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, makeshift mass vaccination centres — some set up in car parks and shopping centres across the UK — will be used to vaccinate the wider community.
The field-style Nightingale hospitals, designed to cope with overflow from intensive care but little used at the height of the pandemic, may also be pressed into service. One person familiar with the plans said the London Nightingale was set to be used not only to carry out vaccinations but to train staff to administer them.
The NHS plans to take on thousands of extra staff to help with the programme. One person familiar with 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.
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.
Martin Green, chief executive of Care England, an industry body, said given the temperature at which the Pfizer vaccine needed to be maintained, “it’s going to be nearly impossible for care home residents to be given that vaccine as they would need to leave their care home and be given it”.
He added: “When the Oxford vaccine comes on board, that one will be given to care homes.”
Geoff Butcher, who operates six care homes in the Midlands, said his group had been told that residents would receive the AstraZeneca vaccine because of its ease of storage, but that staff would be expected to travel to a vaccination centre to receive the Pfizer vaccine. The immunisation was due to start around December 21, he said.
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However another doctor, who asked for anonymity, said that while a lead hospital would be selected in each area to store the Pfizer vaccine, there was no suggestion that GPs could not administer it after receiving consignments. They added that discussions had even begun over whether it would be possible on occasion to combine the Pfizer and Moderna vaccines, with people receiving a dose of each if that seemed the best way of using scarce supplies to ensure that none was wasted.
There also is a risk that people may press for the most protective vaccinations. Prof Salisbury 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.
Medical professionals hope there will be clear rules setting out which vaccines will be administered at which centres.
“We can’t have people come in and say ‘I want the Moderna’,” said Prof Marshall. “When you have a lengthy production line, you’ve got to get on with it and . . . there has to be clear guidance at the centre of this.”
