Our oral closing statement highlights 5 key concerns - however, further details will be explored in depth in our later written submissions.
1: Therapeutics programme - wasn't good enough!
1/
The immunosuppressed were left behind.
2/
What could we have done better?
Dame Kate Bingham is an independent and trusted voice. She has no reasons to defend decisions on therapeutics that weren't the right ones.
3/
Bingham felt
"the government was following a very clear 2-tiered strategy, where CV immunocompromised patients were [.] deprioritised"
"[it] was manifestly wrong, both ethically and morally."
"We did not follow the [goal to] protect the whole population."
4/
It was *cheaper* to let those Clinically Vulenerable people shielding at home without an exit plan.
Then if they were infected to treat them with drugs [which they struggled to access].
5/
Chair of the Antivirals Taskforce, Eddie Gray, was frustrated with the funding approval process for oral antivirals - both the delays and the significantly lower purchase volume than recommended.
6/
Sir Sajid Javid said that by the time he took over, the focus was on vaccines, with less interest on antivirals.
Unlike vaccines, which had an almost unlimited budget, antivirals had no budget - purchase needed Treasury approval, where the clinical case was then questioned.
CVF is concerned that this masks the true picture.
Founder @lara_wong reminded us that some therapeutics, like Paxlovid, are unsuitable for many CV people due to interactions with medications they commonly take.
9/
We need a diverse portfolio of vaccines and antivirals for broader access.
No prophylactic (pre-treatment) has been purchased.
Had the same creativity and appetite for risk been applied to therapeutics as to vaccines, things might have been different.
10/
Sir Chris Whitty stated that antivirals are an area where we are much weaker compared to vaccines, antibodies, and antiparasitics.
He also mentioned there would be a "niche" benefit to the procurement of Evusheld... more on this to come!
11/
2: Access to Antivirals
The system to access therapeutics didn't and doesn't work.
It is significantly more restrictive than 'flu antivirals.
12/
If we can have take away food delivered in 20 minutes, why canβt we deliver life-saving medication just as fast?
13/
CVF reported that the antiviral triage system felt like the Goldilocks story. People were either:
β Too ill
β Not ill enough
Yet antivirals work best when given early, not delayed.
14/
Simply pre-flagging Clinically Vulnerable people would remove barriers and ensure faster, easier access to antivirals.
If we can get a curry delivered to our door in 20 minutes - we should be able to do the same for life-saving medication.
15/
3: Priority vaccination
Vaccination was a huge success overall.
However, many Clinically Vulnerable (Group 6) individuals faced significant confusion over their eligibility, risking them falling through the gaps in the system.
16/
Clinically Vulnerable people who donβt qualify for spring boosters will be blocked from accessing vaccines this autumn, stripping protection from millions who remain at risk from Covid.
17/
Vaccination centers were overcrowded and lacked proper ventilation.
Drive-thru centres were a great example of a safer alternative.
Improvements are essential to protect the Clinically Vulnerable - now!
18/
4: Children's Vaccines
The risk to children impacts Clinically Vulnerable households.
Media suggested children werenβt at risk, but some were - and some tragically died. Itβs vital to acknowledge this reality.
19/
There was a delay in decisions on children's vaccines. When offered, the message was vague and non-urgent, rather than engaging families.
This led to lower uptake and overlooked Clinically Vulnerable households. More consideration was needed.
20/
5: Evusheld
Evusheld was a missed opportunity for a very vulnerable group - the immunosuppressed.
We disagree with Sir Chris Whitty and JVT, who suggested it became less important once vaccines were effective. The reality is, vaccines didnβt protect them!
21/
Dame Kate Bingham said the vaccine rollout doesnβt protect those without an immune system.
Clive Dix cited *cost* as the reason Evusheld wasnβt purchased.
Chris Whitty called it "niche" use - but 1 in 38 people is hardly niche.
22/
Conclusion:
πTherapeutics poor relation of vaccines
πThe system for accessing antivirals doesnβt work
π Healthcare ventilation needs improving
π Vaccination of children = missed opportunity
π Evusheld = missed opportunity
23/
Theme:
πClinically Vulnerable were overlooked
πTheir needs underappreciated
πAnd voices not heard
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Clinical Vulnerability must be recognised under the Equality Act to embed their protection in law and decision-making, ensuring they are not relegated to the second-tier of a two tier system again.
25/
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"Would you support the development of a more diverse portfolio of vaccine formats and antivirals, both as part of future pandemic preparedness plans and during [.] 'peace time' to ensure that Clinically Vulnerable groups are adequately protected?"
1/
"Absolutely, I think it is really important to make sure that we have good therapeutics and vaccines for the whole population."
2/
Q - Why is it important to have that breadth of formats?
...not many [immunosuppressed] were involved in the initial trials.
We now know [.] that booster doses help in terms of vaccine efficacy.
π¨Dame Kate Binghamπ¨
Dubbed the "hero in a pink jacket π"
On Evusheld:
"I felt very strongly [.]. We were following a very clear 2 tier strategy where the CV immunocompromised were being deprioritised [.] I felt that was *manifestly* wrong both ethically and morally [.]"
1/π§΅
The above video was taken out of sequence. The below should give more context...
KB "So actually, the first goal was around protecting the UK population."
CTI [Hugo Keith KC]
"Do you think you succeeded on securing or making available those monoclonal antibodies?"
KB "No!" 2/
Kate goes on to make the argument that by not protecting this population, we were also promoting viral mutation and the evolution of variants.
π¨Clinically Vulnerable Families - closing
** Shared in full**
Thanks to the @covidinquiryuk staff & team
"The vast majority of people who died [.] were Clinically Vulnerable [.] including people who caught Covid-19 in hospitals, which were supposed to be places of safety."
1/
"Most urgently, we need to make healthcare safe for Clinically Vulnerable people."
"And by making it safe for them - by improving ventilation and putting in place other protective measures - we make it safe for others too."
2/
π‘Shielding
CEV people are a diverse group with varied personal circumstances.
It provided a passport:
π Right to work from home
π· SSP entitlement
π Food & medicine deliveries
π Priority vaccine access
"aging estates meant that infection control measures could not always be fully implemented."
- Large open bays
- Inability to distance
- Lack of side rooms for isolating patients
- Lack of ventilation
1/
"The inquiry proceedings have laid bare the catastrophic consequences that are destined to be repeated without fundamental change."
2/
"healthcare workers were at higher risk of contracting Covid-19."
"The Health and Safety Executive [failed] to challenge adequacy of the IPC guidance, to act on concerns raised by [the BMA], and to ensure that employers compied with their health and safety responsibilities."