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January 2021

Herd immunity may not be possible even with high vaccine uptake

 The coronavirus vaccination programme may not be sufficient to achieve herd immunity – even if everyone in the UK is vaccinated – according to new research from the University of East Anglia.   

Researchers modelled the effectiveness of UK-wide immunisation programmes using the Oxford and Pfizer vaccines, taking into account the highly transmissible new COVID-19 variant.  

They found that the only way to reach herd immunity for the UK would be to vaccinate almost everyone – including children – with the more effective Pfizer or Moderna vaccines.  

The study recommends that all health and social care professionals should receive the 95% effective Pfizer or Moderna vaccines to prevent asymptomatic spread to patients and vulnerable people. 

Due to the rapid response nature of this research it has not yet been peer reviewed. 

COVID-19 expert Professor Paul Hunter, from UEA’s Norwich Medical School, said: ‘Getting vaccinated has a huge benefit to [individuals] personally. It greatly reduces the risk of serious illness and reduces your risk of symptomatic disease by an estimated 70 per cent for the Oxford vaccine, or 95 percent for the Pfizer and Moderna vaccines.  

‘But we wanted to find out whether herd immunity is a realistic outcome of any immunisation programme with the main vaccines licenced in the UK given that immunisation, even though it can reduce illness, may not prevent all infections.  

The research team used mathematical models of COVID-19 transmission and vaccine efficacy to predict how well the Oxford and Pfizer vaccines will work to bring the R number down and achieve herd immunity. 

They initially found that 69% of the population would need to be vaccinated with the Pfizer vaccine, or 93% of the population with the Oxford vaccine, to bring the R number below one. 

However, when they took into account the new more transmissible Covid-19 variant, they found that vaccinating the entire population with the Oxford vaccine would only reduce the R value to 1.325. Meanwhile the Pfizer vaccine would require 82% of the population to be vaccinated to control the spread of the new variant.  

Mathematical modeller Professor Alastair Grant, form UEA’s School of Environmental Sciences, said: ‘The Oxford vaccine reduces the incidence of serious illness to a greater extent than it reduces symptomatic illness, which is still common in those who have had this vaccine.  

‘Its efficacy against the incidence of asymptomatic infections is lower, reducing its efficacy against all infection from 70.4% to 52.5%  for the pooled data. This means that its overall protection against infection is only partial – around 50%. 

‘This combination of relatively low headline efficacy and limited effect on asymptomatic infections means that the Oxford vaccine can't take us to herd immunity, even if the whole population is immunised.  

‘Vaccinating 82% of the population with the Pfizer vaccine would control the spread of the virus – but it isn't licenced for use on under 16s, who make up 19 per cent of the population.’  

Professor Grant added: ‘Also, some people will refuse the vaccine, so achieving an 82 per cent vaccination rate will likely be impossible. In the absence of vaccination, herd immunity would only occur when 89% of the population has had the virus.’

A ‘substantial fraction’ of those who have been vaccinated or have had a natural infection can still become infected and pass the virus on others. 

Professor Grant said: ‘For this reason, we recommend that health and social care workers, and others who have lots of contacts with those vulnerable to infection, should receive one of the mRNA vaccines in preference. 

‘The Oxford vaccine will no doubt be an important control intervention, but unless changes to the dose regime can increase its efficacy, it is unlikely to fully control the virus or take the UK population to herd immunity.” 

Professor Hunter added: ‘If we cannot achieve herd immunity, vulnerable unvaccinated individuals will remain at risk. We do need to consider how best to protect these individuals when social restrictions are eventually relaxed as the result of a successful vaccine roll out programme.’ 

‘Immunisation, asymptomatic infection, herd immunity and the new variants of COVID 19’ is published on the MedRxiv preprint server:  

Practice Nurse 2021;51(1): online only, 26 January 2021