The Adam Smith Institute’s latest paper, written by Senior Fellow James Lawson and Head of Research Matthew Lesh, outlines how to protect human life while not re-entering lockdowns in the face of endemic Covid-19:

• The rapid rollout of vaccines against Covid-19 is protecting the vast majority of vulnerable people and the wider adult population, significantly reducing the virus’s capacity to spread and kill, and accelerating the end of the pandemic.

• Covid-19 is becoming endemic with substantial ongoing community spread. The virus is also mutating, producing variants. There is uncertainty about our capacity to respond to a rise in cases over the winter months.

• We must learn to live with the virus while maintaining liberty. This can be enabled by boosting the UK’s vaccine campaign and developing greater societal resilience against Covid-19 and future pandemics.

• The UK is enjoying a “vaccine dividend” which is disrupting the link between Covid-19 cases and deaths by as much as 90%, saving around 50,000 lives in the most recent wave of cases.

• It is imperative to ensure restrictions are withdrawn and not reintroduced by building sufficient resilience. 

• The UK’s vaccine campaign was a success but could have gone even faster. There are lessons to be learnt in multiple areas including around “war-effort” style distribution, use of spare doses, pacing, dosing schedules, reward mechanisms, new supplies, mix-and-matching doses, vaccine centre ventilation and safety, and countering misinformation. 

  • There are about 2.1 million vulnerable (“Phase I”) individuals who are entirely unvaccinated and 600,000 yet to have a second dose. There are 10.4 million adults who are entirely unvaccinated — which, if they catch the virus, could result in 39,600 deaths and 148,000 hospital admissions. 

  • There are many receptive to vaccines yet unvaccinated and growing evidence that there may be waning efficacy over time.

  • The UK is falling behind other countries that have vaccinated more people, such as France, and begun providing booster shots, such as Israel.

  • There is also a lack of transparency about forthcoming vaccine supply and efforts to update or procure next-generation vaccinations.

Recommendations

• If the Government wants to maximise the effectiveness of the vaccine campaign, protecting human life and increasing resilience, they should take the following steps: 

  • 1. Redouble efforts to vaccinate those in the “Phase 1” vulnerable group who are due a second dose and/or completely unvaccinated, including using mobile vaccination units and home visits — providing protection to those most likely to be hospitalised or die. This would make the most immediate contribution towards reducing hospitalisations and deaths, and building resilience.

  • 2. Begin providing boosters, which are essential to maintain protection against waning antibody immunity, the Delta variant and future threats; prioritising the vulnerable but also offering a booster to the entire adult population.

  • 3. Publish a detailed roadmap for Covid-19 vaccinations over the next five years, including an upcoming delivery schedule with plans for a backlog of boosters.

  • 4. Update regulatory process to enable rapid approval of vaccine updates every time there is a new variant of concern, following the annual flu vaccine process.

  • 5. Purchase a diverse range of new Covid-19 vaccines including updated Delta-variant specific vaccines and oral/nasal and “universal” vaccines. 

  • 6. Embrace “mix-and-match” doses, to enable greater supply flexibility and enhanced protection.

  • 7. Offer vaccination to children aged over 12, with parental/guardian consent. This should be undertaken without coercion or implied restrictions, mirroring the rules of other vaccines offered to children and as a lower priority initiative than boosters for the vulnerable.

  • 8. Counter misinformation to address vaccine hesitancy and enhance targeted marketing and distribution for those who are ready and willing to be vaccinated but have yet to make bookings. 

  • 9. Offer the flu vaccine across the entire population — not just to those aged over 50 and vulnerable — to build resilience against winter spikes in respiratory diseases, hospitalisations and deaths.

  • 10. Permit pharmacies and private doctors to purchase, distribute and register vaccines from the international market, enabling more flexible boosters, greater vaccine choice and enhanced distribution capacity.

  • 11. Support expanding human challenge trials to rapidly test updated and new vaccines.

• If the Government wants to avoid ongoing restrictions, protect liberty and increase broader societal resilience, it should take the following steps: 

  • 12. Allow the ‘Coronavirus Act’ to automatically lapse and introduce new limited emergency mechanisms, including extensive parliamentary oversight, for future public health-related emergencies.

  • 13. Reject ‘vaccine passports’, a form of state-sanctioned discrimination that would effectively coerce some people into undertaking a medical procedure without informed consent (but maintain venue-customer and employee-employer freedom of contract).

  • 14. Establish an enhanced antibody testing capability, better informing individuals about their levels of protection and public health officials about overall societal resilience.

  • 15. Simplify travel restrictions further to encourage global economic activity, with better collaboration with airlines, a further easing of restrictions for the vaccinated, and a simplification of the “test to release” scheme.

  • 16. Encourage, using guidance, ventilation through continued al fresco retail, hospitality, and leisure activity, use of outdoor heaters and better ventilation in schools as they reopen.

  • 17. Encourage, using guidance, for vulnerable people to use masks with respirators, such as N95, KN95, FFP3, and FFP2, rather than less protective cloth or surgical masks.

  • 18. Proactively invest in new and emerging treatments to tackle Covid-19, such as monoclonal antibody therapy drugs (i.e. Ronapreve, Sotrovimab, AstraZeneca’s AZD7442), antiviral treatments (i.e. Pfizer’s PF-07321332/Ritonavir), and other emerging drugs (i.e. fluvoxamine).

• If the Government wants to ensure medium to long term resilience against pandemics, it should take the following steps:

  • 19. Review medical regulatory processes to accelerate the assessment, approval, supply and distribution of new vaccines.

  • 20. Expand manufacturing and logistics capacity for rapid production of vaccine updates and new vaccines against future pandemics.

  • 21. Invest in vaccine platforms and proactively assess viral threats on an ongoing basis, developing fast-moving responses.