As Nadhim Zahawi, the vaccine deployment minister, often says, we are engaged in “a race against death”. This is not political hyperbole. Though the vaccination roll-out has made an encouraging start, its supply-chain is still fragile; its distribution uneven (as Sadiq Khan has had cause to complain on London’s behalf); its infrastructure incomplete; and the numbers of jabs administered per day still insufficient, if the Government is to achieve its ambition to offer the first dose before February 15 to all 14 million people in the top four priority groups.
These categories account for all those aged over 70, frontline health and social care workers and individuals who are clinically extremely vulnerable. Thereafter, the programme will be extended to the next five groups identified by the Joint Committee on Vaccination and Immunisation (JCVI), embracing every adult over 50: an additional 21 million recipients. Ministers hope — and “hope” is the word — to reach all nine groups by April. The question now vexing them and their scientific advisers is whom to target in so-called “phase two”.
There is a strong inclination to prioritise police officers, prison officers, retail workers, public transport employees and others who, by definition, spend much of their day in face-to-face contact with other people. Teachers ought to make the cut, but may not do so because of their relatively low average age (39).
The greatest controversy in Whitehall remains the best approach to ethnic minority citizens, and their potential entitlement to priority status. In fact, this ought to be a straightforward decision. But it has ministers and officials alike tied in knots — unnecessarily. The data collated during the first wave of the pandemic is clear enough: black people are four times more likely to die from Covid than whites. Those of Bangladeshi and Pakistani heritage also face a higher risk of being killed by the virus. Bear in mind, in this context, that 35 per cent of all Londoners belong to a BAME community. As the new variants of the virus take a grip, more than a third of our fellow citizens are in disproportionate danger.
Last year, the JCVI acknowledged the problem — but dithered over the solution. By the time it convened on December 30, it was reasonably clear that ethnicity itself (in the genetic sense) was not the cause of the higher death rates, which were, instead, the consequence of the disadvantages and deprivations that minority groups routinely confront: high-risk occupations, cramped housing, poverty and the illnesses it fosters, and unequal access to healthcare.
The committee’s conclusion was infuriatingly vague: it advised health agencies “to work together to ensure that inequalities are identified and addressed in implementation”. This was merely to restate the question as an answer. It is true that the data held on ethnicity by primary care providers is not uniformly robust, which makes targeting difficult. It is also true that there is a higher degree of vaccine hesitancy among ethnic minorities: in October, the Scientific Advisory Group for Emergencies (SAGE) released research suggesting that 72 per cent of black and black British people were “unlikely” or “very unlikely” to get the jab.
Such reluctance has little in common with the indulgent conspiracy theories and pseudo-science of anti-vaxxers. The black community has bad memories of its historic treatment by health professionals: notoriously, in specific scandals such as the Tuskegee experiment beginning in 1932, in which nearly 400 African-American men with syphilis were lied to about their treatment. More generally, there is plentiful evidence of ethnic minority patients receiving unequal medical attention — nurturing a collective sense of mistrust.
But all of this should strengthen the case for the prioritisation of minorities in phase two, both in public information strategies and access to the vaccine itself. In private, ministers fret about the political risk of anything that looks like “affirmative action” in public health policy. But this is not positive discrimination in a syringe, or political correctness gone medical.
It is an entirely clinical and practical decision, which should be taken in line with the broader strategy of getting the vaccine to those at most risk. Plainly, black Britons and most British Asians are in disproportionate peril.
It follows that they should be given the vaccine as soon as possible. Yesterday, more than 1,610 Covid fatalities were reported: a new daily record. This is indeed a race against death, and one we must win by any means necessary.