John Grey, 84, receives the first of two doses of the Oxford/AstraZeneca Covid-19 vaccine, administered by Dr Michael McKenna, at Falls Surgery on the Falls Road, Belfast.
Credit: PA/Liam McBurney
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Vulnerable people suffering from rare diseases are being forced to wait for a coronavirus vaccine because of an algorithm used to determine the risks, according to a member of the expert committee that advises the health department.
The QCovid algorithm was used by the Joint Committee on Vaccination and Immunisation (JCVI) to identify who was most likely to die if they catch coronavirus and therefore who should be prioritised in the government’s vaccine roll out.
The Government currently gives vaccine priority to residents and staff in care homes. Next in line are those all those 80 years of age and over and frontline health and social care workers, followed by those 75 years of age and over. People who are clinically extremely vulnerable are to be vaccinated along with those who are 70 and over.
However, committee member Jeremy Brown, a professor of respiratory infection at University College London, said the QCovid algorithm was likely to underestimate the risk coronavirus poses to people suffering from rare diseases.
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"There are limits to the detail", said Mr Brown. "The data for cancers is grouped as all cancers rather than different cancers and it is quite likely that some cancers are much more of a problem than others."
He added that people who are suffering from rare illnesses and have been shielding successfully are also unlikely to show up in the data.
"I look after teenagers who have very severely damaged lungs having had a bone marrow transplants. I’ve got half a dozen in my clinic and they have protected themselves very effectively."
Because there are so few people suffering from this condition and even fewer have been infected with coronavirus, the algorithm will not be able to identify the risk they face, said Mr Brown.
"If you’re not exposed to the virus, we can’t work out whether you’re going to die from the virus or not."
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An algorithm is a set of rules a computer has to follow in order to make calculations using large amounts of data.
In the case of QCovid, which was developed by researchers at Oxford University, the algorithm uses six million GP and hospital records to create a "model" which calculates a person’s risk from coronavirus.
The algorithm’s author, Julia Hippisley-Cox, a professor of clinical epidemiology, declined to comment.
Algorithms have been controversial when used to inform policy. Last year, an algorithm used to grade A-levels sparked uproar when it was accused of being biased against pupils at statistically poor performing schools.
Maarten van Smeden, a Dutch epidemiologist at UMC Utrecht University Hospital, who reviews models for the British Medical Association’s trade journal, described QCovid as world-leading and "state-of-the-art" yet agreed the model does have limitations.
"If there’s some factor we don’t know about that is hugely important but only affects a few people – such as a very rare disease – this will not be picked up by the model," he said.
A member of staff administers the Pfizer-BioNtech COVID-19 vaccine to a member of the public on Jan 8 2021
Credit: Jon Super/AP
Although multiple datasets were used to create vaccination strategy, QCovid and another dataset called OpenSAFELY were the main resources used to inform JCVI’s advice to government, according to Brown.
The datasets found that a 70-year-old is 100 times more likely to die than somebody under the age of 39.
"Now, that means that if you have an underlying health condition that increases your risk of Covid and you’re 25, it has to be approaching an increased risk of 100 fold to overcome the protective effects of age," said Mr Brown
According to the scientist, people with rare illnesses who are particularly at risk can access an early vaccine under exceptional circumstances. The Department of Health and Social Care did not reply to a request for comment.
"One very important concept here is that everyone in this country is going to be vaccinated at some point, apart from those that refuse and apart from children," said Mr Brown, adding people with rare illnesses who have been effectively shielding will also be covered in the first round of vaccinations.
"It’s just a question of whether it’s going to happen in January, February, March or April," he said.
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