The government should be wary of over-promising on vaccinations

The UK has made an impressive start to its vaccination rollout, which ministers have been quick to compare favourably with other countries. It is only natural that they should want to offer the public optimism that vaccines are coming in an otherwise grim winter. But the line between optimism and false hope is a fine one, and ministers need to tread it carefully. There are big risks if they once again over-promise and under-deliver – and they should be careful to manage public expectations.

Ministers are right to be ambitious – and it is reasonable for them to take some risks

Rapidly securing large volumes of the first vaccines available has allowed the UK to make a very fast start. Those responsible deserve credit. Kate Bingham – a venture capital manager experienced in biotech, appointed to head the Vaccines Task Force last May – has at times courted controversy. But her portfolio strategy, backed by ministers, has put the UK in a great position.^[1]

Building on this success, the government has announced plans to expedite the rollout. It said it will offer vaccinations to all of the top four groups – covering care home residents and workers, health and social care workers, everyone over 70 and the clinically extremely vulnerable – by mid-February; to the remaining five priority groups by mid-April; and to every adult in the country by the autumn.

These are very demanding targets. Meeting them will rely on every part of the machine – from a complex supply chain through to distribution and deployment – working smoothly as it picks up pace rapidly. Any problems – such as those Pfizer experienced scaling up its production late last year – could hold up progress, and the government is gambling that there will be few bumps in the road.^[2] Taking some risks is reasonable given the present situation, but ministers should wary of optimism tipping over into something else.

Over-promising or appearing reckless could harm the rollout

Throughout this crisis, the government has repeatedly over-promised and under-delivered – from the “world-beating” test and trace service to the vaunted return to normality by Christmas. Repeating this trend with the vaccination schedule would be hugely damaging.

The programme depends on the public trusting that vaccines are safe and will be deployed safely – already a big task, with concerns about vaccination prevalent in some poorer and black and minority ethnic communities. The government’s last-minute decision to change its dosing strategy was arguably reasonable, but it was nevertheless confusing and requires careful explanation.

Ministers need to avoid the sense of being desperate to accelerate vaccinations at all costs after all other efforts to control the virus failed. Reports of people being exposed to coronavirus while queuing to receive a shot will not help. Jeremy Hunt, the former health secretary, also warned in the Commons yesterday of “public expectations running well ahead of the system’s ability to deliver” with GPs receiving “floods of calls”. Such confusion could easily lead to disillusionment.

A better communications strategy than seeking headlines with bold claims would be to slowly build confidence in the functioning of the system through results and prepare people for potential bumps along the way. This would be more aligned with a continuing emphasis on adherence to restrictions and would allow ministers to be more upfront about uncertainties, like how vaccines will react to current and future mutations.

Ministers need to ensure targets encourage the right behaviour

Ministers may argue that focusing attention on big, challenging targets has other benefits in jolting the machinery of state into action. But it also risks distorting behaviour. Last spring, the 100,000 tests a day target led to a rapid increase in capacity but also much dubious counting, rather than focus on where tests would be most beneficial.

Focusing on one number – the amount of people offered vaccinations in the top four groups – will create incentives to drive that number up, rather than focusing on the highest priority groups.^[3] Without effective coordination, it could lead to a confusing deluge of offers, or people being invited to travel a long way unnecessarily. It could put further pressure on exhausted frontline health workers, or push vaccination sites to focus on speed rather than safety.

There is also a risk of gaming. It is unclear what exactly constitutes a vaccination being offered and who is being counted, for example there are questions about bank and agency nurses and unpaid carers.

As these questions are debated in coming weeks, the government will need to avoid appearing to cut corners and ensure its rollout is safe and orderly – and is seen to be so. It will also need to publish better data, including about who has been vaccinated (broken down by age, ethnicity, local authority) and where vaccinations are not being taken up. Currently, it is only publishing headline figures while other countries, such as Israel and Germany, are releasing detailed breakdowns.^[4]

Vaccinations could be the UK success story to emerge from the coronavirus crisis, and the government has earned the right to offer people some optimism. However, by giving assurances on approaching sunny uplands now the government has given itself little margin for error in the journey to get there.