UCL Minds


Transcript: Episode 35

New strains and vaccine roll-outs: A shot of hope?


vaccine, vaccinated, people, ucl, virus, astrazeneca, asymptomatic, population, vaccination, disease, pandemic, important, martin, group, deliver, infection, trial, nhs, programme, receive


Deenan Pillay, Martin Marshall, Helen Bedford, Vivienne Parry


Vivienne Parry  00:04

Hello and welcome back to Coronavirus the whole story. My name is Vivienne Parry. I'm a writer, broadcaster and UCL alumna and the host of this award winning podcast. As the title suggests, we cover all things Coronavirus, as seen through the multi disciplinary lens of UCL researchers, staff and students. One of the strange effects of coronas is to collapse time. It seems like only yesterday we were celebrating the arrival of the Pfizer vaccine on this pod with Professor Martina Micheletti. Now in what seems like a nanosecond, but in non COVID time, actually a month, we have two more vaccines, close to 2.5 million people vaccinated already having had their precious shot. But with a vaccination target of 15 million doses by February, there's a long haul ahead. So in this episode, I've assembled some experts to talk about the logistics of the vaccine rollout and the implications of the new strain on its efficacy. My first guest this week is Professor Martin Marshall professor of healthcare improvement in the department of primary care and population health. Martin is the programme director for population health primary care at UCL partners, and he's also vice chair of the Royal College of general practitioners and a GP innum. And he's been incredibly busy, as you'll have seen from your TV screens and radios. I'm also joined by Professor Deenan Pillay. Deenan is a professor of neurology and the UCL pro Vice Provost international in UCL Global Engagement office. His work employs clinical population and lab based studies to help limit the spread of HIV, particularly across Sub Saharan Africa. He's also the former head of the Division of infection and immunity here at UCL, and a previous guest on this pod, and another very busy person on the media. And last but not least, my third guest this week is Professor Helen Bedford, an immunisation expert, and Professor of children's health in the department of population policy and practice. Helen is co director for education at Great Ormond Street, and chair of the personal Child Health Record group, which oversees the development and content of the national standard personal child health record, also a very busy person. So thank you very much for coming. Let's start with Martin. I think the best place to start is that overview of the vaccine rollout because there's a lot happening and changing at the moment. Basically, tell us, Martin, what's the plan?


Martin Marshall  02:36

Yeah, it's exciting times at the moment, indeed, I've just come from a vaccination clinic, I've been jabbing people this morning in my practice in East London. So it all feels very fresh and deep. So we have a plan to roll out the vaccine through essentially three different vaccination centres. So the first lot and probably where most vaccinations at least initially will be delivered, are essentially primary care based mostly general practice, but also some pharmacy. So that's where most of the 2.6 or so million vaccines have been delivered so far. The second bit of the mass vaccination centres which have just been established, there's around about seven of them around the country at the moment, they're probably going to build up fairly slowly, mostly because we're limited supplies currently, but probably will become more important, particularly as we get to the younger population. And then the third part of the programme is the hospital based clinics and the hospital clinics are delivering mostly for their own staff because vaccinating health and care staff is really important, but also for delivering any hospital bound patients or any patients that they might be seeing in outpatients, which not very many, I must say. So those are the three areas. My principal involvement is with the primary care base, the general practice based clinics, they've been up and running since the week before Christmas, and are finding their way I think, doing a really sound job. I think we are starting to hit some really good targets. We're still some way off the 13 or so million that need to be vaccinated by the middle of February, which is the target that the Prime Minister has set us. And those 13 million people are essentially the people in the top four groups of the joint committee for vaccination immunizations, which is people essentially over the age of 70 health and care staff and people with significant health problems.


Vivienne Parry  04:26

And actually, it does seem I mean, I know there are teething problems and when I talk about teething problems, I'm not talking about teething problems, as in Brexit fish teething problems are just enormous. There are genuinely some, you know, difficulties early on. But actually, the vaccine rollout is looking pretty impressive. I think at the moment, Martin.


Martin Marshall  04:46

Yeah, I think that's right. I don't want to play the European game here. But if you look at how many people we vaccinated, in capacity, that European partners we've set off quickly and we're doing we're doing really well. And one of the reasons for that I have to say is Because we're using established system, so don't balance as I say is delivered, the vast majority of those term products is a long and honourable track record of delivering mass vaccination programmes, particularly the flu vaccination programme, but also childhood vaccinations. We know how to do it. This is a different Maxim, of course, it's very different disease, but the principles are the same. And having the staff ready and trained and experienced is such an important part. So unlike, and dare I say, the testing train system, which is which has experienced a number of problems, in part because it wasn't using established services, the government, I think, rightly decided to use the NHS using NHS resources. And as a consequence, we made a really good start, and we're getting that.


Vivienne Parry  05:41

So a lot of the early kind of logistic challenges have been ironed out. One of the challenges still to come. And are they mostly based around availability of vaccine?


Martin Marshall  05:52

Yeah. So I think I coming back to your previous question, I don't think it's fair to say that all the challenges have been ironed out yet, but the challenges that we're seeing are, you might describe as understandable one. So listen to the Brigadier on Downing Street briefing a few days ago. here's a here's a man who's used to some of the most complex logistic exercises, who said this is the most complex exercise he's ever seen. So let's let's be a little bit gentle ourselves in terms of the real challenges, you'll be found around distribution of the vaccine, for example, and some of the IT support and satellite challenges going forward. You're right, what we need in order to be able to deliver the vaccine is first of all supplies, we're getting mixed messages from government, I think the more optimistic ministers are telling us, there's no shortage of supplies get on and deliver. And that's not quite what we're seeing on the ground. And more cautious people like our chief medical officer are also from UCL is suggested that, you know, there will be some limitation to supplies, at least for the next few weeks. So supplies is one of the challenges. The second challenge is the vaccination workforce. And that's a particular issue for us in general practice, because we've got to not only deliver the COVID vaccine, also an expanded food vaccination programme. And of course, our usual business, we can't be missing people who are acutely sick, or people who've got unstable long term conditions or people who might have cancer or whatever. So we have to continue doing that as well. The only way that we can do all of those tasks is by having a larger vaccination workforce than we have at the moment. And we're looking at ways of delivering that. And that includes bringing recent retirees, doctors, nurses, pharmacists back into the workforce. It includes bringing other people like dentists into the vaccination workforce, and training up known traditions as well. So that's the kind of third area and then the fourth, the second area. And then the third area, I guess, is around the willingness of the population to be vaccinated. And at the moment, things are looking pretty positive in that direction, in part because we were vaccinating initially the older population, and they tended to have more experience of receiving vaccines and perhaps less critical, I think, as we're getting to the younger age group, it's going to be a little bit more challenging. Although the data that I've seen so far in terms of vaccine compliance, the figures are heading in the right direction, the last figures I saw from the department around about 70% of the population say that they would receive the vaccine, we've still got work to do there, but I think we're heading in the right direction.


Vivienne Parry  08:10

And please tell me, Martin that all those ridiculous things about needing file safety certificates, and you know, radicalization, training, whatever it was that people had to provide, has that been sorted out,


Martin Marshall  08:22

it's being sorted out, I have to say that as chair, the Royal College of general practitioners, it's a well, any leadership position in the current environment is quite tough. But at the moment, I'm finding it quite easy, because all I have to say is common sense things. Like you don't need to go through days or weeks of training, in terrorism understanding or whenever, in order to be able to do a pretty simple technical task, like deliver a vaccine. And so we've been making that noise quite loudly, as you've heard in the media, it's been heard by the department, which is good. And we're finding ways of either getting rid of or bypassing the silly red tape. Of course, you know, basic training is important. If you have actually to, you've got to know how to resuscitate someone, you've got to know how to deal with anaphylaxis, acute allergic reactions. So it is important that you're prepared and trained, but you don't have to go through the very lengthy training required, which is kind of part of the NHS bureaucracy required to do normal clinical practice. So we are getting there. Are we there yet? Not quite easy answer.


Vivienne Parry  09:21

And also Tell me please, that the vaccinators are being vaccinated, because quite a number of them are in risk groups themselves, you know that they're older, you're pulling them out of retirement, please tell me that they're getting vaccines.


Martin Marshall  09:36

Yeah, they're certainly in the priority group and that you're actually right, that's really important because we're seeing, you know, 10s hundreds 1000s of patients at the moment, most of whom are in the low risk group because they are older patients, but we're going to be seeing people who are in a higher risk group of carrying the virus. And so yes, we are being vaccinated quick enough, possibly not yet, you know, for the groups that are vaccinated. that we need in place in two or three weeks time when particularly when AstraZeneca comes on board. And we have large volumes, we need to be vaccinating them right now because it takes two to three weeks for the vaccine to to work, I received my vaccine about 10 days ago, I'm still vaccinated at the moment, even though I've not received maximum protection for that single food vaccine. But I'm taking care, you know, I'll do all the stuff that we need to be doing anyway, around wearing masks and good hygiene and all the rest.


Vivienne Parry  10:28

Okay, now, one of the things that has proved most controversial and I'm going to bring dienen in on this in in a moment, is that the people who are having the Pfizer vaccine are having one dose and not two doses. And you know, the reasoning for that is pragmatic. And you've already alluded to it, a shortage of vaccine. And actually, every one person that receives two doses means that one other person doesn't get it. And that person that doesn't get it may end up in hospital. And that not only puts them at acute risk, but actually also takes another bed, which might be devoted to perhaps someone who has cancer or another condition that needs urgent treatment. So it has been controversial. And I know that for the GP side of it, you know, having to ring hundreds of people and say we're not going to give you your second vaccine has caused enormous problems. But are you broadly supportive of that pragmatic approach? Martin,


Martin Marshall  11:29

I'm more than broadly supportive of it. I'm very supportive of it. I'd be interested to see what where Dino says from viral ologists and immunologist perspective. But from my perspective, I'm just very pragmatic about this. And for the reasons that you've described, the, the concerns that GPS have had are twofold. I guess the first is, as you say, just the challenge of having to cancel 90 year old patients at 48 hours notice, when they were ready to come in for their second vaccination. That was really difficult. Some jeebies are also worried about the promise, the consent process that we went through with our patients, which said that you will receive two jobs. There's another group of doctors who are worried, sorry, that first group of doctors, they're worried about the practicalities. But actually they buy the argument that a delayed second dose makes sense, at a time when Supplies are limited. But there is a second group of doctors who don't buy the science, the science is presented to us by the joint committee and by our chief medical officers, the former chief medical officers, and they believe that you do have to have two jobs in order to be effective. The data that we're told from senior scientists in working in policy world is that if you receive the Pfizer vaccine, it doesn't work straight away. But within two to three weeks, you get about 89%. coverage, efficacy from one vaccine, and from the second vaccine, which would have happened three weeks later, you get 95%. So it's a really marginal benefit in the short term of receiving the second vaccine. And that's the argument when things are limited that we need to vaccinate more people in order to get better population cover. Now, you know, there are arguments against that which do talk about, you know, particularly the duration of immunity that you get from a single vaccine. But I think the argument is, is very pragmatic, and it's very clear. And as a college we were supposed to get strongly.


Vivienne Parry  13:22

And one of the points, of course, here is that now Pfizer decided to go for that three week interval, probably because, you know, a perfectly rational decision that they knew that this would have to be delivered quickly, which meant that they didn't test, say, eight weeks or 12 weeks. So it's not that it they're not saying it's safe is that they haven't got the data to say it safe because they didn't test those intervals. But Dean, and I want to come to you now because there are several issues here. One is about this thing about viral escape. And perhaps you can talk about that a bit. But first of all, what's your thoughts about delaying the second vaccine shot?


Deenan Pillay  14:03

Well, I had that as as I think Martin is very well described. We're talking about two paradigms here. One, one can think about the pure scientific basis of an F we think about the vaccine as a drug. You know, there's a well oiled machinery for trialling drugs, for identifying what drugs are safe, how to use them. And as doctors, we all go with that. And so on the one hand, there's that approach, and on the other hand, is the pandemic we find ourselves in with the NHS on its knees, you know, we really need to do something very quickly. To reduce the infections in the population. We recognise that vaccination is one component of that, and it's a pragmatism particularly in the context of supply. I think we mustn't forget that, that if we had the ideal, we have the complete supply. We had the infrastructure to give vaccines to everyone. Want over a period of a month and get the whole population immunised? I'm sure we wouldn't be thinking about these sorts of things it is. So that that's that's summarising my, my view is I do think the decision has been the right one in the context of those constraints. Having said that, you're right, Vivian, is that the AstraZeneca trials. And there were a number of trials that were probably not as coherent together as the Pfizer trial. But part of that incoherence or semi incoherence was that the booster was given at different times, follow it, you know, from four weeks, just 12 weeks, in the many different settings that that trial was undertaken. And therefore, the company did have data, which drat straddled that whole period of time. So that's why the data there, by contrast, the Pfizer vaccine trial was, I think, probably undertaken in a far more rigorous way. Um, don't don't don't mean that in a negative way, it's just the way that these are done in the speed required for these COVID vaccines to come to be be be put into people. And therefore the data are there and we don't have any other data, there is no variation in the time to the second dose within the trial, because it was all according to protocol. So there we have it, and the scientists, there's a debate amongst immunologists that I see about whether RNA vaccines need boosting in a different way to the sort of vaccine the AstraZeneca is, and Martin has quite rightly said that you do start to get protection after about 12 days of one dose of Pfizer vaccine, it just may be the time the duration that that is in question. But But putting this into context, it is very likely that the duration of these vaccines will all of them will be limited, we may very well move into a sphere, where we're immunising every year, every two years, maybe with a slight variation in the vaccine in with the same sort of model that flu is and therefore looking to the to the future. I think the more that are immunised now, the better. And then we can spend some time thinking about how best to do it. But I just one question rebacked. Martin, really, is that there is the opposite. And I know I'm sure you've been part of these discussions, Martin. But there remain a number of uncertainties with regard to dosing and, and so forth. And it seems the NHS is ideally placed to undertake, if not RCTs, then sort of more natural experiments or before and after experiments and a whole range of methodologies to evaluate the efficacy of different these different approaches. And my question is, are there data systems there? I know there's been a new data system put in to capture vaccine data, align it with, with NHS numbers, primary care records, in those data systems sufficient to be able to do those sorts of experiments and evaluations in real time.


Martin Marshall  17:56

Yes, yes, they are doing and Public Health England are leading on it. I don't know the detail. But I know they're committed to trying to answer that question given as you say, there's certainly a shortage of good evidence from the original manufacturers about it.


Vivienne Parry  18:09

So dinan Another issue is this one about transmission. So as I understand it, the Oxford group did some work on transmission. So the concern is that you vaccinate somebody, they certainly don't get the disease as severely that's very clear, but they may get it still get it asymptomatically and then spread the virus without realising. So this problem of asymptomatic transmission by vaccinated individuals seems to be one on which there is almost no data. Oxford group did some and I think they showed a reduction in asymptomatic transmission amongst vaccinated group of about 27%. But what do we know about transmission by those who've had vaccine


Deenan Pillay  19:00

it's a really important point, and critical to whether we extrapolate from immunisation of the population to whether we can get herd immunity, because her getting to a herd immunity does infer that the vaccines stops people big being infected and therefore being able to infect others. And you're right. These studies have not been done in a formal way. But certainly Pfizer did not do these studies,


Vivienne Parry  19:25

which are difficult to do, aren't they?


Deenan Pillay  19:27

Well, the AstraZeneca trials did have what's called a sub study, in other words, a smaller number of people that you you alluded to where this was tested. So in essence, when these trials are done, the standard way in which they're done, people are randomised to get the vaccine or not. And then if they feel ill, they present themselves to the trial clinic, and they will be tested for COVID. In other words, the endpoint that's been looked for is symptomatic disease with COVID but but they're not looking for asymptomatic infection. Which will infer testing read more regularly, even if people don't have symptoms. So there was a sub study in the AstraZeneca trial, which did do exactly that, that did swab people, I think it was weekly, that after getting the, and there are data there. And it's really, it's really interesting. And of course, as you we all realise, there was the dose mock up, really, in AstraZeneca. So there was a low dose, high dose and a high dose, high dose of the two of the two regimens. And in both of those, there was this sub study done. And what was found was actually in the high dose high dose, which is the dosing that's now been approved within the UK, there was no difference between those arms when asymptomatic shedding was looked for, but on the face of it that that the conclusion is, oh, it doesn't affect asymptomatic shedding. But one needs to sort of apply a sort of more statistical approach to this. And if I can try and make at least what I'm trying to say, as simple as possible. So for a full two dose regimen, we know from the AstraZeneca trial, there was a 60% reduction in disease, but no difference in asymptomatic shedding, but against placebo. However, you know, since the vaccinees, those who had vaccines had less disease, yes, does it symptomatic disease, then if in fact, the vaccine was acting by changing a disease or symptomatic infection to an asymptomatic infection, that would be a positive thing, you would actually expect more asymptomatic infections in the vaccine II in those who received the vaccines than the placebo, because in the Vax vaccinees, there was less disease. And if all the vaccine is doing is moving the disease, that the infection from disease symptomatic to asymptomatic, you'd expect more. So it's a paradoxical view, the fact that there was no difference in symptomatic infection, despite a very significant reduction in symptomatic infection says to me working through this, and I've talked through with with with other trials around this, it does infer that there is also a benefit for asymptomatic infection. I hope I've explained that in the in this clear away. Like


Vivienne Parry  22:18

thank you for that. So so another couple of quick questions. First of all this worry about viral escape that somehow that between, you know, one day and the second dose that you're allowing the the rise and rise of a more difficult to control variant.


Deenan Pillay  22:36

Yes. So this is a really interesting thing that's come left field, isn't it about the virus that there is, as a biologist, we all expect viruses to vary and mutate, that's a function of being a virus always wanting to continue to transmit and survive. But we've always assumed that this class of virus this, the corona viruses don't vary too much. But also, it is because they've just not been studied, as well as many other viruses. And despite SARS 20 years ago, and MERS 10 years ago, which is the same family as COVID. The assumptions always been that it's going to be flu that brings the pandemic and much more work has been done on understanding how influenza varies. So it's really a surprise to us. And with hindsight, we can say what was a really good idea was to develop within the UK, something called the COVID genomics consortium called the UK,


Vivienne Parry  23:34

which we've heard a bit about from Judas Brewer on this.


Deenan Pillay  23:37

Yeah, that's right. And I'm lucky I'm I'm fortunate I'm, I'm privileged to be on the Oversight Committee of that, and it's a really impressive initiative. And that's obviously contributed a large amount to the international databases of the genetic sequence of these viruses. And that's allowed us to identify these variations that there are which there are many, many variations, but be able to identify pretty quickly, that there's big growth, unexpected growth we all feel in the southeast and London, just before Christmas, was contributed to partly at least buy this new variant. But I should say it's interesting. There's now the South African variant, there's the Brazil variants that today are causing the headlines. But these variants, we do not know that they exist, they'd started in these countries, they're only identified in these countries, because those countries are undertaking genetic sequencing of the virus. And overall, we must have sequenced probably less than point five of all the infections in the world. So we've got to expect that there. There's a much higher prevalence of these around the world. That and the key question coming back to the vaccine issue is whether these variants actually will compromise the effectiveness of the vaccine. There is some evidence that this is potentially possible. For instance, we know that where there are treatments used have monitored clonal antibodies, these are our treatments to prevent the infection or to treat early on those individuals receiving those treatments, their viruses do evolve very rapidly to become resistant to those antibody treatments. Having said that, vaccines generate a large array of different immune responses, both antibodies and then what we call T cells. And so we think it's unlikely. But nevertheless, it demonstrates I think the important thing is that although I think the current vaccines will work and contribute to reducing the pandemic, that we will need to be relooking, at vaccines, perhaps in the way that we do with flu every year, we change the vaccines a little bit, not only because of big, different types of virus, but they're slight mutations or so called drift that happens between viruses genetic drift, that may be the way we're going with this virus,


Vivienne Parry  25:57

Dean, and thank you very much. Now, the virus adapting isn't the only challenge. Only challenge we've got a whole heap of them, but to vaccinating the population. We need a vaccine that works, but we need the population that wants to be vaccinated. Helen, can you explain what the social response to the vaccine has been? Has there been much of an issue about people feeling uncomfortable with taking the vaccine?


Helen Bedford  26:23

Well, it's it's this is really interesting, because virtually as soon as it was announced that vaccines were going to be developed, opinion polls, and some studies were conducted, finding out what the population felt in terms of whether they were likely to accept a COVID vaccine. And these have been conducted in the UK and wider. And most of those, show that about three quarters of the population say that they would be very likely or quite likely to have a COVID vaccine. And this is before the thing was even developed. So when people are making decisions about vaccinations, they obviously want to know, does it work? Is it safe, how long I'm am I going to be protected? Those sorts of questions, and we didn't have that information. So this was a completely hypothetical question. And I thought, I think that that was a fantastic starting place. So it depends whether your glass half full glass half empty, really 75%. In the absence of any information at all, saying yes, I would have this vaccine is a great start. And now, of course, the vaccines are in use, we don't have any uptake figures. But studies are conducted continuing about the public response to this. And what we're seeing slightly worrying Lee is there are some groups in the population that are less likely or say they're less likely to accept and they tend to be black and minority ethnic groups, particularly the South Asian groups who have been hardest hit by the disease, and if anything, are in most need of the vaccine, and this is a this is a great concern.


Vivienne Parry  27:57

They've also been very hard hit by lots of misinformation.


Helen Bedford  28:02

Yes, absolutely. Just targeted directly at them. And it's it's just so upsetting to see this. But work is going on now with community leaders and trusted religious leaders to work with the community. And I think that that is the way we need to go. But I do feel although the science around developing the vaccine has been fantastic. The science around communicating the benefits of the vaccine has been less in the forefront and we needed to be talking about this months ago,


Vivienne Parry  28:33

we have a really rather well, bizarre attitudes to vaccines were some vaccines people very much want. So I was remember when I was a member of the Joint Committee on vaccination, that people didn't want to have MMR but they were queuing around the block for meningitis B, because they perceived meningitis B to be an important and necessary vaccine, and meningitis as a terrible disease, whereas they didn't receive that for MMR. And I guess part of what's driving this vaccine acceptance is that people increasingly do see COVID a really problematic and potentially fatal disease.


Helen Bedford  29:18

Yes, I'm sure that that's absolutely the case. Because we but we do see groups, but I mean, very small numbers, activists who are, you know, saying that COVID doesn't exist at all that it's fake, that anti mask, anti lockdown, and the anti vaccine activists tend to group with them too. But I think the majority of the population do have personal experience of somebody in their family or their their network, having experienced this disease and seeing how desperate it is.


Vivienne Parry  29:47

And I also think people fear the random nature of COVID. By which I mean, you know, we all look around us that people we know, and the one that we think that would have gone down like a sack of spy He seems fine. And the one that we thought was super fit and would easily get through COVID seems to have been badly affected. So I think that's really rather unsettled people, and made them feel that actually what they thought about themselves as being fit and likely to get through it all right, actually may not be the case.


Helen Bedford  30:20

Yes. And there's certainly been a lot of publicity cranked up in the last month or so going towards and seeing sick patients and talking to people who've had COVID, and are now experiencing long COVID. So I think people are becoming aware, more aware that even if you're young, you can still have, you know, horrible long term consequences of this disease. We're learning about it all the time. I mean, you know, a year ago, it didn't exist. So vaccines have been developed. That's the most extraordinary achievement. But we're still learning every day about this disease.


Vivienne Parry  30:51

So the anti vaxxers in some ways, I mean, my view about anti vaxxers has always been that you might as well not try and persuade anti vaxxers because it's a belief system, and it's not going to change for them. But hesitancy that's a much bigger group of people, people who have understandable reasons it's been rushed through too quickly. These are not people who are being difficult. They are just being cautious and expressing some views, which they'd really like answered. So how are we going to deal with that group?


Helen Bedford  31:25

Well, the first thing is, I agree with you entirely, that the anti Vax group is a tiny proportion, and the people we need to be talking about are the general population. So I don't actually like the term hesitancy because I think it's a little bit negative, quite right, that people should have questions and concerns. If you're going for any medical treatment, you would ask questions, why should that not be the case for vaccination, so we need to be clear about what people's concerns are. And that means listening to people. And there will be different concerns and different groups of people and responding appropriately to those concerns. And this means that doing it in lots of different formats, not just via the newspapers, but health professionals have a really important role to play here. Because the public trusts health professionals, they're up there top of the list of people that are trusted by the public, but also through other means. And this means using the kinds of media that different ethnic minority groups might use. So not everybody watches the BBC and reads the times. And we need to be a little bit more creative about how we're getting this information out to the public.


Vivienne Parry  32:32

Now, in these podcasts, I generally hand out my magic wand that I have in my back pocket to all of our guests. And I wanted to ask each of you, if you had my magic wand in your possession, what's the one thing that you do to help with a vaccine rollout? Let's stay with you on that talent. What would you like to do? Well, actually,


Helen Bedford  32:56

it's a personal thing. I'd like to roll my sleeves up and be out there vaccinating but as I have broken my arm, I can't do that. But I would really like to be doing, you know, involved in the process of protecting people, you


Vivienne Parry  33:08

get to you get two magic ones, I think


Helen Bedford  33:13

you want another magic one? I would I would just like the public to feel more confident. And I think most of the public do, but it's that small minority that have concerns. And I just think we need to find ways of of reassuring them that, you know, this vaccine is safe, effective, and it's going to protect you from a potentially life threatening disease.


Vivienne Parry  33:36

dienen. How about you? What would you do with my magic wand?


Deenan Pillay  33:40

What I guess what I see vaccines as one component of what should be a much more comprehensive pandemic, by the government. And I do think that the lack of trust for vaccines is also part of difficulty we've had overall, you know, very poor track and trace system inadequate support for particularly the very poor and disenfranchised or asked to isolate, and perhaps they can't do that, and so on. So I would say as well as obviously rolling out the vaccine. And the way it's going is that trust can be built by ensuring that there really is a clear, overall comprehensive government strategy to dealing with this pandemic, which needs to be assetid it needs to make sure that schools are safe and that the appropriate due care for the iris scan, you know, public facing individuals getting their vaccines and so forth. But it is a broader trust issue. And I feel fear that the way that the UK Government has dealt with this pandemic so far, has not engendered the sort of trust which is required for vaccine at short notice be taken up so that that would be my wish,


Vivienne Parry  34:58

I must admit as you're talking to them. wants to give an anti hyperbole pill, maybe it can have some sort of Harry Potter spells. That stops people saying absolutely ridiculous targets or aims, because it's really not helpful. Martin, how about you? What would you do with my magic wand?


Martin Marshall  35:17

Well, if I, if I'm allowed, I'm going to have to swishes Vivienne and the first year, yet, thank you the first round very much in the same places as you indeed. And so if you look internationally at countries that have done relatively well, in in dealing with this crisis, and it is difficult to do that sometimes, because countries that seem to do well, for a while then seemed to do badly. But the ones that have done relative relatively well, I've got three characteristics. The first one is that is that they've learned from previous epidemics or pandemics. The second one is that they have an infrastructure in place a state infrastructure in place to allow them to respond. And the third one is Devin says, Do you see a high level of trust in government and governance. And I think it's fair to say that all three of those areas we've not done well, in the UK, and I guess that probably explains our, our relatively poor performance. So my first swish of the wand is to rectify those problems. And I guess in particularly around the infrastructure, a strong public health system as they have in Germany, a stronger properly resourced system of primary care, as we kind of happened not good enough, in the UK, is exactly what we need. So that's my first wish my secretary, she's just a larger vaccinated workforce, very pragmatic, don't have enough people at the moment to vaccinate and to deliver business as usual in order to prevent excess deaths from cancer and heart disease and everything else. We need a larger workforce and we need it very, very quickly.


Vivienne Parry  36:44

Right. Absolutely. with you on that one. Well, I think there's been an awful lot of swishing going on but just this once, I'm going to allow it. Thank you all so much. So you've been listening to Coronavirus the whole story. This episode was presented by myself Vivienne Parry, produced by UCL with support from the UCL health of the public and UCL grand challenges and edited by the splendid Cerys Bradley. I was joined today by professors Martin Marshall, Deenan Pillay and Helen Bedford. And if you'd like to hear more of these podcasts and UCL Minds, of course, you would subscribe wherever you download your podcasts, or visit ucl.ac.uk forward slash Coronavirus. This podcast is brought to you by UCL Minds, bringing together UCL knowledge, insights and expertise through events, digital content and activities open to everyone. I hope to be with you again soon.



Bye for now.