THREAD: The Pfizer Covid-19 vaccine has been approved for use in the UK. My editorial in @bmj_latest discusses the logistics of Covid-19 vaccination, a public health programme that is essential for the future wellbeing & economic security of the UK. https://www.bmj.com/content/371/bmj.m4654 1/12

We need to ensure the NHS, and primary care in particular, is well-prepared for the programme and given all the resources needed for successful delivery; and that unrealistic expectations of the timescale are not created amongst the public. 2/12

Primary care should be at the heart of the UK’s vaccine programme. General practices are easy for patients to access and their staff are well-trusted by the public. Unfortunately, a decade of under-investment in primary care has led to a shortage of general practitioners. 3/12

The government must take some immediate actions to reduce pressures on primary care and increase capacity; such as cutting the administrative burden on general practices by suspending appraisals, revalidation and CQC inspections for the foreseeable future. 4/12

Services for the management of acute and long-term problems, and preventive programmes such as children’s immunisations, must continue to operate normally. Additional capacity is needed so that the vaccination programme does displace or delay other essential clinical work. 5/12

Adenoviral vector vaccines are logistically easier to deliver as they can be stored long-term in standard vaccine fridges and so could be administered by staff working in the patient’s usual general practice. These vaccines also need to be approved rapidly in the UK. 6/12

mRNA vaccines must be stored at very low temperatures and have to be used within a short period of time after defrosting. Hence, mRNA vaccines are more suitable for large vaccination centres with a high throughput of patients rather than the typical general practice. 7/12

In the longer term, as more data on safety and efficacy becomes available, it would be appropriate to focus on a smaller number of vaccines, rather than continue with the government’s current approach of having many different vaccine options. 8/12

Using a smaller number of vaccines would simplify the vaccination programme, cut its costs and reduce the likelihood or patients missing out on their second dose of vaccine because of its unavailability or receiving the wrong vaccine at their second appointment. 9/12

We do not yet know how long the protection from infection generated by vaccination will last. People may therefore require booster doses of vaccine at regular intervals and the NHS should also plan for this. Primary care is well-placed to do this if adequately funded. 10/12

We need observational studies to assess how frequently vaccine failures occur (i.e. how many people contract Covid-19 despite being immunised), as well as data on adverse events and safety. The UK is well placed to generate this data because of its computerised GP records. 11/12

The problems that afflicted Test and Trace in its early days, such as the failure to record test results in primary care records, must be avoided. This is could be achieved by integrating vaccination recording at the time of vaccination in the patient’s primary care record. 12/12