From David Vincent in Shrewsbury, UK: Going to the races

Ludlow races

February 6. On Tuesday evening we drove down to Ludlow race course for our covid vaccination.  No horses, no riders, no vets, just teams of volunteers in a couple of marquees, remarkably cheerful towards the end of what I was told had been a twelve-hour day checking identities and administering jabs.

We waited in lines of spaced seating.  None of us in our first youth, and all of us, it now strikes me, white. This was rural Shropshire, and should come as no surprise.  A county which voted decisively for Brexit immigration controls has in fact very few migrants.

But with the new finding that white over-eighties are twice as likely to have been vaccinated as black, there is a fresh concern that the BAME community is not participating in the vaccination programme.*  There are similar worries about medical staff who have been offered the vaccine.  The Health Service Journal reports that at the Guy’s and St Thomas’ Foundation Trust in London there has been “substantially lower covid vaccine uptake among its black African, black Caribbean and Filipino staff so far.”** Challenged about these discrepancies, the minister in charge, Nadhim Zahawi, took a glass 85%-full line, stressing the large numbers who had taken the vaccine, and admitting that the Government was not fully recording those who had not done so.

Since the pandemic began there has been opinion-poll evidence from many countries about the scale of what are now politely described as “vaccine hesitants.” The latest survey finds that nearly 40% of the French and 23% of Germans say they will definitely or probably refuse a vaccination***  I have always been cautious about these reports.  No one ever died of giving a negative response to a pollster.  It’s easy enough to unload grievances against politicians, health services, big pharma, when, as is still the case in Germany and France, the issue is largely hypothetical. 

One positive consequence of these widely-reported figures is that they have provoked governments, health providers, community leaders and celebrities into launching educational programmes to counter on-line anti-vax propaganda. The British government has set aside £23m for this purpose. Unfortunately, according the Centre for Countering Digital Hate, anti-vax social media in the UK have also redoubled their efforts now that the choice has become real.****  

It comes down to a question of speed. 

There is a large body of literature on the centuries-old anti-vaccination movements, and on the pervasive presence of malign channels of communication.  But we do not have the time to continue debating the excessive individualism of the modern world.  The current higher BAME mortality rate is going to increase dramatically if we have to wait for generations of folk remedies to be challenged, or for the community’s mistrust of the NHS and agencies of authority such as the police to be overcome.  Equally it is a fantasy to suppose that the main digital platforms are going to deny themselves the advertising revenue generated by alternative covid cures any time soon.

This is why the most effective response to the present dilemma may be that adopted by doctors in Liverpool. They are treating vaccine resistance by BAME groups as an immediate practical matter.  It’s no good, they argue, depending solely on large-scale venues which, like Ludlow race course, can be a long way from where people live (though to be fair the race course had organised a special bus service).  Instead they have started pop-up vaccination centres in local neighbourhoods.  Rather than waging war against social media in general, they have engaged with channels of communication up and down particular streets.  And if particular groups do not trust representatives of white society, alternatives have been sought. 

According to a newspaper report, “Dr Cait Taylor, a GP who is joint clinical director of the Central Liverpool primary care network, decided she and other white medics would not be giving the inoculations. Instead, they put a call out for medical students from BAME backgrounds, offering £10.21 an hour for Urdu and Arabic speakers. ‘We wanted to inspire confidence’ she said. ‘People felt more comfortable there than at a GP surgery where you might be met with a white receptionist, or a white vaccinator, or a doctor who doesn’t explain things to you properly, or doesn’t know your language.’”*****

 Cait Taylor concludes, “the message we’ve got loud and clear from local communities is: come to us and we’d love to take the vaccine, thank you very much.”  As should have been the case from the outset with the test and trace system, as much of the delivery as possible should be left in the hands of health professionals who know and are known by the neighbourhoods they are seeking to assist. 

 *https://www.theguardian.com/world/2021/feb/04/black-over-80s-in-england-half-as-likely-to-have-had-covid-vaccine?CMP=share_btn_link

**https://www.hsj.co.uk/acute-care/exclusive-fewer-black-and-filipino-nhs-staff-vaccinated-amidhesitancy-concern/7029397.article

***https://www.theguardian.com/world/2021/feb/04/covid-vaccine-refuse-france-germany-us-quarter?CMP=share_btn_link

**** https://www.bma.org.uk/news-and-opinion/pushing-back-tackling-the-anti-vax-movement

*****https://www.theguardian.com/world/2021/feb/04/inspiring-confidence-liverpool-gps-tackle-the-vaccine-race-gap

From David Vincent in Shrewsbury, UK: Isolation and Bad Medicine

Today a front-page headline in Times: ‘Coronavirus vaccine hopes raised by success of early trials’.* Read closely this is more a ‘good news because it’s not bad news’ story.  Phase 1 of the Oxford vaccine trial has not thrown up any counter-indications, but the major test still lies ahead.  The commercial partner of the project, Astrazeneca, is quoted at the end of the article cautioning that ‘news on whether the university’s vaccine worked was unlikely before data was gathered from much larger trials towards the end of the year.’

Nonetheless the story brings back into focus the issue I discussed on July 7 of whether any vaccine would be effective in the face of opposition by a significant minority of the population, in Britain or elsewhere.  An insight into the scale of the problem was supplied by an article in the New York Times last week by Anne Borden King.**  She is an active opponent of the anti-vax movement, founder of the ‘Campaign Against Phony Autism Cures’ and a consultant for the watchdog group Bad Science Watch.  She has also just been diagnosed with breast cancer, and shared thee news on Facebook.

The consequence was an avalanche of advertisements on her Facebook feed for ‘alternative cancer care’, promoting ‘everything from cumin seeds to colloidal silver as cancer treatments. Some ads promise luxury clinics – or even “nontoxic cancer therapies” on a beach in Mexico.’  There were, by contrast, no legitimate cancer advertisements.

This is not a new problem, either historically in print, as I explained in my piece, or in the internet age where the misinformation comes to you unbidden, or is seductively available via Google searches.  What was particularly interesting about Anne Borden King’s article was the connection she made with life in the pandemic.  Under any circumstances a cancer diagnosis threatens a sudden loss of personal control as the patient is subjected to intrusive tests and invasive treatment.  No matter how supportive friends and family try to be, there are few places as lonely as a hospital waiting room.   With the coronavirus restrictions, this sense of social alienation has got worse, which partly explains why fewer appointments for cancer treatment have been made and kept.  ‘During the pandemic,’ writes Anne Borden King, ‘many of us are also isolated.  Our loved ones can’t come to our appointments or even visit us in hospital.  Now more than ever, who is there to hold our hand?’

The pseudoscience cures offer an alternative sense of community, the claim that out there ‘experts’ are on your side, dedicated to supporting the whole person in face of the fragmenting authority of official medicine.  They promise to return a sense of agency to the individual, supported by a network of other enthusiastic users. 

Facebook, under intense pressure to censor proliferating bogus coronavirus cures, has been slow to act.  The only certain defence is to turn off the feed.  Which can only exacerbate the sense of isolation.

Add Mss. Yesterday I wrote about the enhanced importance of hearing clearly in the lockdown.  Later in the day the BBC ‘PM’ programme ran an item featuring two representatives of the deaf community.  They were responding to the newly announced policy (in England) of compulsory face-masks in shops.  To communicate with others, they explained, they needed to be able to read a person’s lips.  This was impossible if the mouth was concealed by a mask.  There were transparent masks on the market, but they tended to steam up.  This is not a minor matter.  According to the Government Digital Service, 11m people in Britain are deaf or hard of hearing.***

* https://www.thetimes.co.uk/edition/news/coronavirus-vaccine-hopes-raised-by-success-of-early-trials-c2gv2cpsd

** https://www.nytimes.com/2020/07/10/opinion/facebook-cancer-ads.html?auth=login-email&login=email

***https://www.gov.uk/government/publications/understanding-disabilities-and-impairments-user-profiles/saleem-profoundly-deaf-user

from David Vincent in Shrewsbury, UK: Anti-Vax

Edward Jenner

July 7. After half a year of the pandemic, we should be immune to shock at the responses to it.

But this morning there is published a finding which is startling and depressing in equal measure.  A survey conducted by YouGov, an entirely reputable polling organisation, has found that almost one in six British adults will ‘probably’ or ‘definitely’ refuse a coronavirus vaccination when one becomes available.  Another 15% say they are not sure what they will do.*

We expect this kind of anti-science in the United States, where according to the latest research, only a third of the population believe in secular evolution, a century and a half after Origin of Species.**  But Darwin is our man, indeed my man, born and educated in Shrewsbury (his parents, for an unexplained reason, are buried in the churchyard of Montford parish church, just down river from my village and some distance from the town where they lived).  Surely we are beyond so irresponsible a rejection of medical research.

In the popular history of medicine, Edward Jenner lines up with Alexander Fleming as a hero-discoverer of life-saving remedies.  In 1796, as every textbook tells it, he vaccinated James Phipps, the eight-year-old son of his gardener, with cowpox, which gave him immunity to the disfiguring and frequently lethal illness of smallpox.  Crucially Jenner not only applied a remedy which was already being investigated, but conducted a series of tests to prove that it had worked with young Phipps and later triallists.  There then followed the first public legislation in the field, with Vaccination Acts in 1840, 1853 (the first to make the vaccination of children compulsory), 1867 which tightened the regulation, and 1898 which introduced a conscience clause for parents still opposed to the practice.

The last of the 19th century Acts reflected the power of the anti-vaccination movement which had grown up as regulations were introduced.  In the present moment, Leicester is in renewed lockdown, at least in part because of the failure of sections of the population to observe social distancing advice.  Here is the same city in 1885, with up to 100,000 anti-vaccinators marching with banners, a child’s coffin and an effigy of Jenner:  “An escort was formed, preceded by a banner, to escort a young mother and two men, all of whom had resolved to give themselves up to the police and undergo imprisonment in preference to having their children vaccinated…The three were attended by a numerous crowd…three hearty cheers were given for them, which were renewed with increased vigor as they entered the doors of the police cells.”***

The Victorian era was notable not so much for the progress of medical science, which for the most part was more successful at diagnosis than therapeutic intervention, but for the growth of mass literacy, which turned every citizen into a consumer of the printed word.  With newspapers came advertisements for every kind of quack medicine.  With the Penny Post of 1840 came the machinery to distribute products by mail order, using stamps as currency.  The most credulous were not the newly literate farm labourers whom Jenner had treated, but the confident, educated middle classes.  In 1909 the British Medical Association, alarmed at the success of patent medicines, conducted an inquiry into the market:

It is not, however, only the poorer classes of the community who have a weakness for secret remedies and the ministration of quacks; the well-to-do and the highly-placed will often, when not very ill, take a curious pleasure in experimenting with mysterious compounds.  In them, it is perhaps to be traced a hankering to break safely with orthodoxy; they scrupulously obey the law and the Church and Mrs. Grundy, but will have their fling against medicine” (BMA, Secret Remedies (1909), p. vii).

Facebook and other sites, which bear a criminal responsibility for the resistance to orthodox medicine, are merely the inheritors of a long tradition of self-medication weaponised by commercial forces and facilitated by communication systems.  The medical profession itself has not always been as secure a bastion against these pressures as it might wish to be seen.  It took twelve years for The Lancet finally to retract the article it published in 1998 falsely claiming that the MMR vaccine caused autism.

It is, of course, possible that if and when a vaccine is made available, there will be less resistance to it than is now threatened.  History offers scant comfort that this will happen.

* https://www.telegraph.co.uk/global-health/science-and-disease/one-third-uk-may-not-get-coronavirus-vaccine-one-developed-new/

**https://www.pewresearch.org/fact-tank/2019/02/11/darwin-day/

*** https://www.historyofvaccines.org/content/articles/history-anti-vaccination-movements