On the rock: Why has the Covid death toll spiked in Gibraltar?

By Niall McCrae:

In an air of excitement, sat-nav images showed the progress of a RAF Hercules aircraft across the Bay of Biscay. The cargo was the first batch of Pfizer’s Covid-19 vaccine, approved for use by the UK Medicines & Healthcare Products Regulatory Authority (MHRA). The British dominion of Gibraltar, with a population of 33 thousand, was projected to be the first European state to achieve full vaccination. 

As soon as the vaccine arrived in Gibraltar on 10th January, administration began in earnest on the priority groups of the elderly and healthcare staff. Within a fortnight, over a third of the population had received the first of two jabs. 

After a lull in the summer, Covid-19 had resurged in the autumn and by the end of 2020 it was again rife across Europe. Gibraltar had a relatively low incidence and mortality, with merely 9 deaths in December, but cases and hospitalisations increased around the Christmas period.

At the end of January, much was made of the UK passing 100 thousand deaths, the first nation in Europe to do so. However, less coverage was given to the simultaneous occurrence of Gibraltar becoming the worst place in the world for Covid-19 mortality, per head. Over two thousand per million had died – considerably more than in Belgium. 

The timing caused controversy, as the spate of deaths arose after the vaccination programme began. With 53 deaths in ten days, the authorities and supportive media blasted social media messages attributing the fatal pattern to the Pfizer jab. In an angry defence, chief minister Fabian Picardo decried such assertions as ‘an unadulterated lie’. According to Picardo, none of those who had died had received the vaccine, because they already had Covid-19 symptoms. Indeed, many of those who perished would have been seriously ill by the time that vaccination started.  

Nonetheless, the death toll has continued to rise, reaching 79 by 3rd February (2345 per million). Eventually the authorities admitted that six of the dead had been vaccinated, but this figure is likely to be higher now, as almost all of the elderly received their first dose of the Pfizer vaccine in January. So, there is at least a correlation between vaccine and death. Could it be causal? 

In the UK concerns have been raised about a sudden post-vaccination rise in deaths in care homes; for example, in Pemberley House in Basingstoke, 24 died in January – over a third of residents. June Raine, chief of the MHRA, said that there is no evidence that the vaccine is dangerous, suggesting that deaths are due to people unknowingly having the disease: – 

‘It is possible to have caught Covid-19 and not realise you have the symptoms until after your vaccination appointment’. 

This was badly worded: surely someone would know if they had symptoms? But Raine did not discount infection after the vaccine was given, stating that ‘a week or two’ was needed to build up immunity after the first jab.  She corroborated, therefore, the belief of some immunologists and other medical experts that vulnerability is raised during the time between initial and second doses, due to lymphocyte depletion. An infection in this period could thus be more deadly. .

But this would only be part of the explanation. Why would older people staying indoors, or living in a care home without prior incidence of Covid-19, catch the disease? Perhaps the vaccinators are unwitting transmitters. This is not too far-fetched: the virus has reached endemic level in Gibraltar, and the risk of infection by this route is not negligible. 

This brings Robert K Merton’s Law of Unintended Consequences to mind. Are hitherto shielded senior citizens being exposed to risk, by receiving a preliminary vaccine that potentially increases vulnerability, and then infected by the very people who are trying to protect them? 

A critic might argue that a few dozen deaths do not amount to much when the global death toll from Covid is over two million. Such adverse events would hardly be noticed in larger countries. But the proportionately high mortality in the small community of Gibraltar strengthens the argument for urgent enquiry.  

At present there is little sign of this being taken seriously. Gibraltarians regard the vaccination programme with pride, and daily progress is reported with a propagandist tone. Like Stalin’s tractor production figures, the vaccine is regarded as an achievement regardless of whether it works. 

For government ministers and regulators to dismiss legitimate concerns with outright denial is not acceptable. How can they be so sure that those older people who died after vaccination were not cases of iatrogenic harm? 

For four years I was manager of a clinical trial with research teams throughout England. A major emphasis in training and monitoring was reporting of adverse events. Any disabling health condition or death was classified as a serious adverse event – irrespective of presumed cause. Now, such safeguards and ethical practices seem to be caution thrown to the wind. The MHRA has a database, but this seems to be one-way communication, with no output on deaths after vaccine. 

In the absence of official data, vaccine sceptics (let’s use that term instead of the slur ‘anti-vaxxer’) will do their own sums. We know the average age of Covid death in the UK is 82. By the end of January, the vast majority of people aged over 80 had received the first jab. At the same time, this age group had a disproportionate increase in mortality. 

So what we need to know is: how many people aged 80+ who died in January had the first does of the vaccine? This question should be readily answerable in Gibraltar, but by our Office for National Statistics too.