The "cost" of COVID-19

Tackling COVID-19 is a major economic issue

Spring is here which is a good time to reflect on how the winter season for Covid-19 infections has been and what we should think about to mitigate the harms of Covid-19 in the future. This article draws on an article I published in the Guardian earlier this year but focuses more on the economic considerations and a recent publication.

The non-standard model for determining who gets COVID-19 vaccines

Recommendations for eligibility for the spring booster campaign for COVID-19 were announced earlier this year alongside a statement of future intent for these vaccines. It is the statement of intent I want to focus on. Last year saw a much reduced offer contrasting with previous years and it seems likely that the autumn 2024 vaccine roll out will further shrink. The committee used a “bespoke, non-standard method of cost-effectiveness assessment” to calculate eligibility versus costs benefit analysis and it seems more focus on this model will be used to inform priorities moving forward.  However, full details of this cost benefits analysis are not available and we remain to see the full detail. Reading between the lines, modelling likely employs and refines the approach used in autumn 2023.  Not to belittle just how much important and voluntary work the Joint Committee for Vaccination and Immunisation do and any budgetary constraints they face regarding vaccine rollouts, it would be invaluable to have much greater transparency at costing considerations for others to better understand the rationale.

Access to COVID-19 vaccines for kids

The major considerations, unsurprisingly, informing the current COVID-19 and influenza booster plans appear to centre on risk of hospitalisation from severe infection or death. Older people and clinically vulnerable people have been consistently most at risk. Clearly, severe disease is a major and important consideration but should other factors be considered? For example, it is unclear whether children will be amongst those eligible for vaccines in Autumn 2024 but this seems unlikely given the vaccines are likely to be given to fewer eligible people. A recent study on in Scandinavia showed vaccines reduced adolescent hospitalisations by 70%. Children can also develop long term impacts from COVID-19 infection. Vaccines for children in the UK were only given a limited offer and are no longer widely available unless clinically vulnerable. As such, it seems likely this position will hold. In contrast, most other countries recommend vaccination for children making the UK an outlier.

This leaves questions regarding booster availability. We may dread getting boosters but for infections such as COVID-19 and flu, boosters are important to account for waning immunity and changes in the virus that affect immune recognition.  Most adults in the UK under the age of 65 will be 1 or more years away from their last booster- NB data below is from March 2023.  As such, the role of so-called hybrid immunity (a combination of infection induced protection following vaccination) is being given greater consideration.

Long Covid and its costs.

What this means for most of us is that we will have to rely on the misery of catching COVID-19 to top up immunity. For many of us, infection necessitate days off as it can cause pretty unpleasant symptoms. Data from the REACT Study that tracked COVID-19 infections in adults in England showed that most people’s symptoms lasted around 10 days.  Not all of those symptoms will necessitate time off work as guidelines have changed on COVID-19 isolation requirements. However, that could be a lot of days off for lots of people resulting in economic implications. Indeed, there have been multiple governmental campaigns to try and reduce sick leave and encourage people back to work. 

Avoiding misery and time off work is only part of the economic picture that COVID-19 wreaks. Around 65 million individuals worldwide are estimated to have Long Covid (symptoms persisting 4 or more weeks). Vaccination is protective against developing Long Covid  and consequently the risk of developing Long Covid has reduced but new cases are still developing and being diagnosed so there is uncertainty about durability of prior vaccine induced protection. People with Long Covid have their lives affected significantly impacting, amongst many things, their ability to work.

In the UK, since the beginning of the pandemic, economic inactivity due to long-term sickness. New economic analysis reveals that if the 1.6 million working-aged people with Long Covid struggle to work this could have huge impacts on their household income and consequentially expenditure. As such, Long Covid could be a long-term drag on economic growth as well as adding pressure to already strained NHS. The cost of healthcare provision too for people with Long Covid is high and only increases over time - a huge cost for NHS with estimates about £4.2 billion per year. Based on the assumption that there are no long-term healthcare funding commitments to manage Long Covid, modelling estimate that Long Covid is likely to reduce GDP by around £1.5bn each year. Were prevalence of Long Covid to double (say due to waning immunity) this economic cost could be even worse and could considering the current UK fiscal environment could mean other public services suffer consequently.

Taken together it would seem that economic considerations of COVID-19 might be important to consider however, neither living with long Covid nor the economy appear to be considered in the costs benefit analysis of vaccination. Until we truly understand how we can protect against their being further cases of Long Covid then this seems a glaring omission for costing considerations.

The kicker- throwing away vaccine supplies.

The UK negotiated the purchase of millions of doses of Covid vaccines to be delivered in stages between 2021 and 2024. Vaccines were purchased under this agreement on the understanding that there would be sufficient coverage for people over the age of 50 and other clinically vulnerable groups. With the vaccine offer narrowing and low uptake in certain groups, there is an excess of unused vaccines that will expire shortly. It has been estimated by UK HSA that they expect to write off £229m of vaccines that won't be used that we are committed to buy, or already hold. It is unclear whether this value was considered when determining the cost/benefit analysis as to which age groups to offer vaccines to. If we were going to throw vaccines away, why not expand the age groups eligible?

Vaccines for those that can afford them.

There is some good news for those in the UK wanting COVID-19 vaccines as they can look to buy one later this year at an estimated cost of £45. The cost of vaccinating a whole family against COVID-19 could therefore quickly spiral into hundreds of pounds. We are in a cost-of living crisis with many struggling to afford to eat or heat their houses. In the UK, around 5.7 million low-income households have cut down or skipped meals because they don’t have enough money for food and the UK currently has amongst the highest rates of child poverty.

People who are poorer tend be in more insecure work and most at risk via their occupations of contracting COVID-19 so would benefit significantly from vaccination. However, vaccine uptake is reducing in many groups including people facing socioeconomic challenges. There can be many reasons for not taking vaccines including low trust and convenience of vaccine access but should cost be one of them? Are we moving to a place where vaccines become the preserves of those that are wealthiest? Vaccines should be there to protect everyone- not just the wealthiest.