Lessons from Johnson and a struggling Europe.

The authors of this Vision paper are Francesco Grillo, Giuseppe Cipolletta and Marina Obba.

A spectre is haunting Europe – the spectre of the vaccination campaign which is supposed to bring back to normality societies hardly hit by the Covid-19 pandemic.

According to the European Commission’s targets by the end of March 2021, 80% of the individuals aged 80 or above and 80% of healthcare workers should have been vaccinated. The actual results are such that the take up of the first dose has been 59% in the former group and 61% in the latter (and both significantly drop to respectively 33 and 47%, if we consider only the ones who got the second dose).

The percentage for the whole adult population (above 18) is, indeed, similarly worrying. The target was to vaccinate 70% by the summer (21st June) and at the end of March we are now at 13% (which is 6% if we consider the full vaccination). A simple projection says that if we keep going at this pace, the EU DIESEL (as President Emanuel Macron called the EU) will be of more than half out of its very vital objective.

EU, in fact, does not even have the consolation of the much trumpeted equal treatment of EU citizens. Solidarity does not translate in a trade off with efficiency and the EU is doing badly on both. For instance, while a quarter of people in Malta have been inoculated, only 6% of Bulgarians have.

THE ENGLISH PATIENT

The results, however, become even more embarrassing if we compare the European Diesel with the UK which seems to have suddenly come back to the status of an Austin Martin. At first test, only after 3 months from its withdrawal from the European Union, the UK, has succeeded in the vital yet not easy mission of getting out of the Pandemic thanks to vaccinations.

Data from Oxford University, reproduced in the graph below, are clear: by 25th March, 50% of British citizens had received at least the first dose compared with slightly more than 10% of European citizens.

At current rates, Vision estimates that a coverage of 80% of all EU adults will only be reached on May 19th 2022, a year after Britain will have done so.

THE VACCINE RACE BETWEEN THE ENGLISH ASTON MARTIN AND THE EUROPEAN DIESEL EVOLUTION OF NUMBER OF VACCINATIONS AND DROP IN COVID-19 IN UN AND EU (VACCINATION EVERY 200 INHABITANTS AND DROP EVERY MILLION INHABITANTS, MOBILE WEEKLY MEANS)

 

Source: Vision with data from Oxford University – Our World in Data

The number of deaths and cases directly reflect the dramatic impact of such a rapid vaccination campaign. In the United Kingdom has registered barely 5000 new daily cases for almost two weeks now. That constitutes a third of the daily cases recorded for Italy, France or Germany. But above all, after having had more than a thousand deaths for almost the entire month of January, the British have managed to zero mortality rates with respect overall levels recorded at this time of the year.

Worth considering is, also, the fact that, this miracle was achieved by using – almost exclusively- the Astra Zeneca vaccine which has raised so many Hamletian and damaging doubts in Europe.

This vaccine is also the only one of the COVID-19 vaccines sold at cost (without profit), and the only one produced by a company that is at least half European (the other half being English), as are its CEO, president and most of its production plants. The Europeans could have, in theory, used the data of the NHS on millions of British of all ages “testing” success and side effects of the AZ vaccine (beyond the data of the trials already examined by the European regulatory agency – EMA) and yet Germany’s permanent vaccine commission has just issues a guideline suggesting that AZ should only be used for the ones who are more than 60 (although Angela Merkel, 66, immediately commented that she is “willing to receive the AstraZeneca vaccine when it is my turn”). We still do not know whether the rapidity of London will prevail on the EU stop-and-go. However, it is certain that the English Channel could not have been larger than it seems now thanks to the opposite approach to the same vital operation.

This different performance does not only reflect itself into different number of casualties and infections. Vaccination speed will also determine when different part of the world can exit the most severe phase the Pandemic and re-enter a race for growth, and more importantly, the innovation that the crisis itself will unfold.

Asia has already been up and running since last Summer; the Americans and the British are gearing up now; the EU may accumulate a further delay which will may be difficult to recover and will dent long term growth perspectives even more than the short-term ones.

Brexit was expected to be the Armageddon which would have buried the ambitions of our neighbouring Brits incapable of accepting to no longer be an empire. Yet, if the whole process, including the authorization of the drug, would have required coordination with Brussels, UK’s approach to vaccination would have been technically impossible. The chances now are that in a couple of years, we could find out that the UK is doing better than the EU. More interestingly, the vaccination campaign seems to be a case still largely indicative of the inherent contradictions risking to split a Europe which seems poorly equipped to face the unfolding emergency. Despite the apparent retreat of populism, the showdown between London and Brussels is.

THE TRIPLE HELIX

The success of such a complex campaign rests upon the main factors, on which the UK is showing significant advantage. First, the capacity to control the supply chains of the drugs; second, the ability to set and enforce criteria capable to select population targets which are consistent with overall targets; and finally, the logistical network to ultimately deliver the doses to the citizens.

Within an impressive time, both the British and the Americans, have managed to negotiate with pharmaceutical companies and to fund a research effort of an unprecedented size. The approach has been clearly not just sitting on the other side of a contractual table but trying to co-manage entire global production chains. The American President Donald Trump bought in advance doses from PFIZER in July 2020, whereas the European Commission has not done so until November 2020. On AZ the British Drug Administration issued an emergency authorization one month before EMA.

Thing is that the European Commission, has been burdened with a responsibility that the treaties do not recognise and for which it is difficult to build expertise from scratch. And the problem is that the European Union does not hold the bargaining power and the speed of a fully-fledged State in a situation which has been rightly defined as a “war” by President Biden.

In addition, the UK also enjoys the advantage of not having to go through endless negotiations with undisciplined regions like most European states. Countries with strong local autonomies such as France, Germany, Italy or Spain, are immediately disadvantaged against a country like the UK with a robust internal unity for a rapid and reasonable decision-making. It is true that the UK is home to four ‘nations’ with their own parliaments, and yet, England – which accounts for four fifths of the total population- have no elected regional governments.

All of the aforementioned have paved the way for a design and deployment of the centrally-structured vaccination plan for eleven groups which ought to be followed in rigorous order. It enabled the conclusion of Phase 1, which vaccinated all the population over 50 years in less than three months, and the transition to a re-opening plan planned with the same military precision. Once Phase 1 is completed, more than 600,000 people per day (under 50) will continue to be vaccinated.

There is one final aspect of the UK vaccination campaign that needs to be underscored; the use of data. While not reaching the levels of pervasiveness of South Korea or China, extensive data allowed the authorities to plan the operation and communicate it to the public.

The equivalent of the English ISTAT (Office of National Statistics), has arrived at a calculation, based on the numbers collected in the last year of the pandemic and the last three months of vaccinations on how a vaccination is worth in human lives. 493 injections for individuals aged between 70 and 74 would be enough to avoid one death; vaccinating those aged between 50 and 54 is ten times less effective. As the chart below shows, giving ten thousand fewer vaccinations than planned to people aged 75 to 79 one day can cost the lives of 42 individuals, nineteen days later (based on the average time from infection to death)(1).

HOW MUCH DOES VACCINATION DELAY COST? DEATHS FOR 10,000 LESS VACCINATION DOSES IN A WEEK (COVID-19, 2020-2021, FOR AGE RANGE, FROM DATA RECORDED AT THE OUTSET OF THE PANDEMIC IN MONTHS OF VACCINE ADMINISTRATION)

Source: Vision with data from the Office for National Statistics, Health Foundation and Harrison, Docherty, Calum Semple (Covid-19: Time from symptom onset until death in UK hospitalized patients, 2020)

This provided a clear framework on how to select vaccination’s targets, whereas a country like Italy even managed to have a higher percentage of vaccinated people between the ages of 30 and 39 than between 70 and 79, which may have already costed thousands of lives.

A CHOICE WHICH DEFINES UNDERLYING VALUES PERCENTAGE OF VACCINATED WITHIN THE POPULATION BY AGE GROUPS (COVID-19, 2021, IN PERCENTAGE)

Source: Vision with ECDC and Health Foundation Data

The least worst of political regimes is still democracy. Winston Churchill would have reminded us of this in these last months. And yet, chewing on a cigar, he would also have added that democracies only survive if they are able to be efficient in their darkest hours. The European Union seems better suited to times of peace than to the bizarre wars defining this speeding century. It appears stuck at a very dangerous crossroad. The choice will soon be between full integration or a sorrow return to national responsibilities.

 

(1) Mean time from symptom onset until death in hospitalised patients (COVID-19: time from symptom onset until death in UK hospitalised patients; 2020; Ewen M Harrison, Annemarie Docherty, Calum Semple -Co-CIN) to which five days of incubation should be added.