Three vaccine rollout scenarios: the good, the bad and the ugly

·8 min read
Fireworks and drones illuminate the night sky over the The O2 in London 
Fireworks and drones illuminate the night sky over the The O2 in London

The great vaccine rollout has begun. How it plays out will define the year ahead and the speed at which lives in Britain and across the globe return to normal. 

Five vaccines have so far been granted emergency approval. In the west, the Moderna, Pfizer-BioNTech and Oxford-AstraZeneca shots are now going into people’s arms. 

The Sputnik V vaccine is being used in Russia, Bolivia and Belarus. And in China, where the authorities have been inoculating soldiers key workers since summer, Sinopharm gained general approval last week. 

It’s tempting to think it will be plain sailing from here. Western pandemic plans always banked (too much as it turned out) on the rapid rollout of vaccines and antivirals. We may have struggled with non-pharmaceutical interventions, goes a certain logic, but the great vaccine race is being run on home turf. No wonder our politicians see light at the end of the tunnel.

But the earth is home to 7.8 billion people and almost everybody wants a shot. To end the pandemic and stop the virus from constantly bouncing back nations are going to need to come together and inoculate the majority of the world’s citizens.

So expect to see much more of the chart below in 2021. Currently, Israel is ahead of the pack . It began a mass vaccination campaign less than two weeks ago and has already reached 10 per cent of its population. In the UK - a much bigger country - we are approaching 2 per cent coverage. But for the world as a whole the figure stands at less than 0.1 per cent. 

“Vaccination is the way out of this,” says Dr Clare Wenham, assistant professor in global health policy at the London School of Economics. “But logistical and political barriers will persist”.

Too right. In the absence of global agreements, expect “vaccine nationalism” and geopolitical skulduggery to proliferate in the months ahead. 

Already Britain’s security services are said to be on high alert. While perhaps doubling as a convenient excuse for sitting on unflattering data, senior Whitehall officials say they are unable to talk in detail about vaccine supplies for fear that incoming consignments will be targeted by organised crime gangs and hostile states. 

So how might the next year play out for Britain? Will the country thrive or crash again? Will there be cooperation or will the global rollout of the vaccine better resemble an episode of Wacky Racers? Here are three scenarios: the good, the bad and the ugly. 

The good 

A best case scenario sees Boris Johnson's (latest) optimistic prediction of freedom by Easter come to pass. 

Britain manages to ramp up vaccine supply and distribution fast and inoculates its 25 million most vulnerable citizens by early April.

Hospitalisations plummet and the threat of health and other essential services being overwhelmed quickly dissipates, allowing lockdowns and other social distancing to be carefully unwound from April 1.

Although vaccine supply is tight at first, the strategy of prioritising first doses, initially seen as a gamble by some, proves to be a game changer and is copied across the world. There are even calls for its originator, former prime minister Tony Blair, to return to frontline politics. 

Third wave Covid-19 deaths (those recorded in the first six months of the year) remain below the first peak, but still stand at around 36,000 - the best case scenario on current UK modelling

We are helped by the weather. A spring as warm and bright as last year’s lifts the national mood and helps reduce transmission as people make the most of the outdoors again.

Better still, data showing that the vaccines reduce transmission as well as disease is announced in March by Public Health England.

The RNA-based Pfizer and Moderna jabs turn out to be “sterilising”, meaning they stop transmission entirely. The Oxford Astra-Zeneca vaccine cuts transmission by 60 to 70 percent, and the real possibility of Britain achieving herd immunity comes into view.

Vaccinated Britons start to receive “vaccine passports” and international travel starts again for those who have been inoculated in time for summer holidays.

The strategy of the government's Vaccine Taskforce also pays off. Not only do initial supplies come through as promised but, by August, we are swimming in the stuff, with nearly all the 355 million doses ordered either delivered or on their way to NHS vaccine centers.

Britain uses the extra vaccine to inoculate 80 per cent of the population by November, successfully achieving herd immunity.

At the same time it distributes tens of millions of shots to low and middle income around the world, helping to end the global crisis and boosting our international standing.

By the end of the year, the economy is firing up fast and a new Roaring Twenties begins.

Acutely aware of how inequalities can store trouble for the future, the government puts a radical new “levelling up” agenda in place to ensure that the gains of the boom will be shared equally across the nation. 

Pundits start to refer to Britain as the new old Sweden. 

The bad

Britain is hit not just by bad luck but by a series of bad actors. 

Vaccine distribution, currently at around 250,000 doses a week, remains stubbornly low and gets to nothing close to the two million shots a week that modelling suggests is needed.

The contracts signed by the Vaccine Taskforce prove not to have been drafted tightly enough, and bigger powers, most notably the EU and America, move to mop up the great bulk of early supplies. 

Of the smaller counties, only those with long practice in the dark arts of geo-political maneuvering get the vaccines they need quickly enough. 

By Easter, deaths are peaking at above 2020 levels in London and the south east, and spreading fast across the rest of the country. Total Covid-19 deaths for the first six months of the year hit nearly 85,000 by the turn of summer. 

The NHS staggers on until April but becomes overwhelmed, forcing ministers to authorise a “population triage” policy it secretly drafted after Exercise Cygnus in 2016 but never made public. 

A national “tier five” lockdown, which has been in place since mid-January, is once again extended.

Britain’s predicament is made worse by international comparison. While large parts of western Europe and America are joining China and east Asia in opening up again, the UK remains firmly locked down.

To top it all off, while the Pfizer and Moderna vaccines are shown to stop transmission, the Oxford jab is found to have little impact on the spread of the virus.

This puts “vaccine passports” out of the reach of most Britons, adding to the country’s sense of isolation.

Pundits note that, last century, the Roaring Twenties were largely confined to continental Europe and America too.

The ugly

Not pretty by definition but less to do with others.

In mid January, the country is hit by a new “Beast from the East”. Snowdrifts, severe cold and icy roads make an already difficult vaccine rollout to Britain's most vulnerable citizens near impossible.

The old and the frail are simply unable to get out of their houses to the hundreds of vaccination centers set up for them. 

The dire weather stretches NHS resources still further and accelerates transmission of the virus which thrives in cold, dry air.

Vaccine supply also remains constrained, not because others are buying it up but because global supply chains can’t keep up with demand.

While vast quantities of vaccines are produced in manufacturing plants around the world, especially India, shortages of finishing and packaging products mean that very little gets beyond the factory gates until the spring. 

Worse, the strategy of vaccinating the most vulnerable first starts to break down as governments around the world give in to the escalating demands of vested interests. 

The impact of the jabs in relieving the pressure on health services in Britain and around the world is therefore greatly curtailed.

Deaths in Britain continue on an upwards trajectory deep into the summer and the country remains locked down. All the while, the risk of another mutation grows greater - not least because only one shot has been delivered to most of those vaccinated.

“I'm worried that Sars-Cov-2 may start popping up with mutants that are not only more transmissible but more lethal,” says Dr Peter Daszak, President of EcoHealth Alliance.

“There's no evidence of that yet, but even a marginal increase in lethality, or a one or two per cent increase in number that end up with severe Covid would tip the balance to disaster in many countries where Covid is already peaking.”

Our best guess

The good, bad and ugly are crude themes to build scenarios round. 

Our guess is we will land somewhere between the good and the bad, with events like the weather and further significant mutations impossible to predict. 

A return to normality by Easter seems optimistic given the scale of the current UK surge and difficulties securing and distributing vaccines. It seems more likely it will be mid-summer before all the country’s 25 million most vulnerable are inoculated.  

It also seems likely that the vaccines will provide at least some protection against transmission, meaning herd immunity to current strains could be possible within 12 to 18 months in some parts of the world.

If developed nations see a return to normality towards the end of 2021, the developing world will hopefully start to recover by the end of 2022.

But there’s an obvious caveat: SARS-CoV-2 has a proven capacity to surprise.

Protect yourself and your family by learning more about Global Health Security

Our goal is to create a safe and engaging place for users to connect over interests and passions. In order to improve our community experience, we are temporarily suspending article commenting