A video clip of an unvaccinated doctor challenging the health secretary over the government’s plan to make NHS staff have a Covid jab – or risk losing their job – has been viewed more than a million times on social media.
Making vaccination a condition of employment already applies to care-home staff and, from 1 April, is being extended to NHS workers – about 90% of whom are already vaccinated.
Dr Steve James – a critical care consultant who has chosen not to be vaccinated – told Sajid Javid, during the health secretary’s visit to King’s College Hospital, “the science isn’t strong enough” to support the policy.
“The vaccines are reducing transmission only for about eight weeks with Delta,” he said.
“For Omicron, it’s probably less.”
But that’s not exactly what the evidence shows.
“On the internet, when things go viral, people tend to cherry-pick what they want.”
What does the science say?
While vaccines remain very good at protecting against becoming severely ill with Covid, the protection they give against catching it and passing it on does wane more quickly.
Dr James was referring to a study that found a vaccinated person with Covid was just 2% less likely than an unvaccinated person to pass it on, 12 weeks after a second Oxford-AstraZeneca jab – he acknowledges his reference to “eight weeks” was an error.
But the same study found the Pfizer-BioNTech vaccine, which NHS staff are likely to have had, endured better. Vaccinated people had a 25% lower risk of infecting others than unvaccinated people after 12 weeks.
And this research alone doesn’t tell the whole story – the vaccines also reduce people’s risk to others by stopping them catching the virus in the first place.
One paper found those vaccinated with Pfizer 85% less likely than the unvaccinated to be infected with Covid after two weeks and 75% less likely after 12 weeks.
Vaccinated people also seem to clear the virus faster and have less of it in their system – reducing their chances of passing it on.
These studies all looked at the Delta variant, first identified in India.
Two vaccine doses appear to be less effective against catching and passing on Omicron infections – although, they are still good at preventing severe illness – but much of the benefit is restored with a third booster jab.
What else did the doctor say?
The second part of Dr James’s argument was that he had probably had Covid, providing him with some protection without a vaccine.
“I’ve got antibodies,” he said.
“I’ve been working on the Covid [intensive-care unit] since the beginning.”
So-called natural immunity – having immune cells such as antibodies and T-cells in your system that recognise and fight off the virus from an infection rather than a vaccine – can offer effective protection, although it comes with the risk of becoming very ill or developing “long Covid”.
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But what the doctor didn’t mention is that, as with his point about vaccines, this protection also wanes and may be ineffective against infection with a different variant.
An Imperial College London study suggests the protection from having had Covid against infection by the Omicron variant, first identified in South Africa, “may be as low as 19%”.
The best protection against Covid comes from having an infection and being vaccinated too, several pieces of research have found.
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Dominic Wilkinson, a professor of medical ethics, at the University of Oxford, says doctors have a clear ethical duty to be vaccinated but sacking someone who is not but can show they have had a recent infection that may provide similar protection may be unjustifiable.
If the vaccines completely blocked transmission, it would be a much simpler question, he says.
But since they are less effective against new variants, it is “no longer as clear”.
What was the reaction online?
Dr James says he is not against all Covid vaccination but feels he was framed as such online, after opposing compulsory jabs.
He describes himself as “pro-choice and pro-vaccine”, saying his point was specifically about the science behind the mandate not the vaccine itself.
But another NHS hospital doctor, Dr Meenal Viz, who spends her spare time online correcting misinformation, told BBC News she feared the clip of Dr James would be seized on by those who wanted to suggest the science for the vaccine in general was not strong enough – despite the huge weight of evidence from hundreds of independent institutions and millions of people that it prevented disease and death.
This fits into a pattern she regularly sees online, where short clips, single statistics or lines from a scientific study taken out of context can “completely blow up” and cause more confusion than straightforward falsehoods.
“On the internet, when things go viral, people tend to cherry-pick what they want,” Dr Viz said, potentially leaving people with the impression an intensive care doctor was doubting the science of the vaccine, rather than the much narrower and more complicated point Dr James says he was making.
And her fears were not misplaced.
Dr James’s comments were eagerly seized on by those against vaccination, including some promoting false theories such as the virus is a hoax.
BBC News also found it referenced in more extreme encrypted chat groups, including one used to organise removals of sick patients from hospital against doctors’ advice and coordinate the serving of bogus legal writs accusing doctors and teachers of crimes against humanity.
But Dr James stands by his comments: “If people wish to polarise, they will do that,” he says.