A quick thread on the Chief Medical Officers' Advice to Ministers on Jabs for the Over-12s.

Not about the science, but about the (complex) relationship between decision-makers.

The Advice is here:
huffingtonpost.co.uk/entry/chris-wh… 1/10
The Advice shows that there are 4 levels of decision-making involved. The key point is that, at each stage, as more factors are taken into account, the policy recommendations and prescriptions may differ. 2/10
First, the MRHA has the task of determining whether a vaccine is safe and effective, and whether to grant a licence. Their assessment, which is taken as read by the CMOs, was that benefits exceed risks. 3/10
Next, the JCVI gives advice on how to deploy a vaccine which has a favourable MRHA risk-benefit decision.

It decided that the overall benefit was 'small' or 'marginal' for healthy 12-15 year olds - and not sufficiently large to recommend universal vaccination. 4/10
But, the JCVI opened the door for the CMOs to, 'exceptionally', consider 'wider issues', such as the impact on education. 5/10
The CMOs start from the individual benefit-risk calculations by the MHRA and JCVI. They do not revisit these.

Instead, they broaden the scope of the JCVI analysis, to consider 'indirect benefits', focusing on educational disruption. 6/10
They conclude (at 22) that the additional likely benefits (mainly from reducing educational disruption) provide 'sufficient extra advantage in addition to the marginal advantage at an individual level identified by the JCVI to recommend in favour of vaccinating'. 7/10
But, just as the JCVI left the door open for the CMOs, the CMOs leave the door open for Ministers.

The CMOs make it clear (at 12) that their advice 'is purely clinical and public health derived'. 8/10
They are clear that they have not taken issues 'outside their remit' into account.

And they say that there is a 'subsequent political process where wider societal issues may be considered by Ministers'. 9/10
The process seems complex, and it is, I fear, likely not to be well understood.

While the advice letter sets out the various decision-makers' remits clearly, I do wonder about how well it will all be understood. 10/10

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