From David Vincent in Shrewsbury, UK: Concentrating the Mind

Samuel Johnson: “Depend upon it, sir”

February 15.  When the awards are handed out at the end of this pandemic, a gold medal must surely go to the Office for National Statistics (ONS).

From the beginning it has been the source of sober, relevant and trustworthy data not just on the progress of the disease but on a wide range of associated behaviours and attitudes. It has published reliable answers to the right questions, including attitudes to vaccination now that the programme has gained real momentum.

It has just issued data relating to the end January. With vaccinations being offered to the top four categories it found that 99% of those aged 70 and over had accepted or would accept a vaccine.* Last autumn, when it was being reported that a sixth of the UK population would certainly refuse and offer, and a similar number might do so, I wrote that “the question constitutes an interesting case history for the capacity of digital communication to shape private behaviour.”** Since then the anti-vax campaign has increased its efforts as the vaccines were given approval, and Facebook continued until the last minute to carry its messages.

The ONS survey suggests that orthodox medicine has won a decisive victory. When the invitations were sent out, the conspiracy theories evaporated. Even amongst those still hesitating, the ONS found that most of the doubts had little or nothing to do with stories in the social media. The lead concerns were anxiety about side and long-term effects, then waiting to see if the vaccines actually worked. Only a small proportion of negative respondents declared an outright opposition to vaccines in general.***

The most obvious reason for the outcome, which is critical to the defeat of the coronavirus, is the difference between a hypothetical and a practical choice. The conspiracy theories promoted by the internet should be divided into two categories.

There are those which reflect a state of mind that need never be tested in the real world, and those which sooner or later will have to be. Views about race, sex and religion, about the unreality of climate change and the reality of extraterrestrial beings, may coalesce into active protest, but there is no requirement, no point at which a behaviour has to occur. Like a flu virus they may just mutate over time. Whereas other beliefs, such as the misbehaviour of elected governments, or the evils of vaccination, will at some point become a formal choice, when the polling cards or the medical invitations arrive. In those circumstances, interim polling of attitudes are contributions to a debate, not predictions of an outcome. Also this week it is reported that the Conservatives have opened up a five point gap over Labour. No-one mistakes this for an accurate description of an election that is still four years away. It just has an impact on current political debate. Similarly the anti-vax findings last year stimulated on-line counter-propaganda by orthodox medicine, which may have helped in the final result.

The choice itself foregrounds practical concerns. Since the early weeks of the pandemic we have been told by the ONS and many other authorities, that the elderly and those with pre-existing conditions stand a far greater chance of becoming seriously ill or dying from Covid-19. To paraphrase Samuel Johnson, “Depend upon it, sir, when a man knows he is likely to end up in an intensive care unit, it concentrates his mind wonderfully.”

It is not surprising, therefore, that the ONS returns for those under 70 currently display a greater resistance to vaccination, though the difference is not large. Of the 3% of 50-69 year-olds who currently are not fully committed, two thirds are just saying they are not certain yet. Amongst 30-49 year-olds, where 89% respond positively, the next largest group is 6% don’t know / won’t say. Except for younger medical workers (where there are worrying accounts of BAME resistance) and a few clinically vulnerable, most of these age groups are still discussing only the possibility of vaccination.

There is also the effect of the group. In my network, the over 70s and the clinically extremely vulnerable, emails and blog posts have been buzzing since the New Year with descriptions of what it was like, accounts of after-effects (usually very minor), and complaints from those who had to attend inconvenient centres or had yet to receive their invitation. It was a party everyone was joining and from which no-one wanted to be excluded. The minority of the young, invited because of their role in health or social care, had less of a sense of what in a related area is termed a herd behaviour.

Alongside the vaccine data, the ONS has also updated its measure of the mood of the nation: “Following a decline in well-being in early January 2021, this week well-being scores for life satisfaction (6.4), happiness (6.4) and feeling that things done in life are worthwhile (7.1) remained at some of the lowest levels recorded since the survey began in March 2020.”****

This reflects my own view. I have been surprised by how small the lift in spirits has been since I drove down to Ludlow racecourse to get my jab at the beginning of the month. Euphoric is not a term I would use. At best mildly relieved, and aware of the road yet to be followed.

*https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddisea ses/articles/coronaviruscovid19weeklyinsights/latesthealthindicatorsinengland5february2021#vacci ne-attitudes

**November 11, 2020.

***https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddis eases/articles/coronaviruscovid19weeklyinsights/latesthealthindicatorsinengland5february2021#vac cine-attitudes

****Opinions and Lifestyle Survey, Great Britain, 27 to 31 January 2021. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandwellbeing /bulletins/coronavirusandthesocialimpactsongreatbritain/5february2021

From David Vincent in Shrewsbury, UK: Hitler, Shipman, Satan and Mengele

February 9. The sense of optimism as the vaccines are rolled out is colliding with the battle weariness of medical staff.

Rachel Clarke published the first book-length account from inside an intensive care unit.* Its anger with the government and anguish at the bleak and lonely deaths suffered by covid victims was balanced by a joyful account of the sense of community that the pandemic had created. Writing about the first wave last Spring she discovered something new:

“Not once in my lifetime have I seen anything like this grassroots eruption of improvised altruism. Communities coming together, the young and healthy offering to shop for those shielding, restaurants delivering mountains of takeaways to overworked hospital staff, everywhere the desire to be useful, to do something, to make it better, to help out. It startles and thrills me. There is no such thing as society. We do have more in common than divides us.” (159-60)

Nine months later she has written a newspaper article clearly exhausted by her continuing labours on wards that are still operating at peak capacity, and overwhelmed by the hostility of covid deniers and anti-vax campaigners. “I’ve been called Hitler, Shipman, Satan and Mengele for insisting on Twitter that our hospitals aren’t empty,” she writes. Inside the hospital, all is joint endeavour :

“Outside, on the other hand, the virus has once again carved up the country into simmering, resentful, aggrieved little units. It’s too old, too cold to be doing this again. One way or another, lockdown hurts us all. But instead of unity, community and a shared sense of purpose – that extraordinary eruption of philanthropy last springtime – we seethe like rats in a sack, fractious, divided…In short, we have reached the point in the pandemic where what feels like armies of trolls do their snarling, misogynistic utmost to silence NHS staff who try to convey what it’s like on the inside. Worse even than the hatred they whip up against NHS staff, the deniers have started turning up in crowds to chant “Covid is a hoax” outside hospitals full of patients who are sick and dying. Imagine being forced to push your way through that, 13 hours after you began your ICU shift. Some individuals have broken into Covid wards and attempted physically to remove critically ill patients, despite doctors warning that doing so will kill them.”**

So what now of the new sense of togetherness and joint endeavour? There are two destructive factors at work. The first is simply extreme tiredness, both physical and emotional, and explains why the NHS and the Government have been so desperate to bring down the levels of hospitalisation in the second phase. In Clarke’s book, which ended in April last year, the long hours were compensated for by excitement at the drama which she had volunteered to join, and by her justified pride at the way in which the entrenched procedures of hospital medicine had been revolutionized in the face of the crisis. But now it has just gone on too long.

The second is a product of the incivility of contemporary protests, which draw their language from un-moderated social network sites. A community is not a thing, but a set of relationships embodied in discourse. There is a need to interrogate official statistics, up to and including the current debate about vaccine effectiveness. There are quiet reasons for vaccine hesitancy, from inherited folk beliefs to fear of needles. What so demoralizes overstretched medical staff are the ease and frequency with which dissent becomes face-to-face aggression.

Those working in emergency medicine have always had to deal with ungrateful, shouting drunks. I was once in an A and E unit with a slightly injured child late on a Friday evening where there were more police than nurses in the waiting room.

But now the pubs are closed. The verbal violence is coming from those who respect nothing except their own views, and accept no constraints on their expression. It is not to be borne.

*Rachel Clarke, Breath taking. Inside the NHS in a time of pandemic (London: Little, Brown, 2021). **https://www.theguardian.com/books/2021/feb/06/ive-been-called-satan-dr-rachel-clarkeon-facing-abuse-in-the-covid-crisis?CMP=Share_iOSApp_Ot

From David Vincent in Shrewsbury, UK: Who goes first?

Lord Sumption. Wrong Again

January 18.  It’s getting nearer.  Last week a 93 year-old friend and neighbour was vaccinated.  Today it is announced that my cohort, the 70-plus and clinically vulnerable, are to receive invitation letters (in fact this morning’s post brings only a bank statement and the latest edition of the Journal of Cultural and Social History, ojoy).

Despite earlier fears, this is a party which most of us want to attend.  The latest survey conducted by the Office for National Statistics (ONS) reveals that 86% of the population said they were ‘very or fairly’ likely to accept a vaccination in the period 7-10 January, up from 82% in before Christmas.  Most of the remainder were either uncertain or had already had it.  Only 3% responded that they were ‘very unlikely’ to take one, the same figure as those who by then had been vaccinated.*

Given the inescapable presence of hard-core conspiracy theorists in any population, this is as near to an general acceptance in principal as might be achieved at this stage in the process.   I argued in an earlier post (‘Anti-Vax’, July 7) that the numbers unloading to pollsters their grievances against the state, research-based science, big pharma, transmission masts, were likely to shrink once the hypothesis became a reality, and this appears to be happening.

According to the official timetable, the priority groups are to be vaccinated by mid-February, with the whole of the population gaining protection by September.  There remains a question of whether this is the most sensible strategy.

We don’t need to endorse the view of our old friend Lord Sumption, who is in more trouble this week for mis-construing the obvious and mis-describing the reality.  He argued in a current affairs programme yesterday that the elderly were “less valuable” than the young, elevating simple arithmetical fact that they have fewer years to live into a profoundly unacceptable dismissal of their lives.  And as with others opposing the lockdown regime, he was factually plain wrong in claiming that the restrictions on socialising do not reduce infection across the population.**

The more interesting question is whether the young should be left to last.  The 70-plus is not the most infected section of the population, and therefore not the most likely to infect others.  We  received last week a communication from Shropshire Council indicating that the rate for the elderly in the county is half that of the 20-29 age group.  Nationally the ONS finds a similar distribution, using slightly different age-bands.  On January 2, 3.16% of the 15-24 age group tested positive, with a steady decline across the cohorts to 1.06% for the 70 and over.**

At face, these disparities are not surprising.  The retired do not need to go out to work, and less likely to be found in shopping precincts, bars and all-night raves.  My frail elderly neighbour who has now received his vaccination has been wholly locked down since the end of March, irrespective of the fluctuations in the official rules and advice.  He is absolutely no threat to anyone else.  The same is pretty much true of my household.  Where they have gone out of doors the 70-plus were found by the ONS to be more likely than the 16-29 cohort to answer positively to the question ‘have you avoided physical contact with others when outside the home?’***

Furthermore the young appear to be suffering psychologically more than the old.  The current ONS ‘overall, how satisfied are you with your life nowadays’ score rises steadily from 5.9% for the 16-29 cohort to 7.3% for those now due to receive their vaccination invitations.  There is an even sharper disparity in the loneliness measure, ranging from 13% to 5% for the same groups.****

So the young are having a tougher time and are more likely to catch and transmit the virus.  Why not vaccinate them first?

The short and irrefutable answer, pace Lord Sumption, lies in the age-specific rates for hospitalisation and death, together with the obvious need to keep fit those caring for the ill and the elderly, and to prevent the NHS from being overwhelmed to the cost not only of Covid sufferers but those with any other serious illness.  But there is a price to be paid for this strategy.  Assuming the vaccination roll-out continues as promised, the mortality rates will fall much faster than those for infection. 

It really will be the autumn and not the spring before it will begin to be safe to resume anything like our normal lives.

*https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandwellbeing/datasets/coronavirusandthesocialimpactsongreatbritaindata, Table 12

** https://www.theguardian.com/law/2021/jan/17/jonathan-sumption-cancer-patient-life-less-valuable-others

***https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/coronaviruscovid19infectionsurveypilot/latest

*****https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandwellbeing/datasets/coronavirusandthesocialimpactsongreatbritaindata, Table 7.

From David Vincent in Shrewsbury, UK: Corrigendum

On this my hundredth diary entry, I begin with a correction.  On August 7, I wrote: “It is generally accepted that the only way of ending the pandemic is the discovery of a vaccine and its manufacture and distribution on a global scale by multi-national drug companies.”  A day later, a study conducted by King’s College London and Ipsos Mori reported that only 53% of the British population was definitely or very likely to accept being vaccinated, whilst one in six said they would definitely be very unlikely to go ahead with such a treatment.

This finding is in fact very similar to a survey I discussed on July 6, based that time on a YouGov poll.   

At face, the finding is deeply depressing.  It suggests one of two things.  Either the community spirit that has carried us through is decaying just when it matters.  The widely-observed initial lockdown depended on an act of collective altruism.  Those unlikely to suffer greatly from an infection controlled their social lives on behalf of the elderly, and those with co-morbidities, who were much more vulnerable.  In the new study the young (16-24 and 25-34 year-olds) are twice as likely to refuse a vaccine as the old (55-75).

Or the proportion of the population prepared to disregard medical advice is much larger than we supposed.  It is not so much a matter of disputing a particular scientific finding.  There will always be argument about which remedy is most appropriate, even amongst researchers themselves.  Rather we are faced with a Trumpian disdain for science altogether as a mode of advancing the truth.  It is a wholesale rejection of the Enlightenment project, the notion that the natural world could be progressively understood through evidence-based rational discourse. 

There is, however, a caution against despair.  The opinion poll surveys are asking a hypothetical question.  There is no vaccine, merely encouraging reports of several clinical trials.  Conversely there are any number of bogus cures being widely discussed in books and online forums.  John Naughton in his Observer column on Sunday column traced in convincing detail how the algorithms on sites such as Amazon are promoting anti-vax literature with little to counter it.

As and when the vaccine is found, manufactured, and distributed to doctors’ surgeries, then the whole debate will shift.  Governments will stop issuing vaguely optimistic promises and get behind a determined programme of mass vaccination.  If it is seen to work not just in random trials but in real populations, the proportion of refuseniks will surely shrink to a marginal though possibly damaging fringe (at least in the UK; all bets are off in the States, whoever wins the presidential election).

It may be that the poll findings are not so much a cause as a reflection of a collapsed optimism.  I have been writing entries every weekday for nearly five months.  During that time public spirit has made a transition from panic contained by collective endeavour to weary disillusion with every aspect of the official effort.  We come to the end of the first period of the pandemic with the highest per capital death toll in Europe and the deepest projected economic recession.  Whether it is a second phase or a renewed surge, there appears no end in sight to the level of infections, which in England climbed back over a thousand at the weekend. No-one believes the assurances of any part of government, from face-masks to care homes to test and trace to reopening schools.  Dominic Cummings’ Flight to Durham in late March and subsequent non-apology in the Downing Street garden is held to mark the turning point in public confidence.  He’s still inside Number 10.  It will take a real vaccine, actually and widely available, before spirits change.

But by that time, we will be in the throes of Brexit.

Enjoy the rest of your summer.  I’m taking a break.   

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