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1/18 From early next week, probably Tuesday, 50 of our NHS hospital trust members will start to administer Pfizer vaccine. Who will they vaccinate, where, and what are issues involved? Explainer thread follows. Spoiler alert – large, complex, important logistical challenge!
2/18 Despite challenge, key to remember we’re lucky to be one of the first countries in the world to be able to start mass COVID-19 vaccination at this point. However challenging the actual delivery of the vaccination will be, this is a fantastic development we need to welcome!
3/18 At a top level, the challenge is to match yesterday’s JCVI prioritisation of who should receive vaccine first with yesterday’s @MHRAgovuk conditions of authorisation. This authorisation sets out complex requirements on how the vaccine can be transported, stored and used.
4/18 For those who prefer to use the source material. The JCVI prioritisation can be found here: https://www.gov.uk/government/publications/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi-2-december-2020/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi-2-december-2020. And the detailed @MHRAgovuk conditions of authorisation can be found here: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/940728/Conditions_of_Authorisation_for_Pfizer_BioNTech_COVID-19_vaccine.pdf
5/18 JCVI prioritisation clear. Care home residents & their carers. Then over 80s and frontline health/care workers. Prioritise latter by risk of acquiring infection, individual risk of developing serious disease or risk of transmitting infection to multiple others.
6/18 @MHRAgovuk conditions also clear. At top level (more detail below) Pfizer vaccine has to be transported and initially stored at minus 75 degrees C. It can only be moved four times. Two doses need to be administered three weeks apart. It comes in boxes of 975 doses.
7/18 This means that vaccine needs initial storage in appropriately sized -75C fridges. Currently only realistic place for this is hospital hubs hence strong current focus on using 50 hospitals as initial point of distribution for this vaccine. Other vaccines will be different.
8/18 @MHRAgovuk and NHS currently validating / working on process to enable splitting of boxes of 975 doses into smaller parcels. Vaccine can be stored before final use at 2-8 degrees C but only for five days. This would make vaccine suitable for administration by primary care.
9/18 The other key context is forward vaccine dose availability. We know the number of Pfizer doses for December and January but not beyond that. We don't know when / if the two other vaccines at front of queue - Oxford and Moderna - will receive authorisation. This means....
10/18 …We therefore have to work on the precautionary basis that this initial batch of 800,000 could be the only batch we receive for some time. On that basis, it is vital that hospitals seek to vaccinate as many of JCVI’s highest priority groups as possible in initial phase.
11/18 Yesterday’s combination of JCVI prioritisation/MHRA authorisation conditions therefore changes previous, unofficial, assumption hospitals would concentrate initially on staff. Priority is to vaccinate care home residents, their carers, then over 80s & most at risk staff.
12/18 So, over the next few days, the 50 hospitals will be doing the following three things. First, they will be working with local care homes and local authorities to maximise the number of care home carers / workers coming into hospital hubs for vaccination.
13/18 Second, hospitals will identify as many patients over 80 as possible that they can vaccinate. Obvious candidates would be those attending outpatient appointments and those receiving inpatient treatment. Trusts calculating these numbers over the next few days.
14/18 Third, they’ll see if they can vaccinate care home residents. This won’t be easy though. Working assumption is we’ll have to wait for @MHRAgovuk authorisation of box splitting and primary care distribution for mass coverage of care home resident population.
15/18 If there are vaccine doses left over, hospitals will then vaccinate staff based on defined risk/already booked. Hospitals will ensure all of above who get a first dose will be available for a second dose three weeks thereafter. Vital to ensure all doses used effectively.
16/18 Once the 50 hospitals are clear what volume of doses they can use for the target groups in their footprints, this can then feed into national level allocation between the 50 sites. This will also help ensure that the vaccines used as efficiently as possible.
17/18 Worth pointing out this is all in addition to underlying tasks of getting the right workforce in place; getting that workforce trained; getting the vaccines transported and stored; effective public communications so everyone who needs vaccine knows what to do when etc..
18/18 A very significant logistical task to be done at pace. But this is what NHS is good at. And why we benefit hugely from having a National Health Service, as creation of 33,000 beds for coronavirus patients in first phase showed. Trusts will deliver this vital task!