Care homes and the over-80s will be in the vanguard of the UK’s coronavirus vaccination programme, after Britain’s Medicines and Healthcare products Regulatory Agency approved the first vaccine against Covid-19, firing the starting gun on one of the biggest and most consequential public health drives since the second world war.
The vaccine developed by BioNTech, a German biotechnology company, in partnership with US pharma giant Pfizer, can now be rolled out in the UK under an emergency use authorisation, but the need to keep it at ultra-low temperatures underlines the huge logistical challenge involved in reaching enough Britons to quell the spread of the virus.
Two other vaccines, one developed by Oxford university and AstraZeneca, and another from the US biotech Moderna, have also proved effective in late stage trials. Both are expected to win approval from regulators in the coming weeks.
“It’s the biggest vaccine programme in history and the logistics are enormous,” said Dr Nigel Watson, chief executive of the Wessex Local Medical Committees.
David Salisbury, until 2013 the senior official in charge of immunisation for the UK government, said the whole world was attempting something without precedent: to persuade large numbers of healthy adults to be vaccinated in order to halt transmission — and the “big unknown” was how the under-65s would respond.
Under current plans, vaccines will be distributed via three main routes. The largest is likely to be GP clinics around the UK, which will offer doses to the roughly 17m “high risk” people who usually receive an annual flu vaccination from their local practice.
Second, several hundred hospital trusts will be responsible for vaccinating healthcare staff and some inpatients. Finally, mass vaccination centres will be used to vaccinate the wider community at a range of venues including the London Excel centre, Epsom racecourse, Manchester tennis club, Ashton Gate stadium in Bristol and the Centre for Life science venue in Newcastle.
The armed forces have stepped in to provide support, sending 56 military personnel to help set up seven sites. Two military planners have also been dispatched to each NHS trust in the country to advise on vaccination logistics.
The NHS plans to take on thousands of extra staff to help with the programme. One person briefed on the process said the full-time equivalent of about 10,000 extra people were being recruited via a health service portal. The insider said successful candidates were likely to only need “first aid skills” rather than full-blown clinical expertise.
As well as paid staff, volunteers will be crucial to rolling out the vaccine. Lynn Thomas, medical director for St John Ambulance, a charity, said the organisation had been asked to supply 30,500 people to support up to 100 mass vaccination centres. About 10,000 of that group would be trained under NHS supervision to deliver the vaccine directly, with the remainder providing first aid and other support.
Under the government plans, vaccinations will first be made available to care home residents and staff, those aged over 80 and to frontline health workers. The first phase will then be extended to younger age groups eventually including all those over 50, and those aged between 16 and 64 with underlying health conditions.
But while age is the principal criterion for when and whether people will receive the vaccine, Wei Shen Lim, who chairs the UK’s Joint Committee on Vaccination and Immunisation or JCVI, added on Wednesday that decisions about how to allocate the vaccine in local areas should pay attention to “mitigating health inequalities”. Societal factors such as occupation, household size, deprivation and access to healthcare have all been shown to increase susceptibility to Covid-19, with members of some minority groups at greater risk of developing serious symptoms.
Some public health professionals have raised concerns that the logistics of distributing the Pfizer vaccine — which has to be stored at -70C, transported on dry ice, and used within 5 days of being removed from the ultra-cold freezer — may be too onerous for GPs and care homes.
Martin Marshall, chair of the royal college of GPs, said there was still considerable uncertainty around which vaccines doctors would be allowed to administer, and when. “At the moment we’re hearing it’s too complicated and there are too many risks,” he said, pointing to concerns that the vaccine might diminish in effectiveness after being taken out of ultra cold storage. “You risk wasting a lot and we can’t afford to waste any.
“The general feeling is, why would you take those risks when all you have to do is wait a bit longer and get a vaccine without the same requirements,” Prof Marshall added, alluding to the Oxford university and AstraZeneca vaccine, which is stored at between 2C and 8C and has a six-month shelf life.
Prof Lim at the JCVI acknowledged that the storage requirements for the vaccine could affect the ability to use it in care homes. The JCVI has said that every effort must be made to supply the shot to care home residents but “whether that is actually do-able is dependent on deployment and implementation”, he added.
Speaking alongside Prof Lim, Munir Pirmohamed, who chairs the Commission on Human Medicine Expert Working Group, said the fact that the BioNTech/Pfizer vaccine was stable for five days when refrigerated at between 2C and 8C would allow doses to be “transported to the relevant implementation sites”.
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A further challenge for the UK government is that some people may press for the most protective vaccinations. Prof Salisbury, the former immunisation official, pointed to the 62 per cent efficacy shown in all-age trials of the Oxford/AstraZeneca vaccine, compared with about 95 per cent for the Pfizer/BioNTech and Moderna versions. It was “unfortunate” that the vaccine the UK had bought in the largest quantities “appears to be from the lower efficacy product”, he said.
“If you protect 95 per cent of those vaccinated, that’s great. If you only protect less than two-thirds of those you vaccinate that’s not so good. You are protecting a third fewer people and therefore the challenge to interrupt transmission with a lower efficacy vaccine is even higher,” Prof Salisbury added.
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