How will the COVID-19 vaccination programme get underway?

Following the MHRA's approval of Pfizer/BioNTech's COVID-19 jab the government has said that vaccination will begin next week. GPonline looks at how the early stages of the programme will work.

(Photo: Paul Biris/Getty Images)
(Photo: Paul Biris/Getty Images)

This article was updated on 7 December to reflect new information relating to how the vaccine roll out would begin in hospitals and when GPs would start vaccinating patients.

Last week the UK became the first country to approve the Pfizer/BioNTech COVID-19 vaccine for use.

During a Downing Street press briefing on Wednesday 2 December prime minister Boris Johnson said that the NHS was now gearing up for 'the biggest programme of mass vaccination in the history of the UK', which will start this week.

The vaccination programme represents a huge logistical challenge for the government and the NHS, not least because the Pfizer/BioNTech jab itself is so fragile.

The vaccine needs to be stored at temperatures of -70 degrees Celsius and has an active life of five days when thawed and stored in a fridge at 2-8 degrees Celsius. It comes in batches of 975 doses, delivered in 195 five-dose vials and must be diluted before being administered.

The vaccine can also only be removed from the fridge a limited number of times. As England's deputy CMO Professor Jonathan Van Tam said at Wednesday's briefing: 'This is a complex product with a very fragile culture. This is not a yoghurt that can be taken out of the fridge and put back in multiple times.'

The first doses of the vaccine are expected to be delivered into the UK from Pfizer's manufacturing facility in Belgium on 4 December, so how will the programme get underway?

How many vaccines are available for use?

An initial 800,000 doses of the Pfizer/BioNTech have been quality checked and have been sent to the UK.

During the  briefing on Wednesday NHS England chief executive Sir Simon Stevens explained that deliveries of the vaccine would be phased. He said while the 'initial tranche in December is going to enable us to get started', the bulk of the programme for at-risk people would take place from January through to March or April.

Sir Simon also said that because those who are vaccinated need two doses of the jab the NHS would have to 'reserve the second dose for the people who are getting the first dose in December to make sure that second dose is available for them'.

Where will the first vaccines be delivered and who will get them?

The first batch of the Pfizer/BioNTech vaccine will be delivered to 50 hospital hubs across England and also distributed to Scotland, Wales and Northern Ireland, from next week. In England Sir Simon said that the 50 hospitals would 'start offering the vaccine to the over-80s and to care home staff and others identified by the JCVI'.

He said that the people to receive the first vaccines in England would be 'people who were already down to come into hospital next week for an outpatient appointment'. In those instances he said the hospital would be in touch with patients directly.

NHS England has also said that in-patients over the age 80 who are being discharged will be offered the jab and hospitals will work with care home providers to vaccinate their staff. Any vaccines that are not used for these groups will be offered to healthcare workers at highest risk from COVID-19.

What is the priority list?

On Wednesday 2 December the Joint Committee on Vaccination and Immunisation (JCVI) updated its priority list for who should receive the vaccination. The focus on the list is ensuring that those at greatest risk of severe outcomes from the coronavirus and frontline health and social care workers are prioritised.

The current priority list for phase 1 of the vaccine programme is:

  1. Residents in a care home for older adults and their carers
  2. All those 80 years of age and over; frontline health and social care workers
  3. All those 75 years of age and over
  4. All those 70 years of age and over; clinically extremely vulnerable individuals
  5. All those 65 years of age and over
  6. All individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality
  7. All those 60 years of age and over
  8. All those 55 years of age and over
  9. All those 50 years of age and over

Professor Van Tam said the groups listed by the JCVI for the first phase of the programme accounted for 99% of COVID-related mortality deaths in the UK and that by vaccinating these people first it would significantly reduce the burden on hospital systems as well as protecting individuals.

Guidance from Public Health England published earlier this week revealed that pregnant women and under-18s will not be receiving the vaccine. However, given the JCVI's updated prioritisation list it is likely those aged over 16 in an at-risk group will receive the vaccine.

So, why aren’t care homes getting the vaccines first?

The complex storage and distribution requirements of the Pfizer/BioNTech jab mean it is unlikely to be administered in care homes in the very early days of the programme – although this could change.

The Welsh government has already said that due to the practical constraints around the vaccine it 'cannot deliver this vaccine to care homes'.

The MHRA needs to provide authorisation for the packs of 975 doses to be split, which makes it difficult to take the vaccines into smaller settings such as care homes or residential houses for housebound patients.

Sir Simon suggested in the press briefing on Wednesday that he expected the regulator would give approval for 'a safe way of splitting these packs of 975 doses'. He added: 'Then, the good news is that we will be able to start distributing those to care homes.'

The Scottish government has said vaccination of care home residents in Scotland will start on 14 December in Scotland after the country's health minister said it had reached an agreement with the MHRA about how the packs of vaccine can be split.

Professor Van Tam said that he expected there would be 'some blending' of the first two priority groups on the JCVI's list 'in the real life deployment of the vaccine' during an interview with the BBC on 5 December.

He said it made 'no sense' to wait until all care homes had been vaccinated before moving onto the second group. 'Several things play into that. One is that we can't waste vaccine. Number two is that the bigger principle is go as fast as you can with the volumes you can to get people protected,' he added.

When will GPs start vaccinating patients?

NHS England has said that some designated GP practice sites will begin to administer COVID-19 vaccination to patients aged over 80 from 14 December.

GP-led sites designated to deliver COVID-19 vaccination in their primary care network (PCN) area will be informed on 7 December whether they are being 'stood up' as part of the first wave of rolling out the vaccination programme in England.

A letter from NHS England on 4 December says that sites chosen in the first wave will need to deliver 975 doses of vaccine in the week beginning 14 December - and that this must be completed within 3.5 days.

It is unclear how many GP sites will be included in the first wave, but NHS England says it is working with CCGs to identify sites that will be ready to start vaccination from 14 December.

When will the Oxford/AstraZeneca vaccine be approved?

Professor Van Tam told the BBC on Thursday that he was hopeful the Oxford/AstraZeneca vaccine would be approved before Christmas, although he said the final decision rested with the MHRA.

The UK has 100m doses of this vaccine on order and expects to have 4m available before the end of the year.

If this vaccine is approved it would significantly speed up roll-out of the programme because it is more stable, can be stored in a standard vaccine fridge and has a shelf life of six months. Once open, vials need to be used within six hours when stored at room temperature or within 48 hours when stored in a refrigerator. It is supplied in packs of 10 vials, each containing eight or 10 doses of vaccine.

How many people need to be vaccinated and what uptake is predicted?

This is one of the big unknowns about the programme. At the moment scientists are unable to say exactly what uptake the NHS needs to hit in order to provide some kind of herd immunity or to reach a position where life could become more 'normal'.

It's also unclear how willing people will be to have the jab and whether this willingness will differ between socio-economic and ethnic groups.

A poll by research firm Kantar in early November found that 76% of Britons said they would be happy to have the vaccine. However a poll by the London School of Hygiene and Tropical Medicine, also published last month, found that respondents who identified as black, Asian, Chinese, mixed or other ethnicity, were almost three times more likely to say they would reject a COVID-19 vaccine than people in white British, white Irish and other white groups.

The government will be producing a nationwide communication campaign to ensure uptake is as high as possible, but it also seems likely that locally-targeted communications will be required to boost the numbers coming forwards.

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