The Economist - USA (2020-11-28)

The EconomistNovember 28th 2020 Britain 51

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L

ots of spaceand vinyl flooring—that is

what local directors of public health

want. “The last time you went into an nhs

appointment...the floor would have been a

certain type of splash-proof vinyl in case

you bled all over it or threw up,” says one. It

is the sort of floor a mass vaccination cen-

tre requires.

The search for suitable venues has just

become more urgent. On November 23rd

the Oxford/AstraZeneca vaccine team an-

nounced positive results (though there are

some concerns about the data—see Science

section). A cheap, transportable vaccine

wouldbegoodnewsfortheworld.It would

alsobegoodnewsforBritain,andnotjust

becauseit wouldbetheproductofa British

universityandanAnglo-Swedishfirm.

The government has ordered 40m

dosesofvaccinefromPfizerand5mfrom

Moderna,thetwootherfirmstohavean-

nouncedphase-three-trialresults.Bothre-

quiretwodosesperperson.Ithasordered

100mfromAstraZeneca,whichmayneed

justone-and-a-half.Ifallareapproved,the

AstraZenecavaccinewouldthusaccelerate

thecountry’sjourneytoherdimmunity.

ThatapprovalisinthehandsofBritain’s

medicinesregulator,themhra, whichis

reviewingdatafromallthreefirms.Astra-

Zeneca hadplanned tohave 30mdoses

readybySeptember;itmissedthattarget,

butisexpectedtohavetensofmillions

readywhenapprovalisgranted.Oneinsid-

ersaysthehopeistodeliver5mjabsa week

bymid-January.

The Joint Committeeon Vaccination

andImmunisation,whichadvisesthegov-

ernment,hasdrawnupa prioritisationlist,

withcare-homeresidentsandworkersat

the top, followed by the over-80s and

health-careworkers.Themhrawillproba-

blyatfirstofferanemergency-useauthori-

sation,whichmayrestrictvaccinationto

themostat-riskuntilmoreevidenceisin.

TheBritishstate’slacklustreresponse

tothecovid-19pandemicprovidesplenty

ofreasonfortrepidationabouttheroll-out.

Butunlikethetestingprogrammeortrack-

and-trace,theNationalHealthServicewill

berunningthings,removingtheneedto

set up a leadership structure and local

organisationfromscratch.

Itisnotanentirelynewexerciseforthe

healthservice.Britaindishes out nearly

15mflujabsa year.Theneedtostorethe

Pfizervaccineat-70°Climitstheroleof

general practitioners (gps) who deliver

much of the flu campaign, since few sur-

geries have sufficiently icy freezers. But the

AstraZeneca vaccine can be kept at 8°C.

Around half of the vaccines will be de-

livered in the community, the other half in

mass vaccination centres. They will spring

up in places like hospitals, sports halls and

universities. Paramedics, physiotherapists

and student medics will be called upon to

staff them. So, too, may vets, dentists and

trained volunteers, for whom the govern-

ment has tweaked human medicines regu-

lation to allow them to administer jabs.

All of this is a big ask for the nhsat a

time of year when it is normally most

stretched. This year’s expanded flu vaccine

campaign suffered from distribution pro-

blems. gps are in discussions with nhs

leadership about what parts of their job can

be put on hold to allow them to focus on

vaccination. “We would want to protect pa-

tient-facing services,” says Steve Mowle of

the Royal College of General Practitioners.

Perhaps the biggest challenge will be

theitsystem.It willneed to contact people

attherighttimefortheir first and second

jabs,and to integrate information with

medicalrecords.This is important, says

PennyWardoftheFaculty of Pharmaceuti-

calMedicine,a professional body, so that

analystscantrawltherecords for unidenti-

fiedsideeffects.Notall are optimistic. A

scientistadvisingthe government says he

cannotthinkofanything since the start of

thepandemic“where we relied on digital

supportandit happened in a timely way”.

Ina programmeofthis scale, things will

almostcertainlygowrong. But if enough

goesright,thereisa glittering prize on of-

fer.Byspring,vaccination and increased

testing“shouldreduce the need for eco-

nomic and social restrictions”, in the

wordsofBorisJohnson. “We should be able

torenderobsoletethe very notion of a co-

vid-19lockdown.”^7

The vaccine roll-out should go better

than the pandemic management

Covid-19 vaccines

Emergency exit

Arming the nation

potholes. Rishi Sunak, the chancellor,

needs shovel-ready spending opportuni-

ties to justify his claim in the spending re-

view on November 25th that “we’re priori-

tising jobs”. Potholes are ready and waiting

for those shovels—hence his commitment

that £1.7bn would be spent this year.

Innovation should help get the job

done. Rubberised asphalt is spreading

across the nation’s roads. Adding shredded

tyres to the bitumen used to make asphalt

creates an elasticity that helps it mould

into the existing road and stops it breaking

down as easily. Tarmac, a materials com-

pany, is supplying it to several councils.

Sheffield council is trying out a simpler

version, designed by another company,

Roadmender Asphalt. Cumbria is experi-

menting with recycled plastic as a bitumen

substitute, and in Oxfordshire and Kent

“Gipave”, a material made from adding a

graphene-based additive to asphalt, is be-

ing used to resurface entire roads. It is

15-20% more expensive than asphalt but

has twice the lifespan.

Repair design may help, too. Potholes

are normally repaired by cutting squares

out of the asphalt around them, but corners

encourage water ingress, so Roadmole, a

small road-repairing firm, produces a re-

motely controlled machine that cuts circu-

lar holes instead. The firm claims that none

of the potholes they have fixed in the past

eight years has needed to be redone.

In order to innovate, councils need

cash. David Renard, the lga’s transport

spokesman, says the government’s bung

will help fix the backlog. But the supply of

candidates for repair never dries up. Back

in Worthing, Mr Smytherman says that his

celebrated pothole is beginning to reap-

pear. Another party looms. 7

Verging on dangerous