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Covid vaccine: How will the UK jab millions of people? Covid vaccine: How will the UK jab millions of people?
(21 days later)
The UK has begun the mass rollout of a vaccine against Covid-19, aiming to inoculate tens of millions of people within months. The UK has launched its biggest mass-vaccination programme, aimed at protecting tens of millions of people from Covid-19 within months.
With the military called on to help and sports stadiums and conference centres being converted to temporary vaccination centres, what does it take to deliver the biggest vaccination programme the country has ever seen? In a race against a faster-spreading variant of coronavirus, ministers have pinned their hopes of ending a third national lockdown on protecting the most vulnerable groups by spring.
Where is the vaccine coming from? But there are huge challenges, not least the unprecedented scale but also the need for rigorous safety checks and deep-freeze storage as well as establishing enough vaccination centres and recruiting enough vaccinators.
The first vaccine to be declared safe and effective and approved for mass use by UK regulators is made by Pfizer-BioNTech, which has manufacturing sites in Europe and the US. Initial vaccine doses for the UK are being produced at Pfizer's site in Puurs, Belgium. What is the plan?
Because the vaccine is made using genetic material - a technique never before developed on this scale - it has strict temperature requirements and needs to be stored at a very cold -70C to prevent it from degrading. This means it needs to be transported in a carefully controlled deep-freeze delivery chain. The government aims to offer vaccines to 15 million people - the over-70s, healthcare workers and those required to shield - by mid-February and millions more by spring.
Before the vaccine leaves the plant, batches of 195 vials are placed in trays and then put inside special ultra-cold thermal boxes, known as "shippers". The speedy rollout of the vaccine to vulnerable people is seen as critical to reducing the pandemic's death toll and relieving pressure on the NHS.
These boxes - each containing almost 5,000 doses - are fitted with GPS temperature monitoring devices which constantly send information on the state of the consignment back to Pfizer. These boxes are then transported by plane or truck to the UK for distribution to vaccination hubs. But to meet this target, ministers need to deliver more than two million jabs a week by the end of January, in one of the largest civilian logistical operations launched in Britain.
In addition to the Pfizer vaccine though, two other jabs - developed by Moderna and Oxford-AstraZeneca - are expected to be approved for widespread use in the UK soon. Since the beginning of last month, 1.5 million people have been vaccinated, Prime Minister Boris Johnson has said. But more than 13 million people will need to receive jabs in the next five weeks. And the UK's chief medical adviser, Prof Chris Whitty, has described such a timetable as "realistic but not easy".
Moderna's vaccine will need to be flown in from Switzerland or Spain. Like Pfizer's, it also has to be frozen, but only at -20C, the temperature of a standard freezer. The NHS began administering a vaccine made by Pfizer-BioNTech.
But the British-made Oxford-AstraZenca vaccine should avoid such challenges, as it can be transported in refrigerated vans or cool boxes and can be stored at normal fridge temperatures. But the operation is being significantly ramped up following the approval of a second vaccine, from Oxford University and AstraZeneca.
What happens when the Pfizer vaccine arrives in the UK? A third vaccine from Moderna was approved on Friday.
Pfizer's vaccine is taken to a central depot, where batches are tested by a medical logistics company for quality. At these secure sites, each box is opened, unpacked and has its temperature data downloaded, with the process taking between 12 and 24 hours. And the campaign to reach as many people as possible as quickly as possible has also been boosted by a shift in policy - to prioritise the first dose of either vaccine, with a second dose up to 12 weeks later, a bigger gap than originally planned.
Once the quality has been approved, the vaccines are made ready for order by approved NHS sites, or hubs. They are stored in freezers until dispatch. On Thursday, Mr Johnson said it would require an "unprecedented national effort" but the government was throwing "everything at it" to deliver "hundreds of thousands" of jabs each day.
Once at a vaccination hub, the consignment is removed from cold storage by NHS staff. It takes a few hours to defrost and the contents of each vial needs to be diluted in saline before it is given to patients. The vaccine needs to be used within six hours of dilution. Can we jab our way out of lockdown?
GP practices have been told they have to get through 975 doses in 3.5 days - the time limit on keeping the vaccine at regular fridge temperature. Will a vaccine give us our old lives back?
How will people get a vaccine? Covid vaccine: When will you be eligible?
The Department of Health says, over time, when more stocks are available, people will be able to get inoculated at a number of places. They will be invited to book an appointment as soon as it's their turn, probably by letter or email. Where are the vaccines coming from?
Public Health England (PHE) has said that because the Pfizer-BioNTech vaccine "is complex", the first doses had to be administered from hospital hubs. These hubs are dotted around the country and are up and running. The UK is currently receiving doses of two vaccines approved by the medicine regulator. The Pfizer-BioNTech jab - the first given the green light - is being imported from Puurs, Belgium. Meanwhile, the Oxford vaccine is being made in Britain, by two biotech companies:
The process for patients at these vaccination hubs: An anonymised plan from one hospital trust Oxford BioMedica, based in Oxford
Clinical Commissioning Groups and GPs provide hospital hubs with a list of over 80s Cobra Biologics, based at Keele Science Park, Staffs
Hospital bookers call to give patients a timed 15-minute slot Another company, Wockhardt, based in Wrexham, fills the vials and packages them for use
Vaccination takes place in dedicated clinic building, sited next to a car park to allow easy access But the country's initial doses of the Oxford vaccine will actually come from Europe, UK Vaccine Taskforce manufacturing lead Ian McCubbin has said.
Number of afternoon slots are given to care home workers Supplies of the third vaccine to be approved, made by US company Moderna, are not expected to be available until spring.
At the appointment, patients are electronically registered Is there a hold-up?
The system books the patient for their second dose three weeks later and sends a letter to the patient and their GP There are a number of challenges in what is called the vaccine "supply chain" - the logistics of how the jab gets from manufacturers to people.
After the jab, patients are taken to a recovery area One challenge facing pharmaceutical companies globally has been a shortage of glass vials for the "fill and finish" stage of manufacture - when a vaccine is packaged for despatch. Although, unlike elsewhere, the UK is thought currently to have enough of this glassware in storage.
To ensure no vaccine wastage, high-risk staff from the hospital use up any left over doses On top of this, Mr Johnson has referred to the "rate-limiting factor" of batch testing - the process of ensuring vaccines released by manufacturers are safe and up to standard.
Source: NHS Providers The UK's Medicines and Healthcare Products Regulatory Authority (MHRA) requires vaccines to be checked by the National Institute of Biological Standards and Control (NIBSC) to ensure they are:
In addition to the hubs, a number of local vaccination centres, operated by groups of GPs. Numbers will increase as more medicines arrive, a PHE spokesman says. effective
Doses are expected to be delivered to about 200 GP surgeries initially to allow them to start on Tuesday 15 December. Then the programme will be expanded to more than 1,000 surgeries - with each local area having a designated site. For this reason, most patients will be invited to a GP practice that is not their usual one. structurally intact
Similar arrangements are being made in the rest of the UK. free of contaminants
GP practices will receive their batch of the vaccine the day before jabs begin, and are also being supplied with other necessary equipment, such as fridges and laptops for roving visits to care homes and house-bound patients. And this process can take a long time as it has to be done twice - before the vaccine enters vials and after.
The NHS is recruiting 30,000 volunteers to help with the rollout, including lifeguards, airline staff and students - who will be trained to give the jabs. The charity St John Ambulance has been asked to assist. The military have also been enlisted, to help with logistics and building mass vaccination centres. Testing a batch is sterile takes two weeks.
Armed forces have already been assisting in the set up of a mass vaccination centres, such as those at Ashton Gate stadium in Bristol. Other sites are also being prepared, for example Leicester and Epsom racecourses, the Bath & West Showground and the Etihad Campus in Manchester. An MHRA spokesman said it was working closely with AstraZeneca "to ensure that batches of the vaccine are released as quickly as possible". And the NIBSC had scaled up its capacity so "multiple batches can be tested simultaneously". More technical staff are also being taken on.
How many people will get vaccinated? The UK's Vaccines Manufacturing and Innovation Centre chief executive Matthew Duchars says preparing enough vaccine is "quite a challenge" given the timeframe but "doable".
"It's not like we haven't done this before," he says. "But we've not done it so quickly before."
How is the vaccine transported?
The Oxford vaccine can be stored in fridges and transported in regular refrigerated vans or cool boxes. But the Pfizer jab - made from genetic material - needs to be stored at -70C to prevent it from degrading.
This means it needs to be transported in a carefully controlled deep-freeze delivery chain, with vials placed inside special ultra-cold thermal boxes, known as "shippers".
These boxes - fitted with temperature-monitoring devices - are taken by plane or lorry to the UK and onward to their destination. Once at a vaccination site, the consignment needs to be removed from cold storage by specially trained NHS staff and takes a few hours to defrost before being diluted in saline and given to patients.
The newly-approved Moderna jab requires temperatures of around -20C for shipping - similar to a normal freezer.
How will people be vaccinated?
People will be vaccinated in three main ways, at:
local GP practices and community pharmacies
hospital hubs
mass vaccination sites across the country
About 1,000 GP sites, 200 community pharmacies, 223 hospital hubs and seven mass vaccination sites should be up and running by next week. And the prime minister says no-one should have to travel more than 10 miles for a jab.
The first seven mass vaccination centres are:
Robertson House, in Stevenage, Herts
the ExCel Centre, in London
the Centre for Life, in Newcastle
the Etihad tennis centre, in Manchester
Epsom Downs Racecourse, in Surrey
Ashton Gate Stadium, in Bristol
Millennium Point, in Birmingham
In Scotland, as well as GPs surgeries and hospital hubs, Motherwell Concert Hall and The Event Complex Aberdeen are being considered alongside sports venues.
So far, 80,000 people have been trained to deliver the vaccines, NHS boss Sir Simon Stevens says, with thousands more set to join the effort. The charity St John Ambulance Brigade is among those helping out.
And a further 21 quick-reaction vaccination teams will also be ready to deployed anywhere around the country, commander of military support to the vaccine delivery programme Brig Phil Prosser says.
Who will be vaccinated?
While the NHS administers about 15 million flu vaccines across the UK every year, with all four nations achieving some of the highest vaccination rates among the over-65s in Europe, the scale and speed of the Covid jab rollout is unprecedented.
The aim is to inoculate as many people as possible aged over 16 in the UK. The most vulnerable take priority, as set out in a list of nine high-priority groups, covering about a quarter of the UK population. They are thought to represent 90-99% of those at risk of dying from Covid-19.The aim is to inoculate as many people as possible aged over 16 in the UK. The most vulnerable take priority, as set out in a list of nine high-priority groups, covering about a quarter of the UK population. They are thought to represent 90-99% of those at risk of dying from Covid-19.
People aged over 80 in hospital, frontline health staff and care home workers have been the first to get the jab. People aged over 80, front-line health staff and care home workers have been some of the first to receive the Pfizer jab.
As soon as there is clarity on how smaller batches of the medicine can be transported safely, care home residents will follow, the Department of Health has said, probably from next week. Together, care home residents, their carers and the over-80s make up an estimated 4.5 million people, while frontline NHS staff make up a further 1.6 million. GPs and local vaccination centres have been asked to ensure every care-home resident in their area is vaccinated by the end of January.
How long will it take? Together, care home residents, their carers and the over-80s make up an estimated 4.5 million people, while front-line NHS staff make up a further 1.6 million.
The government has said the programme will be "one of the biggest civilian logistical efforts that we've faced as a nation". Health Secretary Matt Hancock said the speed of rollout would depend on how fast vaccinations could be manufactured. Is there enough vaccine?
The NHS administers about 14 million flu vaccines per year. But the Pfizer/BioNTech candidate has additional requirements which will make it more difficult to deliver, including the fact people will need to receive two doses, about 21 days apart. The UK has ordered 100 million doses of the Oxford vaccine - enough to inoculate 50 million people.
NHS England has said the bulk of the vaccination programme for "at-risk" people will take place from the beginning of 2021 through to March and April. This, when combined with the 40 million ordered Pfizer jabs, will cover the entire population, Health Secretary Matt Hancock has said.
The amount of vaccine will define "the time to impact", says Prof David Salisbury, a former director of immunisation at the UK Department of Health. "Everything is dependent on the supply of vaccines," he says. The UK also has significant orders of the newly-approved Moderna vaccine and four other candidates.
How many doses do we have? But having vaccines on order is not the same as having them ready to go. Of the 100 million Oxford jabs ordered, only 530,000 were ready for nationwide rollout on 4 January. Although, the government has said this number will rise to "tens of millions" by the end of March.
The UK pre-ordered 40 million doses of the Pfizer-BioNTech vaccine and has taken delivery of 800,000 so far - enough for 400,000 people. Meanwhile, the UK has taken delivery of 22 consignments of the 40 million Pfizer jabs ordered.
The UK was originally planning to have 10 million doses of the Pfizer jab before the end of the year, but it is now likely to receive just four million. Pfizer was forced to reduce its production targets due to challenges securing raw ingredients, among other things, which caused manufacturing delays. And Pfizer says the number it has sent to the UK is now "in the millions".
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