this week CONTAGION page 213 • VACCINE SAFETY page 214 • COVID VARIANTS Q&A page 216 DAVID CLIFF/NURPHOTO/PA DAVID NHS shake-up to reverse Lansley reforms Key elements of the Health and Social Care the health secretary will have a new duty to Matt Hancock, the health Act 2012 are to be reversed in the biggest publish a report every parliament that “will secretary for England, legislative shake-up of the English health support greater clarity around workforce will oversee a major service in a decade. planning responsibilities.” reorganisation of the health services in the country A draft white paper, leaked to the The Care Quality Commission will be website Health Policy Insight, outlines given direction to assess local authorities’ proposals to reverse major parts of former delivery of adult social care, and the health health secretary Andrew Lansley’s secretary will be able to intervene if there is controversial reorganisation, including a risk these duties will not be met. But there formally abolishing requirements to do with are no details for social care changes. competition and competitive tendering in The Medicines and Healthcare Products the NHS, and shifting control and decision Regulatory Agency will be able to set up new making power back to Whitehall. national medicines registries and work with As The BMJ reported in December, the NHS to maintain them “where there is LATEST ONLINE clinical commissioning groups, created in a clear patient safety or other important 2012, will be replaced by larger statutory clinical interest,” the draft paper adds. Increase in medical “integrated care systems” that will manage Danny Mortimer, NHS Confederation school applicants local health systems. But the government chief executive, said, “There is often anxiety will not equal more also intends to shift substantial power from about ‘another NHS reorganisation,’ but the doctors, says BMA NHS England to the secretary of state for NHS and the partners we work with have NHS agrees to health and social care, who will be given been on this journey now for several years. pay £13m for boy direct control over local integrated care This is the logical next step.” who was left brain systems, NHS England, and NHS foundation However, he added, “There is concern that damaged from lack of nutrition trusts, which will lose their independence. in an overly centralised system the reforms after birth Ministers will also be able to intervene “at need to better empower local NHS and care any point” of a reconfi guration process and leaders to lead—they are best placed to run McKinsey agrees to pay $574m be given powers over arm’s length bodies to services for their communities.” to US states to stipulate their functions and abolish them. bmj.com See Andy Cowper BMJ 2021;372:n384 settle opioid The document does not include a specifi c Gareth Iacobucci , The BMJ claims plan to tackle workforce shortages but says Cite this as: BMJ 2021;372:n377 the bmj | 13 February 2021 211 SEVEN DAYS IN BMA welcomes decision to enable doctors to make deferred choice on pensions The BMA has backed the government’s decision to allow doctors to make a deferred choice on their pension contributions, in response to a Court of Appeal ruling that changes made in 2015 unlawfully discriminated against younger members of public service pension schemes. The changes meant that o nly older members—those within 10 years of retirement in April 2012—were allowed to remain in the older and more favourable fi nal salary scheme. Aft er consulting on two options, the government said it had decided to proceed with the deferred choice rather than the immediate choice option. “This means that members will make their decision between scheme benefi ts shortly before benefi ts are paid from the scheme,” it said. “In the meantime, members will be deemed to have accrued benefi ts in their legacy schemes, rather than reformed schemes, for the remedy period, until they make that choice.” Most respondents to the consultation backed the deferred choice option, as it would give greater certainty on benefi t entitlements at the point at which they made a decision, while the immediate choice would have forced them to make a decision now, on the basis of assumptions about factors such as future earnings. Vishal Sharma (left ), chair of the BMA pensions committee, said the government had listened to “common sense.” Gareth Iacobucci , The BMJ Cite this as: BMJ 2021;372:n362 Covid-19 covid reported side effects more International news of Health figures, reported by No classic symptoms in frequently after the first dose. South Africa pauses the BBC, found that only 531 of 40% with past infections A second small study from the use of Oxford vaccine almost 750 000 fully vaccinated Around a quarter of people University of Maryland, also Rollout of the Oxford- people aged over 60 tested with evidence of past covid- published as a preprint, reported AstraZeneca covid-19 vaccine in positive for SARS-CoV-2 (0.07%). 19 infection were completely similar findings. South Africa was paused after a Of these, just 38 were admitted asymptomatic, a UK study found, study in 2000 healthy and young to hospital with moderate, while 40% did not have any of the Data for Oxford vaccine volunteers reported that it did severe, or critical disease. three typical symptoms—fever, support 12 week dose gap not protect against mild and persistent dry cough, or loss of moderate disease caused by Vaccine hesitancy taste or smell. The UK Biobank the new variant (501Y.V2) that Bishops and church leaders SARS-CoV-2 Serology study emerged there. The unpublished tackle misinformation analysed monthly blood samples study, seen by the Financial The NHS joined forces with of nearly 19 000 people from 27 Times , examined the efficacy of cross denominational leaders May to 4 December. Some 99% of the vaccine against the 501Y.V2 of the Christian faith to launch participants who tested positive variant—which accounts for a campaign aimed at tackling for previous infection retained The UK’s approach of leaving a around 90% of cases in South misinformation that has antibodies for three months after three month interval between Africa—in HIV negative people. caused distrust about the being infected, and 88% did so doses of the Oxford-AstraZeneca No data have been made covid-19 vaccine, particularly for at least six months. vaccine was backed by new available to the public. in black majority communities data, and Oxford University and churches. Supporters Past infection may mean researchers said the vaccine N ew infections in Israel of the Give Hope campaign only single mRNA dose “may have a substantial drop after vaccinations organised by YourNeighbour, a People who have already had impact on transmission.” The Early findings from Israel’s network of more than 1000 confirmed covid-19 may need paper, a preprint under review covid-19 vaccination churches from over 40 only a single dose of an mRNA by the Lancet , is an analysis programme suggested denominations in the UK, vaccine, two small studies of additional data from trials that the rollout of the include Paul Butler, bishop indicated. The first, from Mount involving 17 177 participants in Pfizer-BioNTech vaccine of Durham; Agu Irukwu of Sinai in New York and Paris and the UK, Brazil, and South Africa. was leading to fewer the Jesus House; Rose published as a preprint, found A single standard dose of vaccine new infections and Hudson-Wilkin (left), that seropositive people had a provided 76% protection overall was at least 50% bishop of Dover; rapid antibody response after one against covid-19 symptoms in effective 13 to Anthony Cotterill of dose of either the Pfizer-BioNTech the first 90 days after vaccination, 24 days after the Salvation Army; or the Moderna vaccine. It also and protection did not wane in the first dose. and other senior found that people who had had that time frame. Israeli Ministry church leaders. 212 13 February 2021 | the bmj SIXTY SECONDS MEDICINE ON . Research CONTAGION Russian vaccine efficacy is 91.6%, results show AS IN, WHEN A DISEASE IS SPREAD BY The covid vaccine developed by TOUCHING SOMEONE OR SOMETHING? the Gamaleya Research Institute, Well, yes. But the term contagion can also part of the Russian Ministry refer to situations in which ideas spread from of Health, has an efficacy of one place to another. Which brings us neatly 91.6%, interim results from a on to Matt Hancock. phase III trial showed. Findings HAS HE BEEN SPREADING THE GOSPEL published in the Lancet showed ABOUT TECHNOLOGY AGAIN? the two dose regimen of the viral The viral vector No, not this time. England’s health secretary vector vaccine was generally well “Sputnik V” vaccine has in fact revealed that the UK’s swift tolerated, with no associated response to rolling out a vaccine for covid- serious adverse events and a good enough excuse” for 19 was influenced by Contagion , the 2011 similar efficacy in people aged “painfully slow” progress, MPs CYBER Steven Soderbergh fi lm starring Gwyneth over and under 60. The Gam- argued. The committee chair, Paltrow and Matt Damon, which is about COVID-Vac, also known as Sputnik Meg Hillier, said, “Government CRIME the spread of a deadly virus and the ensuing V, was given to 15 000 volunteers must move on from aspirational global response. NHS staff (of whom 1611 were over 60), and words and start taking the hard SOUNDS EERILY FAMILIAR 4902 received a placebo. decisions required to deliver real in England Indeed. There was a surge in interest in results—time is running out.” received a total of the fi lm last year because of covid-19, Climate change and Hancock clearly picked something “Millions” face potential Alcohol 137 476 up aft er watching it.