effective vaccines to prevent Covid-19 and the identification of an effective therapeutic (or drug) to treat Covid patients are two of the success stories of the pandemic.
The Covid-19 pandemic was caused by a new pathogen SARS-CoV-2. As a result, there were no vaccines and no clinically proven therapeutics (or drugs) available to combat the disease at the start of the pandemic.
The discovery, development and approval of new vaccines can take between 10 and 20 years but, within a year of its first case of Covid-19, the UK had developed the Oxford/AstraZeneca vaccine and had authorised access to two more, the Pfizer/BioNTech and the Moderna vaccines.
It began vaccinating in December 2020, before any other European country. In 2021, about 132 million Covid-19 vaccinations were given across the four nations of the UK, making it the largest vaccination programme in UK history.
The vaccines offered significant protection against serious illness and death. One study estimated that the UK Covid-19 vaccines saved almost 450,000 lives of people aged 25 or older in England and over 25,000 in Scotland up until March 2023 (Wales and Northern Ireland were not included in the study).
This success was built on
- decades of global research and preparation, including research to develop mRNA vaccines (many of which were conceived as cancer vaccines) and previous work on vaccine platform technologies
- the UK’s formidable science and clinical research infrastructure
- existing networks such as the UK Vaccine Network
- the excellent work of the UK’s temporary taskforces, in particular the Vaccine Taskforce,
- the willingness of the UK government to adopt an at risk approach to funding vaccine development.,
- the innovative approach adopted by the Medicines and Healthcare products Regulatory Agency for the authorisation of the vaccines, working in partnership with the pharmaceutical industry
In short, it depended on a huge collaborative effort on the part of the private and public sectors and academia.
Vaccines alone are not enough. They may not work against every pathogen, they may not be suitable for everyone and it may take years to develop one that is effective. Therapeutics are therefore an essential tool in the response armoury.
They were used to target the Covid-19 virus, as well as to treat associated medical complications. The UK’s RECOVERY trial identified arguably the single most important therapeutic of the pandemic –namely dexamethasone, the anti-inflammatory drug used to treat Covid-19 patients. By March 2021, dexamethasone is estimated to have saved 22,000 lives in the UK and 1 million across the globe.
The unknown nature of the next pandemic therefore requires a range of vaccines and therapeutics to be developed which can be pivoted to combat a new pathogen.
To do this, it is crucial:
- to maintain the UK’s vaccine and therapeutics infrastructure by continued investment,
- to support research and development capabilities and
- to maintain the close links between government, academia and industry that proved so successful in the Covid-19 pandemic.
The UK has a world class reputation in biomedical research, but research and the development of vaccines is only one side of the equation. We need to be able to regulate, manufacture and distribute the vaccines at pace.
Turning to the distribution of the vaccines and therapeutics, the vaccine delivery programmes across the UK were also largely successful. By July 2021, almost 87% of the adult population in England had received at least one vaccination dose; in Scotland and Wales this figure was about 90% and, in Northern Ireland, it was nearly 82%.
This success was due to those who planned and operated the vaccine programmes, the extraordinary efforts of people across the UK who helped to deliver them, and those in the healthcare systems in each of the four nations who ensured efficient and coordinated delivery.
That is not to say that lessons cannot be learned from the vaccine roll out. The system depended on placing groups of people into cohorts to prioritise those deemed most at risk from the Covid-19 virus.
Deciding how particular groups should be prioritised – such as pregnant women, unpaid carers and people with learning disabilities – was far from straightforward and the communications concerning eligibility caused confusion in some groups.
In relation to access to therapeutics within the community, access was restricted to narrowly confined groups according to clinical vulnerability. However, there was some confusion as to who might be eligible for antivirals.
In any future pandemic, messaging in relation to eligibility criteria should be clear and easily understandable.
While the majority of people took up the offer of vaccination, when it was made, there was lower uptake within communities in areas of higher deprivation and in some ethnic minority communities.
For many, their concerns centred on the safety of vaccines and possible side effects. To some extent, this lack of confidence in Covid-19 vaccinations was a global issue, fuelled by the rapid sharing of false information online. However, it is clear that a lack of trust and confidence in authority was also a significant contributing factor in the UK. Governments and health services must work with communities to rebuild trust and promote a better understanding of, and confidence in, vaccines.
Communities should be re-assured by the fact that, although almost no drug, vaccine or medical procedure is without risk, there are effective systems in place to assess their safety and efficacy. I have found that Covid-19 vaccines and therapeutics were no different. Vaccines were subject to rigorous trialling and regulatory approval before they were rolled out to the four nations. Any safety concerns were identified quickly and monitored.
However, to further strengthen the system for safety checks, I am recommending that regulators should have access to up to date patient data from across the UK to allow for quicker and more comprehensive monitoring of the effects of new vaccines or therapeutics on the population.
Tragically, a number of people suffered harm as a result of having a vaccine. This was a small minority compared to the overall scale of the vaccination programme, but of no less importance to the individuals affected and their families. I heard moving evidence of representatives from the vaccine injured and bereaved Core Participant groups, who have often felt silenced, ignored or treated as vaccine deniers. Similar experiences were also described to the Inquiry through its listening exercise, Every Story Matters.
It is vital in the context of a whole-population vaccination programme, in which the state is asking people to be vaccinated in part to protect others, that people are adequately supported when side effects do occur. A sufficiently supportive government scheme must be in place to help such people and their loved ones.
I have found that the current scheme for those who have been injured as a result of having a vaccine – the Vaccine Damage Payment Scheme – is not sufficiently supportive and requires reform.
As well as recommendations about access to data for regulators and reform of the Vaccine Damage Payment Scheme, I make three other recommendations which I believe will also ensure the UK is in an even better position to develop and deploy vaccines and therapeutics in the next pandemic. They cover:
- establishing a pharmaceutical expert advisory panel to oversee the UK’s preparedness to develop, procure and manufacture both vaccines and therapeutics;
- producing targeted vaccination strategies and communications, including consulting with local networks about campaigns and delivery, in order to increase vaccine uptake and reduce inequalities;
- improving monitoring and evaluation of vaccine uptake and delivery, in order to understand the measures proven to be effective in increasing vaccine uptake.
The Inquiry has also identified a number of key elements of the UK response to the Covid-19 pandemic which must be properly embedded in pandemic planning and built upon in order to better prepare for the next pandemic:
- the rapid and coordinated funding for research into vaccines and therapeutics;
- the adoption of an ‘at risk’ approach to vaccine procurement by funding research and development of a wide range of vaccine candidates, knowing that some will not be successful, to create as many opportunities as possible to discover an effective vaccine.
- an expedited regulatory approval and recruitment system for clinical trials, as well as expedited authorisation of new vaccines and therapeutics, without compromising on public safety;
- the rapid establishment of specialist vaccine and therapeutics taskforces to bring together national expertise and to act decisively to coordinate the search for effective vaccines and therapeutics.
These approaches worked during the Covid-19 pandemic. However, we must maintain the capability we had in place in 2019/2020 to enable us to fight the next pandemic. We must not allow it to wither.