Vaccine hesitancy could be behind rise of the Indian Covid variant

·6 min read
A sign in Bolton, Lancashire, which has seen a rise in Indian variant cases, offers people a Covid jab without the need to make an appointment - Oli Scarff/AFP via Getty Images
A sign in Bolton, Lancashire, which has seen a rise in Indian variant cases, offers people a Covid jab without the need to make an appointment - Oli Scarff/AFP via Getty Images

The Indian Covid variant has been linked to just four deaths in Britain so far, despite a surge in cases.

Yet some experts believe the signs are worrying enough to pause the lockdown release until the virus mutation can be brought under control.

So what is driving its spread, should we be concerned – and will vaccines still be effective?

Virus profits where uptake of jabs is lower

It is noteworthy that many of the areas that have seen a recent upswing in cases have also suffered the highest levels of vaccine hesitancy.

In high vaccine uptake wards in Blackburn and Bolton, the average weekly Covid rate was 89 cases per 100,000 people. But in wards with a lower uptake – where more than one in five are refusing the jab – the rate increases to 261 cases per 100,000. On average, case rates are around three times higher in low vaccination areas.

Recent data from the Office for National Statistics (ONS) show that Muslims are less likely to agree to have the jab. While 93.2 per cent of Christians accepted a vaccine – the highest of any religion – 78.8 per cent of Muslims agreed to do so.

In areas such as Blackburn, where the Indian variant is taking hold, nearly one third of the population is Muslim. The Government has been working with Imams to increase trust in the vaccine programme.

How dangerous is the Indian variant?

There are three versions of the Indian variant in Britain, and it is B.1.617.2 which is spreading quickly. This version carries a mutation on the spike protein, which the virus uses to latch onto human cells, and the change may help it spread more easily.

However, it is missing a different mutation carried by the South African variant, which allows it to evade immunity from an infection or vaccination.

Latest data from Public Health England (PHE) shows four people have died after testing positive for the Indian variant so far, a case fatality rate of 0.3 per cent. In contrast, the English/Kent variant has a case fatality rate of two per cent.

Although it may be too early to compare the death rates, experts say the Indian variant has been in Britain for long enough now to start causing a rise in hospital admissions if it was resulting in severe disease. Yet even in areas in which infection rates are rising, there has been no subsequent rise in admissions.

Prof Robert Dingwall, who sits on the joint committee on vaccination and immunisation, said: “Given that it’s typically seven days to symptomatic infection, the Indian variant has been around long enough for hotspot communities to be seeing a rise in admissions, but we haven’t seen any uptick. We have a rise in reported infections, but that does not seem to be translating into hospitalisations.”

However, reinfection rates are an area of concern. According to PHE, some 13 people – one per cent of all cases – have become infected with the Indian variant after already suffering a Covid infection, suggesting the mutated virus may be evading immunity. In contrast, just 0.2 per cent of people becoming infected with the Kent variant had a previous infection.

Yet the good news is that it appears that vaccination is keeping the Indian variant under control.

According to PHE’s Siren study, looking at healthcare workers, there is no sign of an increase in infection post-vaccination. Vaccinated medics in India also appear to be protected.

Figures also show that in hotspots such as Blackburn, the variant is spreading far more quickly in the under-60s, suggesting vaccination is protecting the older population. Lab studies suggest that, although it may be able to evade immunity slightly more than the Kent variant, it is not as good at doing so as the South African variant – and vaccines still work to some extent against that mutation.

Would a local lockdown and surge vaccination work?

On Thursday, Boris Johnson refused to rule out imposing local lockdowns in areas with a high number of cases.

However, areas in which the Indian variant is surging are not only associated with low vaccine rates but also deprivation and a high level of manufacturing and key worker jobs.

Analysis has revealed that workplace outbreaks are more likely to occur in manufacturing sectors and warehouses, so it is no coincidence that areas such as the West Midlands – which relies heavily on manufacturing jobs – remained in lockdown measures for much of last year, without a fall in case rates.

It suggests lockdowns are unlikely to make the situation better because many people are unable to work from home. While 57.2 per cent of Londoners can do their jobs from home, only 35.3 per cent in the West Midlands can, according to the ONS.

Experts are also concerned that surge vaccination will risk slowing down the overall programme and could pose a threat of allowing the variant to become established elsewhere.

Narrowing the gap between vaccinations from 12 weeks to eight could also prove problematic. A study by the University of Birmingham, published this week, showed the three-month gap increased antibody levels by three and a half times compared to a three-week gap.

What do the models say?

Modelling by the University of Warwick suggests the NHS is still in danger of being overwhelmed if the Indian variant is much more transmissible than the Kent strain.

A variant that is 40 per cent more transmissible could create a peak of 6,000 hospitalisations per day in August – far exceeding the January peak of 3,768. And if the mutated virus was 50 per cent more transmissible it would seriously hamper the ability of vaccines to prevent spread, leading to between 10,000 and 20,000 admissions per day, Warwick predicted.

The models say that even if the final lockdown release is delayed, hospitalisations in England would still reach between 5,000 and 14,000 a day, but experts warn there is huge uncertainty about the estimates and far lower peaks are possible.

Latest data from PHE suggests the Indian variant is at least as transmissible as and may out-compete the Kent variant. And while other variants have struggled to get a foothold, the Indian mutation had eclipsed the South African variant within 40 days of arriving.

Yet it is still in the minority. Across England as a whole, the Indian variant now makes up approximately 6.1 per cent of sequenced cases, while 91.4 per cent of sequences are still the dominant B.1.1.7. Kent variant.

Will the Government pause the roadmap?

Boris Johnson has consistently said the roadmap is irreversible and, having committed to lifting restrictions on May 17, it is unlikely the Government will U-turn now.

On Friday, Nadhim Zahawi, the vaccines minister, said there was currently no evidence that the Indian variant escapes the vaccines or is having a more severe impact on people.

And although there are a few pockets where infections are rising, latest data from the Office for National Statistics (ONS) show that overall infection rates are continuing to fall. In England in the week ending May 8, the ONS estimates around 40,800 had an infection, or one in 1,340 people – down from one in 1,180 the previous week.

Prof Dingwall said: “The Government needs to hold its nerve rather than allow itself to be pushed to measures that are unnecessary, demoralising and won’t work.”

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