Pay people to get Covid-19 jab to ensure widespread coverage, ethicist says


People should be paid to get a Covid vaccine to ensure that millions get protected against the disease, a leading expert has said.

Oxford University ethicist Professor Julian Savulescu said people could either get money or an exemption from face mask and social distancing rules if they got the jab.

He said that simply asking people to volunteer for the jab might fail because many people don’t trust vaccines. 

Or some – particularly younger people – might decide not to get the vaccine if they don’t see any benefit in it for them because they’re not at high risk from Covid-19.  

But enforcing vaccines by law would be fiercely opposed by many as a breach of personal freedom, even if it could help spell an end to the pandemic. 

Therefore, Professor Savulescu argued a plan B based on encouraging people undecided about getting vaccinated might be useful in ensuring the widespread coverage needed to achieve herd immunity.  

Herd immunity is a state in which so many people are resistant to catching the virus, either because they’ve already had it or because they’ve been vaccinated, that it can’t spread any more. 

It is not yet clear whether either of those options will produce total immunity to Covid-19, so even people who have had the illness will likely be encouraged to get the jab.

Exactly how many people will have to have it to stop the virus spreading is unknown, with estimates ranging from fewer than half to more than 80 per cent. The more people get vaccinated, the better herd immunity works.

Major research has found only half of British people say they are ‘very likely’ to get a Covid-19 vaccine if one becomes available. 

Bogus conspiracy theories claiming that the vaccines are dangerous or will be used to implant tracking chips into people’s bodies have spread online, denting public trust. Officials will not approve a jab until rigorous trials prove it is safe and effective.

A voluntary vaccination scheme could fail due to hesitancy about safety of a Covid-19 jab, even if it has been through rigorous trials and approved by regulators, Professor Savulescu warned. Pictured: A volunteer receiving the experimental Pfizer jab, tipped to be one of the first to finish trials 

When a coronavirus jab is first proven to work, only the most vulnerable will receive it, experts have confirmed, because there will be short supply. 

And health bosses have warned the first wave of vaccines won’t be good enough to allow society to immediately return to normal.

Professor Savulescu, director of the Oxford Uehiro Centre for Practical Ethics, argued his case in an opinion piece in the Journal of Medical Ethics today.

Given the rising global death toll – more than 1.22million have died worldwide – and the devastating impact of lockdowns, there have been calls to make a Covid-19 jab mandatory.

But many people will strongly object to state-enforced vaccination as an infringement on personal freedom and human rights. 

Professor Savulescu said: ‘Vaccines are some of the safest and most effective interventions we have, and have achieved incredible successes. We no longer face diseases that killed our ancestors.

Professor Julian Savulescu says people should be paid to get the Covid-19 jab to ensure widespread uptake

Professor Julian Savulescu says people should be paid to get the Covid-19 jab to ensure widespread uptake

‘But vaccine hesitancy is on the rise even for well-established vaccinations. The problem is likely to be bigger for a new vaccine. 

‘In an ideal world, the vaccine would be proven to be 100 per cent safe. But there will likely be some risk remaining, and there are risks that have not yet been identified.’

Before a Covid-19 vaccine is rolled out across the population, the developers need to take their final trial data to regulators who will decide whether to approve it for mass use.

But in any case, the first Covid-19 jab is not expected to be 100 per cent effective, and may even fail to prevent serious disease.

FIRST COVID-19 JABS COULD BE READY FOR CHRISTMAS – BUT ‘WON’T ALLOW LIFE TO RETURN TO NORMAL’ 

Oxford’s coronavirus jab could still be available by Christmas – but taskforce chief says only four million doses will be available for key workers at first. 

Both Pfizer and Oxford University have entered into their final stages of testing with data suggesting the jab could be deployed ‘within weeks’.

Kate Bingham, chairwoman of the government’s vaccine task force, said the inoculations had the ‘possibility of being ready before the end of the year’. 

But she warned that only four million doses of the Oxford vaccine would be manufactured by Christmas – with ten million doses of the Pfizer vaccine potentially being available by January.

The estimate, which falls short of the Government’s suggestion in May that 30million doses could be supplied by September, would mean that mass deployment among NHS workers and the elderly would not yet be achievable. 

Ms Bingham, the UK’s vaccine tsar, has arranged to buy six different vaccines, amounting to more than 350million doses, but there is no guarantee that any will work. 

They will all also have to be submitted for approval by the Medicines and Healthcare products Regulatory Agency (MHRA) but it is not yet known how long this will take.

Professor Andrew Pollard, from Oxford university, agreed that there was ‘a small chance’ its vaccine would be ready before Christmas. 

He said: ‘The first step is to reach the point where we can do an analysis and find out whether or not the vaccine works.

‘I’m optimistic that we could reach that point before the end of this year.’   

Both Professor Pollard and Ms Bingham warned the first wave of vaccines would not be good enough to allow society to immediately return to normal, scuppering Boris Johnson’s promise that ‘life will return to normal next summer’.

The pair made the comments at a virtual House of Commons Science and Technology Committee on November 4.

When Ms Bingham was asked by MPs if a vaccine could wipe out Covid-19 next year, she said: ‘Well, to wipe out coronavirus, I think [the likelihood is] very slim.

‘But to get a vaccine that has an effect both reducing illness and reducing mortality? Very high.’  

The UK’s vaccine tsar Kate Bingham said last week that ‘we should be prepared’ that jabs might not prevent infection but rather reduce symptoms and, even then, ‘might not work for everyone or for long’, adding that the first jab will be ‘imperfect’.  

Professor Savulescu said a ‘zero per cent risk option’ for a Covid-19 vaccine is very unlikely and therefore one can’t be made compulsory.  

‘However, another way of looking at this is that those at low risk are being asked to do a job which entails some risk, albeit a very low one,’ he said.

‘So they should be paid for the risk they are taking for the sake of providing a public good.’ 

Therefore, governments should consider offering people an incentive to get the jab, he suggested.

The incentive could be either financial or ‘payment in kind’, such as being allowed to forego the need to wear a face mask in public, he said. 

‘Anti-vaxxers’ may never be convinced to change their stance but people sitting on the fence might be persuaded by a cash grant.

‘As long as we are accurate in conveying the limitations in our confidence about the risks and benefits of a vaccine, then it is up to individuals to judge whether they are worth payment,’ Professor Savulescu said.

He insisted payment isn’t about coercion or encouraging people to take unreasonable risks.

Vaccine development and trials are in place to ensure confidence that there is very low risk, he emphasises. 

And he said it is not necessarily exploitation of poorer people  if ‘there are protections in place such as a minimum wage or a fair price is paid to take on risk’.

‘A payment model could also be very cheap, compared to the alternatives,’ he argues. 

‘The cost of the UK’s furlough scheme is estimated to reach £60billion by its [original] planned end in October, and the economic shut down is likely to cost many billions more, as well as the estimated 200,000 lives expected to be lost as a result.

‘It would make economic sense to pay people quite a lot to incentivize them to vaccinate sooner rather than later—which, for example, would speed up their full return to work.’ 

But a number of scientists were not in favour of a paid approach.

Helen Bedford, professor of Child Public Health at UCL, and Dr David Elliman, consultant in community child Health, said in a joint statement that offering money, especially when many people are struggling financially during the pandemic, was ‘dangerous’.

They said: ‘It is highly unlikely that we will know exactly how effective a vaccine is in preventing spread of the disease in the early stages, and until we do know, it would be dangerous to offer these incentives.’

Keith Neal, emeritus professor of the epidemiology of infectious diseases, University of Nottingham, agreed ‘paying people to get vaccinated would set a very dangerous precedent’.

He added: ‘If we did this, people will expect it for other vaccines and also social media falsehoods would have a field day suggesting it can’t be safe if that’s what you need to be paid to have it.’

Experts said the money would be better used to provide vaccines to other countries, to avoid re-introduction of the coronavirus into the UK, to bolster public health campaigns and ensure easy access to vaccination services.

A major study warned in September that a fifth of people in the UK may refuse to be vaccinated against coronavirus when a jab is available.  

In the largest survey of its kind, 22 per cent of people said they were unlikely to be vaccinated with 10 per cent strongly opposed to it.

Just half (49 per cent) of the 17,500 people asked by University College London researchers said they ‘very likely’ to be immunised, while three-quarters (78 per cent) said they considered it ‘likely’. 

Concerns over vaccine safety, mistrust of pharmaceutical companies and a preference for natural immunity were some of the factors behind the low uptake, which authors stressed ‘lack any basis in fact.’ 

Almost one in three (30 per cent) had substantial beliefs that vaccines can cause unknown future problems, while one in seven (15 per cent) said they believed to varying degrees that vaccines do not work.

Researchers found a ‘concerning level of misinformation around vaccines’ which could significantly affect uptake once a Covid-19 vaccine is approved.

WHAT PROGRESS IS BEING MADE WITH COVID-19 VACCINES?

Covid-19 vaccines could be rolled out in the UK within the first half of next year, with the NHS to prepare itself to deliver doses by Christmas ‘if they become available’.

After successful trials, vaccines could be rolled out at GP surgeries, pharmacies and mass testing centres.

But health chiefs say a mass vaccination programme is unlikely to get under way before next year.

There are currently more than 200 coronavirus vaccine candidates being tested around the world.

Here is everything you need to know about the race to get a Covid-19 vaccine.

What progress is being made with Covid-19 vaccines?

A total of 44 of the vaccine candidates in development are at clinical trial stage.

Of these, nine are in the phase three stage of clinical evaluation and are being given to thousands of people to confirm safety and effectiveness.

There are two frontrunners in the Covid-19 vaccine race – one from German biotech firm BioNtech and US pharmaceutical company Pfizer, and another being developed by the University of Oxford and AstraZeneca.

Both vaccines are currently in phase three clinical trials.

The Oxford vaccine, called ChAdOx1 nCoV-19, uses a weakened version of a common cold virus (adenovirus) which causes infections in chimpanzees.

Other potential vaccines in phase three trials include ones by US drugs firm Moderna and biotech company Novavax.

What trials are ongoing in the UK?

Aside from the Oxford vaccine, a coronavirus jab is being developed by Imperial College London.

The Imperial vaccine is in phase one of clinical testing, where doses are being given to a small group of people to determine whether it is safe and to learn more about the immune response it provokes.

Pharmaceutical companies Sanofi and GlaxoSmithKline have also teamed up with the hope of making a Covid-19 vaccine available by the middle of next year.

The Sanofi/GSK candidate is in the phase two stage, where the vaccine is being given to hundreds of people so scientists can learn more about its safety and correct dosage.

They plan to begin phase three trial by the end of the year.

When will the results from these trials be available?

The head of the UK’s vaccines taskforce, Kate Bingham, said data from the vaccine trials at the University of Oxford and AstraZeneca, and Pfizer with BioNTech, could be available this year.

She said if she puts on ‘rose-tinted specs’ she would hope to see positive interim data from both Oxford and Pfizer BioNtech in early December.

Professor Andrew Pollard, head of Oxford’s vaccine trial team, said he is optimistic data on safety and efficacy of their vaccine will be available by the end of the year.

Professor Robin Shattock, who is leading Imperial College London’s Covid-19 vaccine effort, said data on its efficacy will be available in the middle of next year.

Does the UK have access to any of these potential vaccines?

In August, the Government announced the UK has secured access to six Covid-19 vaccine candidates in development, representing 340 million doses.

Ms Bingham said there should be about four million vaccine doses available by the end of the year.

The UK has also secured 30 million doses of the vaccine being developed by BioNtech and Pfizer.

The deals cover four different types of vaccines – adenoviral vaccines, mRNA vaccines, inactivated whole virus vaccines and protein adjuvant vaccines.

Adenoviral vaccines are weakened versions of adenoviruses, while mRNA candidates are made up of small or inactivated doses of the whole disease-causing organism.

Inactivated whole virus vaccines, on the other hand, contain whole bacteria or viruses which have been killed, while protein adjuvant jabs are those where an adjuvant is added to enhance the immune response.

Should any of these candidates be approved, the most vulnerable, the elderly, people living in care homes, and health and social care staff will be front of the queue to receive a jab, followed by those who are high at risk.

When will a coronavirus vaccine become available?

A vaccine usually takes years, often decades, to develop but scientists working on potential coronavirus jabs are hoping to achieve the same amount of work in a few months.

Most experts are optimistic that a vaccine is likely to become available by mid-2021, which would be around 12-18 months after the new coronavirus first emerged.

NHS England chief executive Sir Simon Stevens said the ‘expectation’ is that any vaccination programme would begin in the new year – pending positive results from clinical trials.

Meanwhile, Ms Bingham said she has 50% confidence that by Easter or early summer next year, all vulnerable people in the country will have a vaccine.

Prof Pollard said clinical trials would need to take place in the child population before Covid-19 vaccines can be given to youngsters.

He said: ‘Those trials are being planned, but at the moment we do not have any data about immune response or the safety of children, and so that is something which has to be done through the normal scientific process, and I would anticipate that that will happen towards the end of this year or during the early part of next year.’

Where will the vaccines be administered?

Sir Simon said a potential vaccination programme will see vaccines delivered at GP surgeries, pharmacies and mass testing centres – including at the Nightingale hospitals.

He said GPs will be put on standby from December should a vaccine be made available before Christmas.

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