By Natasha Hakimi Zapata
In These Times, March 30, 2021
LONDON — Dr. John Lister watched in horror as the United Kingdom’s Covid-19 mortality rate climbed above 1 per 1,000, one of the highest death rates in the world since the start of the pandemic. So, when the 71-year-old Briton was informed he would receive the Oxford-AstraZeneca vaccine in late January, he could hardly contain himself.
“It was a great moment of excitement when I got the notification,” Lister tells In These Times.
Lister, a health policy expert and associate professor at Coventry University, was one of 15 million people in the United Kingdom to receive a Covid-19 vaccine before February 15, thanks to a vaccination program that has consistently ranked among the three fastest in the world. As of mid-February, the U.K. government’s tiered plan had succeeded in vaccinating roughly 80% of its healthcare workers and more than 90% of nursing home residents and people older than 70. These groups represent 88% of the country’s Covid-19 deaths and make up roughly a fifth of its population of just over 68 million.
This development marks a turning point in a pandemic response once described as “a string of failures,” which has left more than 100,000 people dead. While Prime Minister Boris Johnson has met the U.K. government’s benchmarks, the real triumph belongs to the National Health Service (NHS), the universal healthcare system of more than 1,000 hospitals that spans England, Scotland, Wales and Northern Ireland.
Founded in 1948 in the wake of World War II, the NHS was the jewel of the Labour Party’s social welfare state, the first of its kind in the West. Despite decades of efforts from conservatives to privatize the NHS, its three basic principles have endured: that treatment is free at the point of service, available to everyone (including non-residents) and publicly funded. The NHS vaccination program has been arguably the West’s greatest success story: By February 15, 22% of the U.K. had received a first dose compared with 11% in the United States.
Even before it began jabbing the public, the NHS had built the infrastructure for a rapid vaccine rollout. “Our system is pretty unique,” says Lister, co-founder of Health Campaigns Together, a broad coalition working to protect the NHS from cuts and privatization. “Because everybody is covered by the NHS, we have this database [that allows us] to identify risk factors in a way that no other country is able to do.”
The private-sector parts of the U.K. response, meanwhile, have failed to achieve results. Hundreds of millions of pounds have been squandered on “unusable” or otherwise inadequate personal protective equipment, and the outsourced contact-tracing failed to have its intended effect. Dr. Tony O’Sullivan, co-chair of advocacy group Keep Our NHS Public, says the decision to outsource contact tracing “led to a failure to rely on tried and tested systems that were in place with the National Health Service [based on] the cooperation between hospitals, primary care [physicians] and local [government].”
While vaccination rates in the United States are increasing, with President Joe Biden promising “enough vaccine supply for every adult in America by the end of May,” the rollout looks haphazard by comparison. As of early March, the U.S. Centers for Disease Control and Prevention reported just 27% of those 75 and older had received a first dose. For those 65 – 74, it was 28%.
Dr. James Kahn, a professor of epidemiology and biostatistics at the University of California, San Francisco, attributes the trouble in the U.S. rollout to the “highly variable and disorderly” distribution of vaccines. A New York Times report from February 19 finds some states had been stashing up to 6 million doses, while other states struggled to obtain enough for their most vulnerable residents.
Dr. Steffie Woolhandler, who works alongside Kahn at the Physicians for a National Health Program — an organization of more than 20,000 health professionals advocating for single-payer healthcare — believes a centralized health database (like the one the NHS maintains) could have prevented these problems. Woolhandler is also quick to praise another aspect of the U.K. rollout: Primary care physicians contact their patients directly and can review their personal health records, as well as help assuage any concerns about the vaccine.
“Everyone having longstanding access to medical care means that, when an emergency comes up, you can mobilize that access and get everyone in,” Woolhandler says. “It’s more than just a list of names and phone numbers; it’s actually a set of relationships.”
Maryland-based pediatrician and healthcare advocate Dr. Margaret Flowers ascribes the United States’ sluggish vaccine rollout to the country’s “disjointed” healthcare system and decades of underfunding for public health infrastructure. Online registration portals, Flowers says, are often inaccessible to Black and Brown communities who have been disproportionately impacted by Covid-19. The closure of more than 120 rural hospitals since 2010 has made it difficult for local residents to reach vaccination sites. And several private institutions have offered wealthy donors doses ahead of the most vulnerable people.
Whereas the FBI, the Food and Drug Administration and Interpol have each issued warnings about Covid-19 treatment and vaccine fraud schemes in the United States, the NHS offer of free service at point of care has inoculated the country against this kind of profiteering. “If anybody is offering to sell you the vaccine,” explains Lister, “they’re a crook.”
Now, as every adult in the U.K. is being promised a first shot by the end of July (depending on supply), Lister says one thing is clear: “What [the NHS vaccine program] really does is prove the superiority of the universal health care model.”