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?
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.
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.
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”.
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.
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.
Moderna’s vaccine – yet to be approved in the UK – 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.
But the British-made Oxford-AstraZenca vaccine – also, not yet approved – should avoid such challenges, as it can be transported in refrigerated vans or cool boxes and can be stored at normal fridge temperatures.
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.
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.
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.
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.
The Department of Health says, over time, when more stocks are available, people will be able to get a vaccine at a number of places. They will be invited to book an appointment to get a vaccine as soon as it’s their turn, probably by letter or email.
Public Health England (PHE) has said that because the Pfizer-BioNTech vaccine “is complex” and “needs to be stored at very cold temperatures and moved carefully”, the first doses had to be administered from hospital hubs. These hubs are dotted around the country and are up and running.
The process for patients at these vaccination hubs: An anonymised plan from one hospital trust
Clinical Commissioning Groups and GPs provide hospital hubs with a list of over 80s Hospital bookers call to give patients a timed 15-minute slot Vaccination takes place in dedicated clinic building, sited next to a car park to allow easy access Number of afternoon slots are given to care home workers At the appointment, patients are electronically registered The system books the patient for their second dose three weeks later and sends a letter to the patient and their GP After the jab, patients are taken to a recovery area To ensure no vaccine wastage, high-risk staff from the hospital use up any left over doses
Source: NHS Providers
In addition to the hubs, a number of local vaccination centres, operated by groups of GPs, will be up and running next week. These numbers will increase as more vaccines arrive, a PHE spokesman says.
Doses are expected to be delivered to about 200 GP surgeries initially to allow them to start on Tuesday. 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 centre that is not their usual one.
Similar arrangements are being made in the rest of the UK.
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.
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.
Armed forces have already been assisting in the set up of a mass vaccination centres, such as at Ashton Gate stadium in Bristol. Other sites are also being prepared, such as Leicester and Epsom racecourses, the Bath & West Showground and the Etihad Campus in Manchester.
The aim is that as many people as possible over the age of 16 in the UK will receive a Covid-19 vaccine. The first vaccines will be given to the most vulnerable first, 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.
As soon as there is clarity on how smaller batches of the vaccine 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.
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 has said the speed of vaccination rollout would depend on how fast vaccinations could be manufactured.
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.
NHS England has said the bulk the vaccination programme for “at-risk” people will take place from the beginning of 2021 through to March and April.
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 pre-ordered 40 million doses of the Pfizer-BioNTech vaccine and has taken delivery of 800,000 doses so far – enough for 400,000 people.
The UK was originally planning to have 10 million doses of the Pfizer jab available 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.
The Oxford-AstraZeneca vaccine is expected to be approved by the UK regulator soon.
Design by Lilly Huynh and Irene de la Torre Arenas
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