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Covid-19: Vaccination Prioritisation

Volume 808: debated on Wednesday 25 November 2020


Asked by

To ask Her Majesty’s Government what plans they have to ensure that high-risk adults under the age of 65 are prioritised for access to any Covid-19 vaccination ahead of adults less at risk who are over the age of 65.

My Lords, the Joint Committee on Vaccination and Immunisation has found that mortality increases exponentially with age and has published interim advice accordingly. An age-based programme captures many with underlying conditions. None the less, the sub-committee is reviewing evidence on clinical risk factors, including the clinically extremely vulnerable, and the committee will update its advice if necessary after review.

I thank the Minister for his Answer. As someone who has been shielding since early March, I celebrate those involved in producing the vaccines in such a short time. However, I am concerned to learn that those under 65 in the clinically high-risk categories have been given a lower priority for the vaccine, knowing that 59% of people who have died from the coronavirus have been high-risk disabled people. Can the Minister please provide the JCVI’s evidence that informed the Government’s decision that those in high-risk categories under 65 are less vulnerable to the virus? Disabled people tell me that they have not felt shielded or protected throughout this pandemic, and this priority decision seems to confirm that belief. I urge the Government to think again.

I reassure the noble Baroness that no final decisions have been made; this is only interim advice. I point out in particular that the behaviours of individual vaccines might be quite different for different groups of people. It is only when we have the final phase 3 data on the vaccines that we will be able to make the decisions that she alludes to. We are considering the extremely vulnerable carefully. As I mentioned, a review is under way to see whether clinical factors should play a greater role in prioritisation.

My Lords, I could not agree more with the noble Baroness, Lady Campbell. Motor neurone disease is an example of a fatal illness with a very short life expectancy after diagnosis. The Minister might well have seen recent publicity about the case of a six year-old child being unable to attend school in case he brings the Covid-19 virus home to his dad, who is living with motor neurone disease. I hope the Minister will agree that no family should be in the position of having to choose between their child attending school and the risk of shortening the already short lifespan of his father. Will he further agree that people living with motor neurone disease, as well as those with many other life-limiting illnesses, must be on the priority list for very early vaccination?

I hear loud and clear the conundrum expressed by the noble Lord. These prioritisation questions are very difficult. I hear his plea loud and clear and I undertake that these kinds of considerations will be considered in the prioritisation process.

What provision is being made for another group who feel totally forgotten by this Government—namely, extremely vulnerable children, whether they have medical conditions or physical or learning disabilities, many of whom have been unable to access carers or schools since March? When is the review that the Minister just spoke about likely to publish its results?

It will not be possible to publish any results until we have the clear data on the vaccines. Individual vaccines may behave quite differently with different groups of people. There may be some vaccines that work well with the elderly, some that work well with those with clinical conditions and some that work well with children. It is only when we know that data that the final prioritisation can be published.

My Lords, on 12 November I asked my noble friend’s ministerial colleague, my noble friend Lord Greenhalgh, if he would recommend to the JCVI that rough sleepers and those who work with them should be a priority for vaccination. He said he would. Does that remain the case, and will they indeed get priority?

My noble friend has made the case for rough sleepers extremely well. It is one that we are deeply concerned about. When it comes to the prioritisation list, what has been published so far is an interim and indicative list. It will be reviewed, and a more detailed list will be published in time.

As the Government keep the priority list under review, will they also look at the results of the New York vaccine rollout prioritisation? Younger adults who have been shielding are often already on a list, are at high risk and have children at school or college who are also their carers. These children are already stressed, if they attend education, knowing that they risk being asymptomatic virus carriers into the home and that Covid could kill their parent or sibling.

I am extremely grateful to the noble Baroness for suggesting the New York precedent. It is not one that I was aware of and I will look into it. I reassure her that we are liaising with all our international partners over the vaccine rollout to ensure that we put in the best possible practice that we can.

My Lords, I have read the JCVI priority list. As the Minister has indicated, some granularity is going to be vital. There is so far no mention of vulnerable BAME communities, who have borne the disproportionate burden of the pandemic. How will the Government approach those vulnerabilities in setting the priorities and their implementation?

My Lords, the underlying principles of the advice of the JCVI are to reduce mortality, to improve population health by reducing serious disease and to protect the NHS and the social care system. The basic insight is that the risk of serious disease and death from Covid increases exponentially with age and increases in those with a number of underlying health conditions. Those are the basic principles of the interim advice and they will evolve over time.

My Lords, what consideration will be given to the vaccination of up to 250,000 care assistants employed by disabled people under the direct payments scheme who are not on the radar of any care providers or local authorities?

The noble Baroness makes the case extremely well for care providers. The prioritised list starts currently with older adult residents in care homes and care home workers, but she makes the case for the 250,000 who may not be on that principal list. That is something that I will take away with me.

My Lords, I add my voice to the plea that those sleeping rough on our streets are not forgotten when vaccination occurs. I ask the Minister to rule out any government-assisted moves to stop people who decide, just as they do not want vaccination for flu, that they do not want to be vaccinated for Covid from travelling, certainly within the UK.

I hear loud and clear the case for rough sleepers made by both the noble Baroness and my noble friend. The case was made to my colleague, my noble friend Lord Greenhalgh, as well. That is a really important part of the vaccination programme and we will look into the most effective way of doing it. On the noble Baroness’s second point, I am not aware of any moves to try to limit or create mandatory situations for vaccines within the four nations.

Might my noble friend consider setting up a network to catch and bring back into circulation those young people technically in care between the ages of 14 and 21 who have none the less been trafficked out of their unmonitored council care homes, given that the vaccination publicity is so enormous that they might well be able to be tempted back into life again?

My Lords, the vaccination holds the prospect of returning to some form of normality very quickly. It is exactly the kind of situation that my noble friend points out that will be most welcome. There are a large number of people in various types of care who have not been able to be looked after in the way that they might have been previously. It is extremely valuable that the vaccine will be able to return people to that kinds of support, which they both deserve and need.

My Lords, the Question of the noble Baroness, Lady Campbell, shows very clearly that flexibility will be needed, and I think the Government are hearing that. Now that we have three vaccines, including the Oxford-AstraZeneca vaccine, how soon does the Minister think we will be able to roll out vaccinations at a target of 1 million a day? Will he confirm that target? Will that be from January onwards? In the meantime, the need for rapid mass antigen lateral flow testing is all the greater.

My Lords, the noble Lord tempts me to commit to schedules that I am simply not in a position to commit to, I am afraid to say. The performance of the various vaccines is extremely complex: each one of them needs a different delivery plan. In collaboration with the NHS, we are putting in place an extremely energetic and thoughtful deployment programme. Those in charge have been instructed to have that ready to start from 1 December, but I will not hide it from the House that it may well be after the new year that the very large numbers begin. I reassure the House that we are super-focused on this deployment plan, and, as soon as the vaccines become available, we will be trying to get them to the public as soon as we can.

Sitting suspended.