For the last nine months, the world has waited with bated breath for the news that a vaccine offering protection from Covid-19 could be developed. And like buses, when one came along, two more followed in rapid succession. But is this the good news it seems to be, and what are the challenges for the NHS as it prepares to deliver the biggest mass vaccination project in its history?
Well, the good news is that it does look like good news. Sufficiently reassured by the clinical trials so far, the UK government has asked the Medicines and Healthcare Products Regulatory Agency (MHRA) to review all three vaccines as a matter of urgency. Pfizer’s vaccine has already been licensed, and the Moderna and the AstraZeneca/Oxford vaccines should soon follow. Vaccinations are getting underway, and the NHS plans to vaccinate effectively everyone who is at high risk before Easter.
The bad news is that there are quite a few challenges to overcome before that ambition is achieved.
The hurdles ahead
First, there is the logistical challenge. It will be no mean feat to get the right staff in the right place at the right time with the supplies they need, while ensuring that the people they need to vaccinate are also in the same place at the same time.
There are three competing demands on NHS staff. The need to respond to the very considerable pressures caused by Covid itself, the need to keep ‘normal’ NHS services operating as much as possible (including treating the backlog of patients that built up earlier this year), and now the need to deliver the vaccination programme. NHS England have acknowledged that these demands cannot be met solely by the existing workforce.
NHS organisations and GP practices have been asked to identify premises to deliver the vaccinations. They will need to be easy to reach by both staff and the public – and not already being used by the Test and Trace service. They also need to be big enough for everyone to maintain social distancing throughout, while providing storage for the vaccines themselves and also the PPE and other consumables required.
An additional challenge for the Pfizer vaccine is that it needs to be stored at a temperature of at least -70°C. A national distribution service is being established to ensure that every site delivering vaccinations receives supplies of the necessary vaccines, consumables and PPE, seven days a week.
While it does feel appropriate that such logistics are coordinated centrally, we must hope that lessons have been learned from the challenges of PPE distribution during the first wave. We must also hope that Brexit-related disruption to imports from Europe does not impact the vaccine supply chain.
Getting the message right
The speed of the vaccines’ development has been truly impressive – no vaccine has ever before progressed from the starting blocks to licensing for use within a year.
Perhaps unsurprisingly, it appears that throwing vast sums of money and the best expertise in the world at a problem is one way to find a rapid solution. And regulators have worked hard to ensure that they can carry out their safety checks through a ‘rolling review’ process, running in parallel with the clinical trials. The MHRA had already been planning this change to its processes, and brought it forward to respond to Covid-19.
The vaccines’ developers and regulators have given welcome reassurance that no corners were cut around safety in the race to get a vaccine ready. Nonetheless, there will still be a significant communications challenge for the NHS to ensure the public are confident to come forward and be vaccinated. Communications leads working at both local and national level will have a critical role to play working alongside their clinical colleagues.
This will include reassuring the public if there is an individual incident of an adverse reaction to the vaccine. Fortunately, there is no evidence of this being an issue during the clinical trials so far, with both developers and regulators happy. But as with all other drugs and vaccines in use for many years, a rare and isolated incident is not impossible. Should that happen, clinical staff will respond rapidly, and communications colleagues and media should work together to keep an individual incident in context.
The MHRA have specific arrangements in place to track any such incidents, with an anticipated incidence of 0.05-0.1%. Because the Covid-19 vaccines will be administered on a large scale, there may well be instances of people who get ill at the same time as having the injection, which may not have a relationship with the actual vaccination.
A return towards normality?
There will be a national ‘call and recall’ system to ensure that members of the public are called for vaccination in the appropriate order – which should happen at various stages between now and Easter for the priority groups identified. People will be able to make an appointment at a GP practice, a community pharmacy or one of the mass vaccination centres. For people unable to travel, ‘roving teams’ will bring the vaccine to them. The national system will also hold data on who has received the vaccine, and crucially will help to ensure that people receive both doses needed to confer immunity.
It will be absolutely critical that information flows smoothly between the national system and local services. Any glitches will impact not only on public confidence, but on the confidence of the health care professionals relied upon to reassure the public.
The last few months have been some of the most difficult the NHS has ever experienced, and it’s also been an extraordinarily tough year for the public. The next few months will not be easy either. But a successful vaccination programme will mean we can all look forward to a return to normality during 2021, and to the human contact that so many people have so desperately missed.
Buckingham H (2020) “Safe delivery? The main challenges for the NHS in delivering the Covid-19 vaccine”, Nuffield Trust comment.