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First 3-and-a-bit weeks of data on vaccinations (excludes the week just gone) suggests we were delivering only about 50,000 doses a day: broadly equivalent to the number of pre-pandemic pizzas served by Pizza Express each day. https://coronavirus.data.gov.uk/details/healthcare#card-people_who_have_received_vaccinations
At last week’s rate (50,000/day), it would take us about 3 years to vaccinate all adults with a *single* dose. So if, as we think, the rate approximately doubled this week (100,000/day) that would be 3 years to double-dose adults. We are *leagues* away from where we need to be.
At a time when the hospitals are maxed out & NHS staff overworked with colleagues having to quarantine, all dealing with the winter & its Second Wave, I cannot see how existing NHS structures are the right mechanism to distribute (at the scale we need) the Oxford/AZ vaccine.
Given we have this lag, which I can only assume is manufacturing/supply lag, would it not be better to use NHS facilities (hospitals/GPs) to deliver Pfizer & Moderna only to (1) those who have extreme clinical vulnerability (need to consult health records) & (2) NHS/care workers?
Then AZ/Oxford vaccine (normal fridges) could be distributed by pharmacists/vets/air steward(esse)s/retired clinicians from places with (a) refridgeration; (b) space for post-vaccine social distancing (esp if outside); (c) traffic access. Drive-through restaurants, pubs, Pret...
If those receiving on basis of criteria *other than* age (inc care homes, extreme vulnerability, front-line staff) done through hospitals/GP/mobile with Pfizer, AZ/Oxford could go to all adults purely on basis of age band. That admin = Local Authority Democratic Services Depts.
If there is a manufacturing/supply crisis, we need to know of it now. But if we are going to get 100m doses available in the next 3 months, it’d be good to see the plan for distribution that isn’t based on the NHS just working harder after the hardest winter in its entire history
There are two types of challenge: (1) getting 100m doses (50m adults) delivered to the UK ready to distribute; (2) distributing 100m doses at decent rate (i.e. 1m-2m *a day*) which means 2nd shot within 3-6 weeks. I’m only concerned with the latter here.
The NHS cannot, given current pressures, deliver 1m+ vaccines a day under any circumstances. The NHS currently handles about 1.1m GP appointments per day. You can’t just add delivery of 1m vaccines a day, effectively doubling GP workload. Doing this at scale needs something extra
I suspect the reason for not ramping up distribution is, in part, because Government doesn’t expect to have the supply of vaccines to distribute. That raises a whole bunch of separate questions as to why not, and what (if anything) can be done about it?
Matt Hancock has today said that we won’t be *offering* (not even delivering) a vaccine to all UK adults until the Autumn of 2021. That would be approximately a full year after we cracked producing the AZ/Oxford vaccine at-scale in 1,000-litre batches. This is catastrophic.
We’ve recently ordered an extra 10m Moderna (17m total) in anticipation of MHRA approval (FDA already approved). That takes totals ordered to 367m doses for the UK from a portfolio of 7 developers https://www.gov.uk/government/news/uk-government-secures-additional-2-million-doses-of-moderna-covid-19-vaccine
All credit to the Vaccine Task Force for buying a good diverse portfolio, hedging bets on uncertain efficacy, but now we have at least 3 safe vaccines that work: 100m doses from AZ/Oxford, 40m from Pfizer, 17m from Moderna. That’s enough to vaccinate every adult & child in UK.
Save for certain clinically vulnerable individuals, for whom the GSK/Sanofi might be used, we need to accelerate production & delivery of what we have. We should *over* manufacture (in the UK) Oxford/AZ to complete our programme quickly & give away the excess when it comes.
That http://Gov.uk link identifies that we have spent £230m on manufacturing capacity for vaccines. That is a good thing, for this pandemic & for the future, but why so little. HM Treasury estimates we spent *£15 billion* on PPE (60x as much as manufacturing vaccines).
Doing anything on this roll-out requires us to know the volumes of each vaccine that will be delivered by which dates in 2021? For AZ/Oxford, that’s primarily about UK manufacture & fill/finish. For Pfizer & Moderna, it is being made abroad & imported. But *by when* & *how many*?
The evidence from Parliament by Kate Bingham & Professor Lim is still the clearest information we actually have about manufacturing supply chains (see pp.27 onwards). https://committees.parliament.uk/oralevidence/1136/default/ Anyone interested in this area needs to start there.
The reason for buying vaccines in batches of 60m was based on the ‘vulnerable’ population of 30m people (answer to Q284). 1 of the 4 manufacturing investments was Valneva, Livingston, which should reach 200m doses/yr capacity in 2021 (if approved) (answers to QQ.281 & 284)
Ramping-up manufacturing is incredibly difficult with vaccines, but the hard part is scaling from test-tube up to 1,000-litre (or 2,000-litre) batches. But we managed that by October 2020 (evidence on 4 Nov was we were on 1,000-litre Batch 3). This has gone very well in India.
The Sun has an interesting piece, but needs to be read with care: https://www.thesun.co.uk/news/13700836/covid-vaccine-every-adult-autumn-matt-hancock/ The “current rate” of 200,000 would represent 4x the week previously (w/e 5 Jan 350k in the whole week). I’d guess that’s just a one-day record & week-total for w/e 12 Jan was about 700,000.
I’m a little concerned by the quote “We are going to have enough to offer the vaccine to everyone aged over 18 by autumn.". That tells me that more than 100m doses of different vaccines will have been *delivered to the UK* by Sept/Oct 2021, not whether they’ll be in arms by then.
This, however, is terrifying: “A new national booking service for people to be vaccinated will also be unveiled - and no one will have to travel more than ten miles to get one, the PM added.” Why have ‘a national booking service’ at all? B/c Gvt so good at IT projects in a hurry?
And why are individuals ‘booking’? Demand will require handling which takes up administrative resource (which is why GPs texting saying “please don’t contact us to ask when”). Patient convenience is often a good thing, but not exactly a priority in this pandemic. Tell, don’t ask.
But the other point about the rate of vaccination is that you do *people* really quickly when just doing 1st doses. But giving 2nd doses, you are working at the same rate but adding no new individuals. So 200,000 doses = 200,000 people at the beginning, but 100,000 people later.
Now in a perfect world, if you did 50m doses in 25 days (2m/day), you’d do all adults in 25 days, then start everyone again for 2nd dose (because 25 days would be just over 3 weeks since first jab). Going slower means (some/greater) overlap of 1st & 2nd doses = admin complexity.
