“We have our target set,” tweeted the vaccines minister Nadhim Zahawi on Monday. Minutes earlier, Boris Johnson had tasked the NHS with delivering 13.9 million Covid vaccines by mid-February, requiring the administration of around 2 million doses a day. “It is achievable,” said Prof Nilay Shah, the head of Imperial College London’s chemical engineering department, “but everything needs to go right every single day.”
Here are some of the key issues in the biggest immunisation programme Britain has ever embarked on.
Manufacturing
Two companies are manufacturing the newly-approved Oxford/AstraZeneca vaccine, grown from cells in their specialised laboratories and processed in top-of-the range manufacturing suites: Oxford Biomedica, and Cobra Biologics based at Keele University. Oxford Biomedica, which is producing the largest quantity, is working 24/7 shifts and its staff were at work over Christmas and the New Year to get supplies moving. It said it is on target to deliver according to its contract with AstraZeneca, which is for “tens of millions” of doses.
Bottling and safety checks
The vaccine is delivered in frozen form to the “fill and finish” plant run by the India-based firm Wockhardt in Wrexham, north Wales. This is where the vaccine is packed into vials, some containing eight doses and others 10, in order to speed up the process.
Under the emergency authorisation granted by the Medicines and Healthcare products Regulatory Authority (MHRA) in late December, each batch must be quality-approved by the National Institute for Biological Standards and Control (NIBSC).
This is where the delays lie, according to the government. Oxford Biomedica said as a quality certified plant, it carries out the required tests and sends the data to the NIBSC. The MHRA said NIBSC inspectors also carry out some tests, but at the same time, ensuring speed. “NIBSC has scaled up its capacity to ensure that multiple batches can be tested simultaneously, and that this can be done as quickly as possible, without compromising quality and safety,” it said.
The DHSC said vaccine testing can usually take up to 20 days, but it is seeking to bring that down to five days. The testing is normally carried out in two phases, first by the manufacturer, which sends the data to inspectors at the NIBSC. The NIBSC then carries out its own tests, including when the vaccine is being put into vials. The MHRA said these tests are happening in parallel to release the vaccine as quickly as possible.
Family doctors
GPs are set to run mass vaccination clinics while keeping up with their day jobs – which means something has to give, says the British Medical Association. It wants approval to suspend some non-urgent work such as routine health checks and regulatory inspections. It also said that retired GPs keen to return and help the vaccination drive face a daunting array of bureaucratic obstacles. For example, they have to complete 20-30 modules of online training in order to become vaccinators, despite their background in medical practice. But it is hopeful nevertheless.
“We are all excited about where this is going,” said Dr Michael Mulholland, the vice-chair of the Royal College of General Practitioners. “We’re seeing the people in their 80s and 90s coming in and they finally have something that means they can leave the house, at least that’s the way it’s going. But it’s important to remember, this is a marathon, not a sprint.”
Vaccination centres
To ramp up inoculations when the most vulnerable have been protected, seven mass vaccination centres will be set up starting next week at locations such as sports stadiums and exhibition centres. Johnson said that by the end of this week there will be 207 hospitals giving vaccinations and 775 sites led by GPs, which are mainly at practices, in community centres and in small community hospitals. However, not all areas are covered. Sarah Butikofer, the leader of North Norfolk district council, which has one of the oldest populations in the UK, has criticised the fact that the area still does not have its own vaccination site as “appalling”.
Care homes
Care home residents are one of the top priority groups, but getting the Pfizer/BioNTech vaccine to them has not been easy as it needs to be kept so cold. Some care homes in Kent, one of the areas of highest community infection, have complained that vaccines have not yet been made available. The AstraZeneca vaccine, which can be kept at fridge temperature, should be easier to administer. Guidance issued in the last week made clear to GPs that they should continue to vaccinate in care homes where there are cases of Covid as long as they are isolated and any outbreak is limited.
