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Covid-19 Update

Volume 814: debated on Thursday 9 September 2021


The following Statement was made in the House of Commons on Monday 6 September.

“With permission, Madam Deputy Speaker, I will update the House on Covid-19 and our vaccination programme.

Earlier this summer, we took the fourth step on our road map. We were able to take that step because of our vaccines and the way that they are working. The latest data from Public Health England estimates that our jabs have prevented over 100,000 deaths, over 143,000 hospitalisations and around 24 million infections. Across the United Kingdom, we have administered over 91 million vaccines; 88.8% of people over 16 have had their first dose, and 79.8% have had their second dose. Our jabs are building a vast wall of defence for the British people.

But this vital work is not yet complete. With the delta variant sweeping around the world, we have seen how it thrives on pockets of unvaccinated people. Last week, across the UK, we saw an average of 34,000 new cases and 938 hospitalisations each day. It is vital that we continue to plug the gaps in our defences and widen and deepen our wall of defence.

Over the summer, we have continued to do that in several ways. In August, the Joint Committee on Vaccination and Immunisation recommended that vaccines should be offered to 16 and 17 year-olds. It also recommended jabs for 12 to 15 year-olds with specific underlying health conditions and household contacts of someone who is immunosuppressed. We accepted both recommendations, bringing us into line with countries such as Sweden. In recent weeks, 16 and 17 year-olds have been coming out to do their bit in droves, travelling with schoolmates and family members to get the jab.

We are taking the jab to people, too, with walk-in and pop-up vaccination sites at football stadiums and shopping centres, and of course at university freshers’ fairs; I think we have got to 20 universities. Over the bank holiday weekend, NHS pop-up sites at the Leeds and Reading festivals made picking up a jab as easy as getting a beer or a burger. As a result of these kinds of efforts, more than half of 16 and 17 year-olds across the United Kingdom have received their jabs since becoming eligible last month. That is in addition to over three in four—76.3%—18 to 34 year-olds, who have already had at least their first dose. Much of young people’s enthusiasm, I believe, comes from the fact that they have seen at first hand the chaos that Covid-19 can bring. They have sacrificed so much and shown that age is no barrier to public spirit. I am sure the whole House will join me in thanking them for playing their part in helping us all to live safely.

On Friday, the JCVI outlined its recommendations on the vaccination of children aged 12 to 15 years who do not have underlying health conditions. It concluded that while there are benefits to vaccinating this cohort, taken purely on health terms the benefit is finely balanced. Building on the JCVI’s advice, we will now consider advice from the UK’s four chief medical officers and make a decision shortly. We have already accepted the JCVI’s recommendation that 12 to 15 year-olds with the following conditions become eligible: haematological malignancy, sickle cell disease, type 1 diabetes, congenital heart disease and poorly controlled asthma. That will amount to an extra 200,000 teens becoming eligible.

I also want to take this opportunity to address vaccination in pregnant women. The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have both recommended vaccination as one of the best defences for pregnant women against severe Covid infection. Extensive real-world data show our vaccines are safe and highly effective for pregnant women. We now know that pregnant women are more likely to become seriously ill from Covid if they are not vaccinated. In fact, 98% of pregnant women in hospital due to Covid-19 are unvaccinated. Yet we also know that not one single pregnant woman with two jabs has required hospitalisation with Covid-19. I urge pregnant women to continue to come forward and get the jab. Our new Preg-CoV trial is advancing knowledge on how we can even better protect pregnant women and their babies.

Taking all of that together, our overarching ambition is to widen our wall of defence so that we can protect more and more people. As well as widening that wall of defence, we are deepening it. Last Wednesday, 1 September, the JCVI advised that people with severely weakened immune systems should have a third vaccine dose as part of their primary Covid-19 vaccination schedule. It will be offered to people over 12 who were severely immunosuppressed at the time of their first or second dose, such as those with leukaemia, advanced HIV and recent organ transplants. This, I must stress, is separate from any potential booster programme for the rest of the population. The JCVI is still investigating who should receive boosters. Our Cov-boost study is comparing immune responses produced by third doses of different brands of vaccines. As ever, whatever the clinical decision from the JCVI, the NHS will be ready. We will proceed with the same sense of urgency we have had at every point in this campaign.

Vaccines remain our most important line of defence, yet they are not our only line of defence. Regular testing continues to play a crucial part in returning this country to something that feels a bit more like normal. PCR tests remain freely and easily available, and anybody with symptoms should make sure to get tested. Children are returning to classrooms across these islands. I am sure all honourable Members welcome that, as did the Secretary of State for Education at Questions this afternoon. They return to an immeasurably better set up: no more home schooling, no more bubbles, teachers vaccinated, and all 16 and 17 year-olds offered a first dose before returning. That matters because we know that face-to-face education is the best place for children and young people.

Rapid testing can uncover hidden cases of the virus at the start of term. Whether it is our constituents or our children, we must encourage people to do it. On their return to school and colleges, students should take two rapid tests on site three to five days apart. They should then continue to test twice weekly at home. To university students, I would also say this: make every effort to get fully vaccinated before going back. It has never been easier to drop in and get a vaccine and the necessary testing. These are straightforward steps, but they are essential in stopping the spread.

Finally, I am sure the whole House will join me in welcoming the additional £5.4 billion cash injection we are putting into the NHS. This investment will go straight to the front line, supporting our Covid-19 response over the next six months. The funds include £1 billion to help to deliver routine surgery and treatments for patients and to tackle our backlog. The funds take the Government’s total support for health services in response to Covid-19 to over £34 billion this year alone.

We are widening and deepening our wall of defence. We are getting jabs to more people and getting some people more jabs. We are getting the NHS what it needs. The ask of our NHS colleagues continues to be complex and challenging, yet they rise to it day in, day out. I pay tribute to everyone involved in these lifesaving efforts. We must keep going, and I commend this Statement to the House.”

I hope the Minister has had a good break and I thank him for the Statement today. I regret that phrases such as “Groundhog Day” and “Here we go again” keep jumping into my mind unbidden. Obviously everybody welcomes the continued rollout of the vaccine, and I congratulate the NHS and its partners on this. However, we must not pretend and behave as if we are at the end of this pandemic. The figures still show a substantial daily rate of infection, hospitalisations and deaths. If we go into the winter with a high proportion of ICU beds still occupied by Covid patients, this will have a knock-on effect for serious elective surgery, emergency needs and flu. It will affect the ability and capacity of the NHS to deliver the beginning of the catch-up that we face in the next couple of years. The context of this catch-up is starkly illustrated by the figures concerning cancer this week. The Macmillan Cancer report reveals that

“More than 600,000 cancer patients in the UK are facing treatment delays or missing out on vital support because of a shortage of specialist nurses”.

Less than a month ago, the Health Secretary said that he wanted booster jabs to be given at the same time as flu jabs and that they would be starting this month. However, is it the case that, due to supply issues linked to a shortage of drivers, equipment and flu vaccinations, these are delayed? If so, for how long? Is it for two weeks or is it longer?

In this context, it is not surprising that GPs are at their wits’ end, forced to cancel first blood tests because of test tube shortages and now flu vaccination appointments. We need to think about what that means; for example, if you are pregnant and need a flu vaccination, the delay is a serious matter because you cannot put your pregnancy on hold while the supply catches up with you. It is especially worrying as we head into what could be one of the most difficult and challenging winters for the NHS. What steps are the Government taking to ensure that there are not further delays and to avoid a flu crisis this winter?

If the CMOs are recommending vaccination, will the Minister guarantee that our public health workforce, our health visitors and our school nurses, as well as primary care, will have the resources they need to roll out that vaccination? Can he advise what the anticipated time frame for commencement and the communication strategy will be? He Minister must be aware that many parents appear to be hesitant and that with other groups with low levels of vaccine uptake, access to accurate and trusted information is key.

Some scientists have suggested that the vaccination of children against Covid-19 is already too late to blunt an autumn wave of the infection because they will get only one dose, which is not terribly effective at preventing infection with the delta variant. What assessment have the Government made of this and what consideration has been given to limiting the minimum interval between first and second doses?

The Education Secretary has suggested that weekly Covid tests for pupils could be scrapped this month, following a review. That may be quite concerning, given that the autumn could bring a surge in cases driven by a new variant, by more mixing of people at school or work, or indeed by a drop in the levels of immunity provided by the vaccine. Does the Minister agree that testing really ought to continue?

The Education Secretary also seems to have removed many of the infection control mitigations in schools. From these Benches, we urged the Government to use the summer to install ventilation, air filtration units and carbon dioxide monitors in schools. I would like to know how many schools now have these systems installed. I also share with the Minister our concerns that the current rules seem to suggest that a child can go to school even when their parents test positive. That seems not to be a sensible way forward.

Are the Government making contingency plans for an October firebreak lockdown if hospitalisations continue to rise at their current rate? Last week, the World Health Organization designated mu as a variant of interest, adding that it can potentially evade immunity granted from a previous Covid infection or vaccine. Perhaps the Minister could update the House on that issue.

On Tuesday, the Prime Minister finally made his long-awaited social care Statement, over two years after standing in front of the steps of Downing Street proclaiming to have a plan. Now, we had a debate and discussion earlier today about whether it is actually a plan—because we think it is not—and what the tax increase means. However, the timeframe for the delivery of this plan does not seem to recognise that we already have bed blocking in our hospitals. There is already an emergency in social care and the knock-on effect of that on Covid, flu and the winter could be substantial. I would really like the Minister to address that issue.

My Lords, yesterday 38,486 new daily cases were reported. That is equal to daily cases in mid-January and there are now just under 8,000 people in hospital, with 1,000 on ventilators—and yesterday 191 deaths were also reported, equal to the daily numbers at the beginning of March. The consequence of removing all mitigations and life returning to the new normal means Covid is still very much with us, especially the delta variant. Members of SAGE appear, according to the press, to be advising that preparations for an October lockdown should now be made.

It appears that Ministers are reliant on vaccination as the main mitigation, until the NHS is overwhelmed again. But we are already hearing of hospitals having to dedicate more wards just to Covid, with the complexities of double staffing for hot and not-hot wards. These numbers also make it much harder for the NHS to catch up on the long waiting lists, which have been talked about a great deal during the week, with the health and social care announcements.

The Statement talks about test and trace being another pillar. That is right, but the advice to the public is complex and there is evidence that many are not taking tests even when they have symptoms or have been in touch with a positive case. For example, you have to hunt quite hard online if you have had a negative PCR test but still have some residual symptoms to find out whether you should release yourself from self-isolation. Are there plans to make it clearer exactly what people should do, because we all know that sometimes the first PCR test is a little early and a second one is necessary?

Are the news reports true that there is about to be an announcement that anybody double vaccinated will not need to take a PCR test if they come into contact with a Covid-positive person? The delta variant can and is being caught by double-vaccinated people, and—importantly—they can transmit it too. That can have difficult consequences for those not vaccinated, or those who are clinically extremely vulnerable. The noble Baroness, Lady Thornton, referred to the mu variant. If it is true that the Pfizer vaccination is ineffective in holding it back, that is serious and we may need to think about mitigations again sooner rather than later.

The Statement explains the partial changes on policy for vaccinating 12 to 15 year- olds with underlying conditions. It is good to see that those with blood cancers, sickle cell, type 1 diabetes, congenital heart disease and poorly controlled asthma are now added to the list. Actually, it is vital, given Gavin Williamson’s removal of all mitigations in schools. But other children are omitted from this list, who may be on immuno-suppressants or immunocompromised, and who are now expected back in school. The Statement refers to

“no more home schooling, no more bubbles, teachers vaccinated, and all 16 and 17 year-olds offered a first dose”.

But the removal of bubbles and facemasks, and the Government’s shameful lack of movement on providing proper ventilation interventions in classrooms, means that Covid can and will spread, and not just among the children—they may well take it home. While most children will not have a problem, some—those with underlying conditions—will.

Can the Minister explain why all children with serious underlying conditions have been removed from the clinically extremely vulnerable list of shielders? Parents are already getting threatening letters from schools, yet their questions about why their at-risk child has been taken off the list have not yet been properly answered. The evidence in America is that these children are occupying more paediatric hospital beds and more intensive care beds.

Turning to clinically extremely vulnerable adults, it is good that the 500,000 severely clinically extremely vulnerable are to get a third dose as soon as possible. But delaying the decision on a booster jab for the remaining clinically extremely vulnerable, who number just over 3 million, is worrying. Guidance online for them is still 10 pages long, muddled in with advice to the general population, but the key parts are still not to go into any environment with people who are not yet double jabbed or might breach social distancing, and if they come inside your home they should have had a lateral flow test first. As I have said, that amounts to a stay-at-home order but without the support that government provided before. When will the booster decision be made for this particular group of people?

Care home providers are warning that they are already losing staff ahead of the 11 November deadline for all staff to be double vaccinated. This is in addition to the staff shortages that they are already trying to manage, which include the perfect storm of losing staff through Brexit and increased pay in retail and agriculture. Losing more staff who are unvaccinated will be catastrophic. They have asked for a delay to the start of the scheme, particularly now that a new consultation has started for NHS staff on a scheme which would start at a later date. What plans are there to delay this implementation date?

Finally, the Minister for Vaccines came a real cropper in the House of Commons yesterday when trying to justify Covid vaccine passports, when he was on record in the past as not supporting them. Can the noble Lord update the House on the Government’s plans regarding vaccine passports in light of yesterday’s debate, which demonstrated that the relevant Minister could not even explain his own policy credibly?

My Lords, I am extremely grateful for such thoughtful questions. I thank the noble Baroness, Lady Thornton, for her kind remarks: I had a very good break, and I hope that both she and the noble Baroness, Lady Brinton, did so too.

We are in a much better place than we were this time last year, but there are still serious challenges on the horizon. I am grateful for the opportunity to address some of those.

The noble Baroness, Lady Thornton, rightly alluded to the important flu vaccine rollout ahead of us. I reassure her that any issues of supply are focused very much on single suppliers, and we have a wide range of people stepping forward to supply us. We will continue an extended vaccination programme for the whole of the 2022 season, and more than 35 million people should be eligible for free seasonal flu vaccines. It will be the biggest flu vaccine rollout that we have ever done, beating, we hope, the record uptakes that we had last year. It will include a continued offer of vaccination to 50 to 64 year-olds and, for the first time, will be extended to additional cohorts in secondary schools so that those in years 7 to 11 will be offered a vaccination. The vaccination rollout is on course and we hope that it will hit all its targets.

While talking about education, I reassure the noble Baroness that asymptomatic testing in secondary schools and colleges will be continued. That includes two tests in person on return, which many have recently done, but there will be a review point at the end of September. Schools will not be responsible for contact tracing of positive cases. As with positive cases in other settings, NHS Test and Trace will work with those cases to identify close contacts. I believe that will lift a severe burden on schools and make life easier both for parents and for pupils.

On ventilation, both the noble Baroness, Lady Brinton, and the noble Baroness, Lady Thornton, are quite right: these are important developments. But we cannot turn around a massive change in the infrastructure of our education system overnight. As autonomous institutions, it is right for providers of education to put in place their plans based on individual circumstances, including allocating their own budgets. None the less, we are putting in place special provision for ventilation in schools where there is an acute need.

To answer the noble Baroness, Lady Brinton, directly, she is right: vaccines are the primary but not the only way out of this pandemic. She will know as well as anyone our remarkable achievements in that space. The noble Baroness, Lady Thornton, asked whether we are therefore planning to have an autumn “firebreak” of lockdowns. The Government are undertaking a review to assess the country’s preparedness for autumn and winter, which will consider whether to continue or strengthen public and business guidance. We may need to take measures to help manage the virus during periods of higher risk, such as autumn. However, we will do everything we can to seek to avoid imposing restrictions that have significant economic, social and health costs. We will do it only as a last resort if absolutely necessary.

Both the noble Baroness, Lady Brinton, and the noble Baroness, Lady Thornton, asked about children’s and young people’s vaccines. As they know, on 3 September we accepted JCVI advice on extending the list of 12 to 15 year-olds with underlying health conditions who can receive the vaccine. That is very good news. It includes children with haematological malignancies, sickle cell disease, type 1 diabetes, congenital heart disease and a number of other conditions. We are now awaiting the CMO’s assessment of the JCVI advice so far and its advice to us on whether the remaining 12 to 15 age group should also receive the vaccine. We look forward to receiving that advice.

Regarding boosters and a third vaccine, on 1 September we accepted JCVI advice on offering a third vaccine dose to individuals with severe immunosuppression. That dose is being given to bring severely immuno-suppressed individuals nearer to the same level of immunity achieved by healthy individuals in two primary doses. Again, this is very good news. Following the publication of interim advice by the JCVI in June, the Government are preparing for a potential booster vaccination programme from September, and I look forward to bringing details of that to the House at a future date.

On the mandation of vaccination in social care, we are enormously grateful for the huge amount of support among social care workers for our vaccination programme. It is true that some—a very small proportion—have not taken up the opportunity for vaccination. We hear the concerns of providers of social care, but, in the round, this has proved to be an effective programme that has delivered a huge amount of reassurance to those who live in social care and has put safety at the forefront of our efforts. That is why we are looking at a consultation on mandatory vaccination for NHS workers, following a public consultation that we recently announced. While many of those working in health and care have taken up the offer, it is crucial that this is consistent across relevant services to safeguard vulnerable people, which is why we are looking further at mandatory vaccination elsewhere.

Testing is still very much an important part of our campaign against the virus. We are supporting the testing programme, but we maintain it under review. On discharge arrangements, there has been generous financial support for discharge provisions from hospitals to schools because, as the noble Baroness, Lady Brinton, rightly pointed out, that is a very important bottleneck that has tied up a large number of hospital beds. As we go into winter, we want to have the best possible arrangements for ensuring that those hospital beds are prioritised for those who need them most.

My Lords, I have some supplementary questions. I am most grateful to the Minister for the update and for yet again appearing before the House. I will pose short questions about three areas.

First, on the public health messaging over asymptomatic carriers, we seem to have had a complete drop-off of mask wearing and of being distance aware. Neither of those impedes the economic viability of any business at all; they are simply social behaviours. People seem to have gone back to the most inappropriate social hugging, which is unnecessary. Yet I do not see any public health messages coming out just to maintain the control measures we had in place before. Could the Minister tell me what the plans are for that?

Secondly, does the noble Lord plan to widen the list of eligible children to ensure that those who have a family member, whether a sibling or parent, who is particularly vulnerable are offered vaccination—this would not be forced but would be an offer to them—rather than being excluded, as they are at the moment, because they themselves are not ill? They may carry quite a large emotional burden, knowing that someone at home could become very ill, despite being double vaccinated.

Thirdly, on preparing for the winter, does the Minister recognise this week’s notice from the Royal College of Emergency Medicine showing that 80% of respondents are not confident in their ability to cope safely in their departments as we go into winter, and that half of the emergency departments are reporting delays of transfer from ambulances into their departments? That compares with a quarter of such departments reporting these delays in October 2020, which would suggest that the whole backlog and silting up has got worse. Can the Minister explain what provision there is to expand bed provision, so that people who arrive in emergency departments and need admission can be moved rapidly into beds to be looked after, rather than having this backlog, which also stops ambulances going to other emergencies while they are stuck outside an emergency department?

I thank the noble Baroness for three extremely thoughtful questions. I will dwell on them, if I may, because they are a good opportunity to answer some of the concerns that I know many noble Lords have.

On public health messaging and behaviours, there is a question of perception. If we look closely at the analysis done by our behaviours team, we see that the public remain extremely conservative and restrained. While the noble Baroness’s perception may be that mask wearing and distancing have been given up and that hugging is not where she would like it to be, from the data it appears that the public remain extremely concerned about public transport, going to the shops and attending major events. Therefore, we are in a moment of transition, but roughly speaking we are where we would want to be.

Let us be clear: we are keen to get back to the life we once had, and vaccines are going to be the way that we do that. We want to return to intimacy and to the way in which our community likes to live. Testing, social distancing and the panoply of virus control play a role in that—but we are seeking to step back from those days and, so long as the vaccines work in the way they are working at the moment, we are keen not to disrupt people’s lives as much as we can.

On eligible children, that ball is with the CMO at the moment. I completely hear the noble Baroness; she is entirely right about the emotional burden. I also emphasise the importance of making sure that children get the education they need, while at the same time empathising with their concerns for their loved ones and those with whom they live. It is an awful position for those children and families to be in. That is why the CMO is looking at vaccination for 12 to 16 year-olds and possibly beyond.

On winter preparations, I hear the noble Baroness’s comments about the Royal College of Emergency Medicine. The statistics she gave are a matter of concern, but the medical director of the NHS monitors these questions extremely carefully. We think we are in the position we need to be in to get through this winter. We are on the balls of our feet in case there is either an uptick in the current delta variant or a new variant. A huge amount of investment has gone into the redeployment of NHS beds. The NHS has never had a bigger capacity in terms of its workforce and the number of beds available. The use of ICUs and the management of Covid patients have become much more efficient and productive than they used to be, and we believe that we are in good shape.

My Lords, perhaps I could ask the Minister two questions. My first question is the question I asked on the day we broke up in July, about whether there are plans to do booster jabs combined with flu jabs. The Minister was not certain and said he would try to let us know. Has he got more information on that?

My second question is slightly more speculative, but it is something I am very concerned about. BBC news has been extremely conscientious about keeping everybody informed about the Covid rate, the death rate and the number in hospital. Can we have an assurance that no pressure will be put on the BBC by the Government in order to bury the worrying developments that are taking place?

I am very grateful to the noble Baroness for asking about the co-administration of the flu and Covid vaccines. I hope very much that I got back to her. If I did not, I shall give her an update now. JCVI’s interim advice is to plan to offer Covid booster vaccines from September 2021 to prolong the protection of the vaccines provided to those who are most vulnerable to the serious effects of Covid ahead of the winter months. This would take place alongside the annual flu vaccination programme. The NHS will continue to follow the guidance given by the JCVI on the co-administration of flu and Covid vaccines—so, yes, they will be co-administered. That is an enormously effective way of delivering the vaccines, and the reach of both programmes is amplified by the other.

On the BBC, I reassure the noble Baroness that no pressure is put on it. If we had an effective pressure mechanism on the BBC, she would certainly be the first to know about it.

My Lords, may I take the noble Lord the Minister back to a question about Covid passports that my noble friend Lady Brinton asked and that he did not have time to answer in his first response? I understand both sides of the argument regarding Covid passes, but what I do not understand is the potential exclusion of those properly vaccinated overseas, or indeed anyone double-vaccinated outside England.

In July, the Vaccines Minister, in a Statement in the other place, said that, by the end of that month, those vaccinated overseas could have their vaccinations recorded on the NHS England system and access their Covid pass using the NHS app. Despite the Government promising that this would happen by the end of July, it is still not possible. What do these people do when they are told to self-isolate on arrival into the UK from yellow-listed countries, or when they are excluded from designated premises, if the Government bring in compulsory Covid passes for access to certain types of premises?

I am grateful to the noble Lord for raising the point again, and my apologies to the noble Baroness, Lady Brinton, for not addressing her point the first time around. I will just say that, from 19 July, it has been voluntary for organisations to use and implement the Covid pass under step 4. There are some essential settings where certification should not be used, and we have made that plain.

However, the Government are encouraging and supporting businesses and large events to use the Covid pass. The Government intend to make full vaccination a condition of entry to nightclubs and other venues where large crowds gather from the end of September. Work is under way to find a solution for Northern Ireland citizens who have been vaccinated in England but are registered with a GP in Northern Ireland. We are also very close to establishing data flows with the Isle of Man.

To the noble Lord’s point about those who have had their vaccinations overseas, in countries such as Norway, he is entirely right. We are working extremely hard on those processes. I have met with NHSX and NHSD to talk about this matter and I assure him that we are putting every effort into dealing with it. I wish that we had dealt with it by now. It is an extremely complex matter. The validation and verification of vaccines requires an enormous amount of bilateral and multilateral co-ordination, and the approval of different vaccines taken by different people in different locations and the record keeping by overseas countries are things that we have to consider and manage. He is right: when the Covid pass system is brought in, those who have had a vaccine overseas will need special consideration. I reassure him that we are working as hard as we can to resolve that issue.

My Lords, perhaps I might bring up the subject of antibodies. All the statements seem to be focused completely on vaccinations, yet there is growing evidence that those people who have had Covid and have had vaccinations are indeed almost super-immune even to variants. There was an article in today’s Telegraph about that. So my first question is, do the Government have any idea how many people have in fact had Covid? There are an awful lot of people who have not had symptoms, have been at home, have had it and have recovered, and the Government have not really been informed about it. Is there knowledge in the Government about this area and, if so, is research being done on the strength of the antibodies of those who have had Covid and is that being taken into account in policy?

My noble friend has had an interest in this very important area for some time, and I completely applaud his diligence on it. It is an area that I share an absolute fascination with. We know so much about the vaccines but so little about the body’s immune system. It is incredibly frustrating but it is, I am afraid to say, just one aspect of this pandemic.

To answer the specific question of how many people have had the disease, it is difficult to be precise. Unfortunately, a lot of people have had the disease and never known that they had it. The fact that they have now gone on to have a vaccine means that it is extremely difficult for us to trace whether they have had the disease, because we do it mainly through the counting of antibodies. My noble friend can look on the ONS website, which I am sure he probably has, and he will see that the Venn diagram makes it almost impossible to figure out exactly how many people have had the disease. I can, through correspondence, share with him the various modelling that we have done, but there is not a definitive answer to that question.

I wish it were true that having had the disease and the vaccine together creates some kind of super-immunity, but I am afraid that there is a subset of people who have had both the vaccine and the disease who then go on to have the disease again. I have met a few of those people; they are extremely frustrated, as you can imagine. I am afraid that it does not bode well for thinking that the vaccine presents a concrete and immutable guard against the disease. I am afraid we will be living with the thought of boosters and improvements on the vaccine for some time to come. That is emerging as something we are working on. We are doing a tremendous amount of research on this. I had a meeting earlier with the antibody team, and I reassure my noble friend that we are doing everything we can to understand it better.

My Lords, I come back to the advice from the JCVI relating to 12 to 15 year-old children who do not suffer the underlying conditions it has set out. I worry about the implications of that being overruled through the process that the Ministers have set up, seeking the advice of the four Chief Medical Officers. The Minister will know that they concluded that some young people, although it would be extremely rare, could suffer from myocarditis with lifelong consequences.

I must ask about the ethical considerations here as to some young people who will be damaged as a result of that decision because 6 million adults are too stupid or ignorant to have the vaccination. That surely is where our focus should be. Could he say something about what the Government are doing? Does he agree that the integrity of the whole vaccine process, not just in relation to Covid, is at stake here? I think that the JCVI should be listened to.

I violently agree with both the noble Lord’s points in spirit. If I may take them in reverse order, he is right that there are people who are not taking the vaccine, and they put the entire community at risk. Vaccination uptake among the under-30s has plateaued at around 60%. I cannot tell him exactly what will get that number up any further. That is why we look at questions such as certification and mandation. These are already in place in many European countries, including France and Italy, where they have taken advantage of certification and mandation in an extremely tough way to drive through vaccination. That example weighs heavily on our minds as we assess those two important opportunities. It is tough, and we will have important debates here in the House of Lords on both of them should they come to pass.

On children, the noble Lord is right that there are profoundly complex epidemiological and ethical issues around child vaccination. Child vaccination has been rolled out in America and in many European countries. Some European countries are looking at vaccinating those aged over three, not just those aged over 12. Why do they do that? It is because children are vectors of infection and drive the disease through their families, schools and communities. He is right that there are very rare examples, but examples none the less, where harm is done to children through the vaccine. Therefore, the assessment of that harm and weighing it up against the harm done by Covid to children, which again is extremely rare but is a statistical occurrence, and the community obligations and the damage done through the spread of the disease is something that ethicists and epidemiologists are looking at right now. We are being extremely careful about the way we do that. We are aware that it might be open to challenge. Therefore, we are dotting the “i”s and crossing the “t”s.