Abstract
Vaccination for COVID-19 remains controversial. The first question is who to vaccinate? The general answer is to begin with the most vulnerable and then prioritise on the basis of risk. But China, for example, in its pursuit of eliminating SARS-CoV-2, has begun by vaccinating people living and working in border areas. The debate in the UK became most heated over vaccinating children and adolescents, with official policy being out of step with other countries.
The decision to offer only one dose was most directly challenged by new research published in JRSM. 1 Apart from supporting the two-dose strategy, the authors also challenged the government's vaccine committee to publish the evidence behind its decision making, which the committee was expected to do.
Any lack of transparency only serves to ferment distrust among the public, distrust that is heightened by calculations that vaccine manufacturers are charging prices that disregard the public’s investment in vaccine development and bear no relation to the minimal production costs. 2
The failure of vaccines to reach much of the world, where vaccination rates in Africa remain in single figures, mean that variants and boosters will remain major talking points beyond 2021. But the challenges to delivery can only be overcome with considerable planning, and a supplemented workforce. 3 Of the many innovations in primary care that might support the plan, doctor apprenticeships might be more problematic than they seem. 4
The research on COVID-19 vaccines has been both a success, for its speed, and controversial, for being incomplete. The governance of research, and ethics review, must be designed to improve human health, and steps can be taken to decrease the bureaucracy and workload that hamper researchers. 5 A question that oversight of medical research needs to address more often is whether the control intervention is indeed current best practice. 6
However, any dilemma about ‘doing the right thing’ – be it in medical research, clinical practice or health policy – can usually be resolved by placing patients and the public at the centre of our thinking.