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Is there anywhere a tracker which shows, by vaccine type (mRNA Pfizer/BioNTech vs adenovirus Oxford/AstraZenica): (a) doses delivered to UK; (b) doses ordered by not yet delivered (& due date); (c) doses manufactured & bottled but not yet cleared; (d) UK-manufactured WIP volumes?
Also, would be great to be able to track by vaccine type (mRNA w/ refrigeration reqs vs adenovirus needing regular fridges): (a) number of centres distributing; (b) number of clinical staff trained to vaccinate per centre; (c) number of patients processed per centre per day?
Struggling at the moment to work out the bottlenecks. Seems to be manufacturing (special glass vials) & batch clearance, but hard to be sure. Also, if glass vials are the problem, I’ve seen nothing on process for the return & recycling of them from centres back to manufacturers.
The Sun is quoting the UK Gvt as saying it hopes to vaccinate 15 million people by March. Respectfully, that doesn’t seem very many: just 250,000 per day. If each clinician could do 50 injections/day (8 hours/day, 10mins per patient), that suggests only 5,000 clinicians injecting
There are supposed to be at least 1,000 vaccination centres that can deal with the complex refrigeration of the Pfizer/BioNTech vaccine (937 doses per batch, must use in 3.5 days), which should = 2m doses/week if available. Are there really only going to be 5 clinicians/centre?
Now there is MHRA approval for the Oxford vaccine (a major victory), there is no way that (wo)manpower or refrigeration or physical sites are going to be limiting factors. So it must be a manufacturing and/or batch clearance issue, which I think deserves close scrutiny.
I have some professional experience of supply chain planning, and I am simply at a loss to know how estimates of available Oxford vaccine fell from 30m by the end of 2020 (September), to 4m by the end of 2020 (November) to actually having only 530,000 doses ready to put in arms. https://twitter.com/jamesrbuk/status/1344307365957541895
The National Audit Office is monitoring this, but largely from the perspective of value for money. https://www.nao.org.uk/report/investigation-into-preparations-for-potential-covid-19-vaccines/ I’m personally more invested in the “value for money be damned, how do we increase capacity & get this over with faster” considerations.
Headline of the NAO Report on Phase 4 (para 4.14) is that before the switch to single dose (12-week mark for booster), the working assumption was that the UK would only vaccinate 25m people against COVID in all of 2021, and even that was if-but-only-if enough was manufactured.
There is an assumption of 46,000 staff needed: 26,000 clinicians & 20,000 administrative staff, assuming a take-up of 75% (presumably 75% of the 25m). Again, this assumes vaccination being done *throughout* 2021.
I recognise that this is very complex, and there were huge uncertainties about MHRA approval in 2020, but I can’t help but feel that for all the money spent on non-spec PPE, no-one was exactly shooting for the moon on vaccine distribution: i.e. 100m doses (50m adults) in 100 days
We are now in the most frustrating of situations: 2 approved vaccines already ordered, but logistical problems with manufacture & delivery that feel like they could have been solved with enough planning & investment in redundancy (extra plant etc) in anticipation in 2020.
Given the virus is both beginning to mutate & become more transmissible, the need to vaccinate everyone (Phase 1 or otherwise) *quickly* rather than doing it at a leisurely pace over the summer or even into 2022, seems rather more urgent than ever.
This, via @Birdyword, is a great piece on the vial shortage problem from ***May 2020***. Multi-dose vials (5-6 doses in each) eases the problem, but the vials take months to make: https://www.businessinsider.com/coronavirus-vaccine-glass-vial-shortage-could-delay-global-rollout-2020-5
I really want to know more about the life-cycle of glass vials. When inoculations are given, what is the process for collecting all of the previous vials to be re-used/re-purposed? Who collects for manufacturers to re-use? Who owns the empty vial? How quickly can it be re-used?
The shortage is said to be in Borosilicate Glass which is used for vaccine vials as it can handle highly variable temps (useful given Pfizer/Moderna refrigeration requirements). But other materials for vials are available, maybe even better https://cen.acs.org/materials/Vials-vital-COVID-19-vaccine/98/i37
If the Oxford vaccine doesn’t need to be stored at extreme temperatures, and in circumstances where the period between manufacture & use would be ideally days or weeks, not many months, is it as necessary for the glass vials to be borosilicate, or would less inert glass suffice?
This is interesting. It quotes Kate Bingham, outgoing head of the vaccine task force, suggesting that it is a deliberate choice based on shelf-life not to put the batch of Oxford/AZ vaccine into vials early. https://www.channel4.com/news/factcheck/factcheck-qa-how-much-coronavirus-vaccine-do-we-have
She told the Select Committee on 4 Nov: “We have not put it into vials because, as soon as you do that, you start the clock for its shelf life and how quickly you have to use the vaccine”. Can anybody tell me what the shelf-life is of an adenovirus vaccine once filled/finished?
(1) I can’t imagine the expiration date would be less than 6 months. By comparison, the Teva adenovirus vaccine (stored between 2 and 8 degrees C) has a shelf-life of 30 months. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151885/ I can’t imagine why shelf life would play a significant role in this case.
If shelf life was to be a factor, it would be because (as per the NAO report) the Gvt was only planning to vaccinate 25m citizens in the whole of 2021, meaning half the UK being vaccinated in 2022 onwards. But even then, hard to see how shelf-life relevant, unless (eg) 3 months.
(2) But the problem here is mistake compounding mistake. Aiming to only vaccinate 25m people throughout the whole of 2021 was to aim too low & too slow. But that slowness apparently introduces the spectre of vaccine shelf-life expiration, which led in turn to delaying fill/finish
This is the evidence of Kate Bingham before the Parliamentary Science & Technology Ctttee and Health & Social Care Cttee on 4 Nov 2020 (starts at the bottom of p.26). https://committees.parliament.uk/oralevidence/1136/default/ Really worth a read in full, given where we are this week.
[To be clear: I’m not criticising Kate Bingham here. Much of what her task force did - ordering 350m doses, investing in UK manufacture - it has done well. But her evidence is just about the only insight we have into decisions made by Gvt generally (inc taskforce and/or DoH)]
Taskforce invested in four key manufacturing sites:
The working basis was for 4m Oxford/AZ doses available by the end of 2020, rising to 100m Oxford/AZ doses within the first half of 2021.
The manufacturing constraint (which led to revision of the May 2020 estimate of 30m doses by September, to the November 2020 estimate of 4m doses by year-end) was about scaling up to 1,000 litre batches. But by 4 Nov, this had been accomplished (working on 1,000-litre Batch 3):
Bulk manufacture does not, therefore, appear to be the major limiting factor. We were able to produce 1,000 litre batches domestically by October (4 Nov was Batch 3). The Serum Institute of India has already made 50m doses & will produce 100m/month https://timesofindia.indiatimes.com/india/expecting-covid-vaccine-approval-soon-50-million-doses-ready-serum-institute-ceo/articleshow/79995874.cms
Given that our aspiration is not only to make for UK use, but to help create for global use (to be sold at cost), should we not have ramped up manufacturing to a far greater degree in October/November? And why not use those months to fill/finish the first 4m doses into vials?
Reading Kate Bingham’s evidence, the obvious governance failure here is having the Vaccine Taskforce doing upstream (procurement, manufacturing, regulatory approval), but DoH/NHSE doing roll-out. These answers tell the story:
If vaccination was a rolling programme, to be done every year, this distinction makes perfect sense. But for a one-off extraordinary vaccination, I would have thought better to operate outside of usual operations with a dedicated team running the whole project from end-to-end.
Again, the focus on only vaccinating the 25m most vulnerable (over the whole of 2021) made prioritisation on basis of health-risk a big deal (1/3 of those are <65yrs). But if aiming to do (e.g.) all adults within 3 months on basis of age, less need for fine-tuning prioritisation.
The need to pick out those with underlying health conditions is a facet of going slowly. If you go very fast (all adults vaccinated w/in 3 months, by age) you do young adults with conditions just as quickly as current plans, but with a *much* simpler DOB-based distribution model.
Alternatively, you re-direct the 8m under-65s with underlying health conditions & front-line healthcare workers (i.e. those who you want to prioritise *other* than on grounds of age) to get Pfizer/Moderna from Hospitals (who have health records & clinical refridgeration)...
and run Oxford/AZ (normal refridgeration) allocation independently of existing NHS (borrowing clinicians/vets/pharmacists) and vaccinate (and prioritise) purely on the basis of age, using voter rolls. After all, separate streams have to be run anyway b/c of refridgeration.
