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On the figures, Health Secretary says 100 vaccination sites has now become 400, and 350,000 vaccinated by Friday morning. But Tier 4 may persist until it is largely rolled-out. How long will it take for roll-out, and what are the bottlenecks in doing so? 1/x https://twitter.com/matthancock/status/1340612243394846722
The Pfizer & Moderna vaccines have significant refrigeration requirements. There will be around 1,000 centres (approx 1 per PCN) which can store at least 1,000 vaccines (the batch is 975, which can be defrosted and stored in fridges for 3.5 days). https://www.pulsetoday.co.uk/news/clinical-areas/immunology-and-vaccines/gp-covid-vaccination-sites-will-need-to-administer-975-doses-in-just-3-5-days/
*Minimum* vaccination will therefore be about 1,950 vaccines per week per centre (975 per 3.5 days, bi-weekly delivery), which with 1,000 centres would be around 2m vaccines delivered per week *at a minimum*. However, only 800,000 doses of Pfizer have been delivered to the UK.
The UK has *ordered* 40m doses from Pfizer, but there will be great international competition to actually get those doses over the coming months. So much will hinge on MHRA approving the Moderna vaccine (yesterday approved by the FDA in the US).
UK has increased its order from Moderna from 5m to 7m https://www.manchestereveningnews.co.uk/news/uk-news/moderna-coronavirus-vaccine-been-approved-19484632 But combined with Pfizer/BioNTech, that’s still only 47m doses (which if you give each person two shots, 3 weeks apart for full vaccination), only covers 23.3m people (about 35% UK population).
If you’re not following @zeynep you should be, because she’s been a clarion voice during the pandemic, ahead of the curve on almost every major issue (social distancing, masks, ventilation). This is her view propounding *trials* on efficacy of single-dosing the vaccines: https://twitter.com/zeynep/status/1339925606109237248
This puts more pressure on the Oxford/AstraZeneca vaccine. The UK has ordered 100m doses (where 2 doses required per person, so 50m people), but only about 4m will be delivered by the end of 2020 (was hoped to be 30m based on 80% UK manufacture, but manufacturing issues arose).
Obviously, MHRA approval of the Oxford vaccine is also critical, otherwise vaccine supply will be a huge limiting factor in roll-out. However, if both Oxford & Moderna get MHRA approval, we’ll have a decent supply, with capacity for at least 2m doses delivered per week.
If there is sufficient supply (a *huge* if), we should be able to ramp up the rate significantly, especially as the Oxford vaccine doesn’t have onerous refrigeration requirements. So big factors to monitor (a) MHRA approval of Moderna & Oxford; (b) UK manufacturing of Oxford.
BBC has 1.1m carers & residents of care homes in Category 1, so should be done by end of 2020. Frontline staff plus 70+ (Cats 2 + 3) are 10.6m, so 1st dose end of Jan 2021, on the basis of 2m doses/week minimum (supplies allowing). https://www.bbc.co.uk/news/health-55332242
But then, from mid-Jan onwards, the rate of *people* vaccinated with Pfizer/Moderna will effectively halve, as vaccination doses will be split between 1st dose (lower Categories) and 2nd dose (for higher Categories 3 weeks after 1st dose).
The Belfast Telegraph indicates that there should be 20m Pfizer doses delivered to the UK by end of March 2021, so alongside Moderna 7m (but 2 doses per person), that’s enough to cover Categories 1-4 (care homes, frontline healthcare workers, all who are 70+/extremely vulnerable)
26m doses at a minimum rate of 2m per week (remember: for refrigeration reasons) at 1,000 vaccination centres takes us to about the end of March. But Oxford vaccine, if approved, could be delivered at perhaps all GP surgeries (not just 1000 special vaccination centres).
If Oxford vaccine delivered in parallel, if and when approved by MHRA, there are 24.8m people in Categories 5-9 (aged 50-69, or 16-69 with underlying health conditions), so 50m doses. But there is less of a restriction on rate of delivery, and it is *supposed* to be 80% UK-made.
Hard to work out how fast we could vaccinate Categories 5-9 (and the healthy under-50s) if supply of the Oxford vaccine was no issue. By way of a loose comparator, 32m adults vote at 50,000 polling stations in a single *day* at a General Election.
A team of 2 clinicians conducting vaccinations, with separate staff overseeing 15-minute on-site observation afterwards, will have to check medical history (inc. allergies) etc before administering vaccine. My recent jabs were well under 5 mins inside, but allow maybe 10min mean?
If each team can do 50 doses a day, that’s 1500 per team per month. 10 teams per station with a common observation area (e.g. 25 clinicians), would be 15,000 doses per month per station. Even 5,000 stations would see 75m doses in a month, or whole UK population done in 7 weeks.
So *if* Oxford is (a) MHRA approved; (b) UK manufacturing delivers; & (c) Gvt pushes vaccination at-scale because we can’t leave Tier 4 without it, it is *conceivable* that this could be done in weeks. It’s a huge logistical challenge, but then so is counting 32m votes overnight.
Obviously the Government cannot & must not do anything to interfere in the MHRA decision, but other limbs are logistical challenges it can control. Manufacturing slightly less so, but no excuse not to have Nightingale stations & trained clinicians (pharmacists, army) ready-to-go.
I’d love to see daily update on Pfizer/Moderna deliveries & on Oxford/AstraZenica UK delivery/production. I’d also love to know that distribution of latter to fridges, training of teams & observation staff, was happening *pending MHRA approval*, so it is ready-to-go.
I’d also love to know mechanism for inviting general population by category. Clearly frontline healthcare workers & (extremely) vulnerable need to be done through HMRC/health records, but all other categories based on age. Doesn’t need to go through NHS: can do on electoral roll.
Pending authorisation, this logistical challenge (which is complex, but not rocket science) is the difference between Tier 4 ending within 6 weeks of authorisation or 6 months. Given the economic cost, there is no excuse for it not being done properly.
