July 19, 2021

expert reaction to statement from Boris Johnson that from September, full vaccination is planned to be a condition of entry for nightclubs and other venues where large crowds gather

At the Downing Street press conference today, Boris Johnson announced that 2 COVID-19 vaccine doses is planned to be a condition of entry for nightclubs and other venues where large crowds gather in England from September.

Dr Pauline Paterson, Co-director of The Vaccine Confidence Project, and Assistant Professor in the Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, said:

“Not allowing unvaccinated people into nightclubs and events is not the way to increase vaccination coverage.  This risks further entrenching the views of those that already having concerns about vaccination, rather than alleviating them.

“A survey of 17,000 adults conducted by the Vaccine Confidence Project in April found that vaccine passports would likely lower inclination to accept a COVID-19 vaccine for those that are undecided (available by pre-print).

“Even health and social care workers who felt pressured by their employers to vaccinate were less likely to, in a study we conducted, as part of the Health Protection Unit in Vaccines and Immunisation (also available by pre-print).

“Those that are currently hesitant are unlikely to be swayed by this new policy decision.  Vitally it is not possible to have informed consent under duress or coercion.  This policy also risks increasing stigmatisation and segregation.

“Coerced vaccination may not even increase coverage as evidence suggest those unsure will be less likely to vaccinate if passports became a requirement.  It will likely also reduce vaccine confidence, and so potentially reduce acceptance and therefore long term protection further down the line.  Ideally it is key to identify reasons for non-vaccination, acknowledge any concerns and design evidence-informed responses.

“Research has shown that enforcing a vaccine policy by placing social or economic sanctions on those that choose not to vaccinate increases hesitancy and mistrust in the very vaccines the policy is intended to promote.

“If you were offered to take a blue pill, and were told you were not allowed to go out with your friends unless you took it, would you trust it more or less?”

Prof Rowland Kao, the Sir Timothy O’Shea Professor of Veterinary Epidemiology and Data Science, University of Edinburgh, said:

“This announcement reflects some of the difficult choices ahead of us – how to open up activities that are important to us, our social well being and the economy, while trying to minimise additional COVID transmission risks.  While such a move would certainly reduce risks to individuals, vaccinated individuals are still at a substantial risk of becoming infected especially with the delta variant, and even though there is good evidence that all our vaccines are currently providing good protection against severe infection and hospitalisation, we do not yet know the extent to which they may transmit to others.  Thus without other measures, places where people gather indoors in large numbers at close quarters will likely remain places where superspreading events can occur, with potentially many spillover infections into the broader community, where some individuals will remain at high risk of severe illness.

“Continued caution more generally e.g. on public transport, including some measures of physical distancing (particularly those that do not interfere with other aspects of opening up the economy, such as mask wearing) could go some way to mitigating those risks.  As always, efficient test and trace and support for persons who should isolate would be critical parts of keeping COVID numbers down. ”

Dr Peter English, Retired Consultant in Communicable Disease Control, Former Editor of Vaccines in Practice, Immediate past Chair of the BMA Public Health Medicine Committee, said:

“The lower the volume air per person is, the more risky the venue is, and the greater the need for very thorough ventilation.

“The louder the noise, the more people have to shout to communicate; and louder speech, singing and shouting project more (potentially infectious) droplets and aerosol into the air, increasing the risk of transmission.

“Many nightclubs are noisy, crowded, and in small-volume spaces, and thus particularly high-risk for transmission.

“This risk is further exacerbated given that (as we prioritised highest risk people first, and have been moving down the age groups) younger people are less likely to be fully vaccinated.

“Outdoor venues where loud music is played are, of course, much safer.

“It would have been far preferable to keep indoor nightclubs closed until disease incidence (the number of new cases per day) is much lower and decreasing.

“Vaccination is not a foolproof way of preventing infection and transmission; but it does reduce the risk.

“Given that the government has not heeded the advice to keep nightclubs closed, requiring vaccination certificates may help reduce the risk.  Full vaccination is necessary to prevent the prevalent delta variant – at least two weeks since the second dose of vaccine.  Of course, vaccination certificates will need to provide proof of full vaccination in a way that cannot easily be forged.”

https://www.gov.uk/government/speeches/pm-statement-at-coronavirus-press-conference-19-july-2021

Declared interests

Dr Peter English: “Dr English is on the editorial board of Vaccines Today: an unpaid, voluntary, position.”

None others received.