Tag: Vaccination

Can the UK meet the government’s target of offering all adults a covid-19 vaccine by 31 July?

The Prime Minister Boris Johnson has set a target of offering a first dose of a covid-19 vaccine to all adults in the UK by the end of July 2021. What do we need to do to achieve this target? The first step is to ensure we have enough vaccines to offer first and second doses to all adults. There are around 53 million people aged 18 and over in the UK. If everyone took up the offer of a vaccination, we would require about 106 million vaccine doses, along with a small amount of vaccine for people under 18 who are classed as clinically extremely vulnerable.

Currently, we are using two vaccines in the UK: from AstraZeneca and Pfizer-BioNTech. A third vaccine from Moderna has been licensed in the UK but is not yet in use. Other vaccines—such as the candidate from Novavax—are in the late stages of development and approval; and may come into use in the UK by the early summer. The government will need to ensure that these companies can supply enough vaccines for use in the UK to meet its target date of 31 July.

How quickly do we need to vaccinate the UK population to meet the target? By 20 February, the UK had administered around 18 million doses of covid-19 vaccines (17.2 million first doses and 0.6 million second doses). This means that we need to administer around a maximum of another 88 million doses of vaccines if all adults in the UK accepted the offer of a vaccination and received two doses of vaccine.

In recent weeks, about 2.9 million doses of vaccine have been administered each week in the UK. As there are around 23 weeks until 31 July, we would be able to administer about a further 66 million vaccine doses by the target date, bringing the total doses administered to 84 million. This would be sufficient to provide all 53 million adults in the UK with at least one dose and also to provide 31 million of these people with two doses of vaccine.

Maintaining the same pace of vaccination after July would allow all adults in the UK to receive two doses of vaccine by mid to late September. In practice, we may need less than a total of 106 million doses of vaccine to immunise adults in the UK because not everyone will take up the offer of a covid-19 vaccination. Hence, the target of “offering” all adults in the UK a first dose vaccine by 31 July looks achievable if the supply and administration of vaccines can both be maintained at their current rates.

It’s also worth considering whether the UK should be more ambitious in its target. For example, if there was sufficient capacity in the NHS to offer 3.8 million doses of vaccine per week —an increase of 31% on the current vaccination rate—and vaccine supplies to allow this, all adults in the UK could receive two doses of vaccine by 31 July. In either scenario, 2.9 million doses weekly or 3.8 million doses weekly, the UK would have offered two doses of vaccine to all adults in the UK before the Autumn and thus would be better prepared for any seasonal increase in covid-19 infections than it was in 2020.

Maintaining an average of 2.9 million vaccinations per week for the next 23 weeks is ambitious, but it looks practical if vaccination sites can be guaranteed sufficient doses of vaccine.  Vaccination sites will also need to have deliveries timetabled well in advance so that clinics can be planned and patients booked in for appointments. It’s therefore critical that we avoid the problems seen in the earlier phase of the vaccination programme, when deliveries of vaccines to vaccination sites were often arriving late or being cancelled at short notice. This created logistical and planning difficulties for vaccination teams, as well as being very inconvenient for patients who had their appointments cancelled.

We also need to bear in mind that we have thus far been vaccinating groups of people, such as older or clinically vulnerable people and frontline healthcare professionals, where vaccine uptake has been very high. As we start to vaccinate younger, healthier groups of people, we may find vaccine uptake is lower than in older people because of greater levels of vaccine hesitancy. We need to ensure that we engage with vaccine hesitant groups—whether these are younger people or people from ethnic minority communities—to achieve a very high uptake of covid-19 vaccination. Broad population coverage is the vaccination programme’s best hope of success in helping to limit the spread of covid-19, allowing the UK to gradually relax its covid-19 control measures.

At this point, we also don’t yet know if booster vaccines will be required later in the year or in 2022 to deal with the effects of any decline in immunity following vaccination, or to provide protection against new variants of SARS-CoV-2 if older vaccines are less effective. If this is the case, we will need to put in place the infrastructure to deliver additional doses of vaccines to all adults in the UK, making the covid-19 vaccination programme like the influenza one but on a much bigger scale. It’s also possible that we will have vaccines licensed for use in children later this year, which will further increase the number of people who need to be vaccinated. The size of the covid-19 vaccination programme and its importance in allowing a return to a more normal way of life in the UK means that it must be meticulously planned and adequately funded for the indefinite future.

In conclusion, the government’s vaccination target looks achievable if it can guarantee sufficient supplies of vaccine; improve the planning of deliveries to vaccination sites; and provide vaccination teams with the required financial, administrative, and personnel support. This needs to be done at the same time as the NHS deals with all its other emergency and elective work, as well as with the large backlog of work caused by covid-19. As the majority of covid-19 vaccines have been delivered by primary care teams, particular emphasis must be placed on supporting NHS primary care during this period to ensure successful achievement of the vaccination target.

This article was first published in BMJ Opinion.

How can we address Covid-19 vaccine hesitancy and improve vaccine acceptance?

Vaccination offers the UK the best exit strategy from the covid-19 pandemic. [1] To accomplish this objective, achieving high population coverage of covid-19 vaccination is essential. However, despite the good safety and efficacy of covid-19 vaccines, public scepticism about the vaccines persists. [2] Vaccine opposition has existed for as long as vaccinations and, despite the public’s increasing scientific sophistication, has been growing across high-income countries, leading the WHO to list it in the top 10 global health threats in 2019. [3,4] In the UK, the covid-19 vaccination programme continues to gather pace, giving the UK a rare pandemic win; however, those prioritised for vaccination represent groups with low vaccine hesitancy rates. There have been many surveys assessing covid-19 vaccine hesitancy. Potentially affecting as many as one in three individuals in the UK, vaccine hesitancy is pervasive, especially amongst young adults and ethnic minorities, threatening to undermine the pandemic response. [5-7] To avoid disrupting the vaccination programme’s success, developing strategies that address vaccine scepticism is essential.

To dispel vaccine misinformation and myths, differentiating between the under-vaccinated, the anti-vaxxers, and the vaccine-hesitant is required. The vaccine-hesitant represent those who are uncertain about getting vaccinated, but remain open to it if they are convinced that vaccines are safe, effective, and necessary. In the vaccine-hesitant, it is essential to differentiate between vaccine-associated misinformation and mistrust.

A recent survey carried out by the Royal College of General Practitioners demonstrated that people of Black, Asian and mixed ethnic backgrounds are 53%, 36% and 67% less likely to have been vaccinated when compared to their white counterparts. [8] In the US, 32% of Black adults would definitely, or probably, get vaccinated if made available at no expense, compared to 52% of White adults. [9] While these communities are not ill-informed regarding their heightened risk of severe illness and death from covid-19, hesitancy in ethnic minorities remains disproportionately high. [9] Mistrust felt by this population is not irrational and must be addressed with respect. In addition to a history of systemic racism, which affects many Black people globally, the pandemic has allowed mistrust of covid-19 vaccines to thrive; as stated by the WHO, “racist remarks”, including French doctors suggesting Africa should be a testing ground for coronavirus, are not helpful and this “colonial mentality has to stop.” [10] In the UK, 90.6% of covid-19 vaccine recipients are white. [8] To avoid increasing the health inequalities that covid-19 has harshly exposed, engaging with vaccine-hesitant subgroups is required to increase knowledge levels, reduce perceived risks, and enable informed decision-making. Enhancing vaccine access and convenience will also improve support for vaccination. [11]

As real-time evidence continues to emerge, and mass vaccination campaigns approach vaccine-hesitant groups, culturally sensitive and tailored risk communication and messaging, co-involving faith and influential community leaders, are required to continuously inform, update, and reassure the public. [12] Covid-19 vaccines are unlikely to be made mandatory. Nudging individuals, through choice-offering strategies, incentivises vaccination, and aligns intention with actions. [13] Scientists proactively listening to concerns of subgroups and sharing risks and benefits in a manner that does not impose, but persuades, will improve voluntary cooperation. [13] As there are genuine concerns regarding their record-breaking timescales, alleviating uncertainties about vaccine safety and efficacy is essential. Communicating carefully that their development has followed the same legal requirements for pharmaceutical quality, safety, and efficacy as other medicines, and circulating accurate information including how advances in Ebola, whooping cough, rabies, human papillomavirus and hepatitis A and B vaccine technologies were leveraged for covid-19 vaccine development is important. [14,15]

The availability of online anti-vaccine narratives represents the leading cause of the rise in vaccine hesitancy; accessing these platforms for five to ten minutes increases the perception of risk of vaccines and reduces the perception of risk of refusing vaccines and intention to vaccinate. [16,17] While a number of the “next generation” covid-19 vaccines are based on sequence information, as opposed to “classical” virus- or protein-based vaccines, these vaccines are built on years of developments in infrastructure, knowledge and technical capacity. [18] Removing seeds of doubt requires filling information voids through carefully-designed health surveys, observational qualitative research and social media listening that avoid information overload and the unintentional generation of misinformation through, for example, multiple-choice questions that can lead respondents to misremember false responses as correct. [19,20] Additionally, addressing science-based uncertainty and reduced confidence in public health requires clear communication about the science and building trust through community outreach, respectively. [19]

Drugs, including vaccines in vials, remain useless unless people take them. The WHO’s 10-year Blue Nile Health Project, in Sudan, demonstrated limited success of mass drug administration and confirmed that a holistic and sustainable approach, inclusive of political commitment, community engagement and socioeconomic development, are all required for disease control. [21] The 2009-2010 H1N1 pandemic also demonstrated that vaccine communication efforts were a big challenge and increasing public compliance and confidence in governments and medical facilities depend on coordinated efforts. [22-23]

Vaccines stand at the crossroad between an individual’s decision to accept an intervention and the public health benefits achieved when uptake is sufficiently high. At a time when unity is crucial, additional strategies are required to reach diverse communities, build civic awareness, develop a sense of collective purpose and, ultimately, arm the population with the information needed to defeat covid-19, the latest vaccine-preventable disease we face.

Tasnime Osama, Honorary Clinical Research Fellow, Department of Primary Care & Public Health, Imperial College London

Azeem Majeed, Professor of Primary Care & Public Health, Department of Primary Care & Public Health, Imperial College London

This article was first published by BMJ Opinion.

References

  1. Majeed A, Molokhia M. Vaccinating the UK against covid-19. BMJ. 2020; 371 :m4654. doi: https://doi.org/10.1136/bmj.m4654
  2. Markovitz G, Russo A. Survey Shows Rising Vaccine Hesitancy Threatening COVID-19 Recovery. World Economic Forum. 2020. https://www.weforum.org/press/2020/11/survey-shows-rising-vaccine-hesitancy-threatening-covid-19-recovery/
  3. Wolfe RM, Sharp LK. Anti-vaccinationists past and present. BMJ. 2002;325(7361):430-432. doi:10.1136/bmj.325.7361.430
  4. World Health Organization. Ten threats to global health in 2019. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019
  5. Savage M. One in three ‘unlikely to take Covid vaccine’. The Guardian. 2020. https://www.theguardian.com/world/2020/dec/06/one-in-three-unlikely-to-take-covid-vaccine
  6. Office for National Statistics. Coronavirus (COVID-19) weekly insights: latest health indicators in England, 18 December 2020. 2020. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/articles/coronaviruscovid19weeklyinsights/latesthealthindicatorsinengland18december2020#preventative-measures-and-vaccine-attitudes
  7. Scientific Advisory Group for Emergencies. Factors influencing COVID-19 vaccine uptake among minority ethnic groups. 2021. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/952716/s0979-factors-influencing-vaccine-uptake-minority-ethnic-groups.pdf
  8. Royal College of General Practitioners. GPs call for high-profile campaign backed by faith leaders and prominent figures from BAME communities to increase COVID-19 vaccine uptake. 2021. https://www.rcgp.org.uk/about-us/news/2021/february/gps-call-for-high-profile-campaign-backed-by-faith-leaders.aspx
  9. Tyson A, Johnson C, Funk C. U.S. Public Now Divided Over Whether To Get COVID-19 Vaccine. Pew Research Center. 2020. https://www.pewresearch.org/science/2020/09/17/u-s-public-now-divided-over-whether-to-get-covid-19-vaccine/
  10. World Health Organization. COVID-19 virtual press conference – 6 April, 2020. 2020. https://www.who.int/docs/default-source/coronaviruse/transcripts/who-audio-emergencies-coronavirus-press-conference-full-06apr2020-final.pdf?sfvrsn=7753b813_2
  11. Thomson A, Robinson K, Vallée-Tourangeau G. The 5As: A practical taxonomy for the determinants of vaccine uptake. Vaccine. 2016;34(8):1018–24. doi: https://doi.org/10.1016/j.vaccine.2015.11.065
  12. UNICEF. Partnering with Religious Communities for Children. 2012. https://sites.unicef.org/about/partnerships/files/Partnering_with_Religious_Communities_for_Children_(UNICEF).pdf
  13. Dubov A, Phung C. Nudges or mandates? The ethics of mandatory flu vaccination. Vol. 33, Vaccine. 2015;33(22):2530–5. doi: 10.1016/j.vaccine.2015.03.048
  14. European Medicines Agency. COVID-19 vaccines: key facts. 2020. https://www.ema.europa.eu/en/human-regulatory/overview/public-health-threats/coronavirus-disease-covid-19/treatments-vaccines/covid-19-vaccines-key-facts
  15. Wellcome. What different types of Covid-19 vaccine are there? 2021. https://wellcome.org/news/what-different-types-covid-19-vaccine-are-there
  16. Vivion M, Hennequin C, Verger P, Dubé E. Supporting informed decision-making about vaccination: an analysis of two official websites. Public Health. 2020;178:112–9. doi: https://doi.org/10.1016/j.puhe.2019.09.007
  17. Betsch C, Renkewitz F, Betsch T, Ulshöfer C. The influence of vaccine-critical websites on perceiving vaccination risks. J Health Psychol. 2010;15(3):446–55. doi: 10.1177/1359105309353647
  18. van Riel D, de Wit E. Next-generation vaccine platforms for COVID-19. Nat. Mater. 2020;19: 810–12. doi: https://doi.org/10.1038/s41563-020-0746-0
  19. MacDonald NE, Dubé E, Greyston D D, Graham JE. Beware the public opinion survey’s contribution to misinformation and disinformation in the COVID-19 Pandemic. Canvax. 2020. https://canvax.ca/brief/beware-public-opinion-surveys-contribution-misinformation-and-disinformation-covid-19
  20. Roediger HL, Marsh EJ. The positive and negative consequences of multiple-choice testing [Internet]. Vol. 31, J Exp Psychol Learn Mem Cogn. 2005;31:1155–59. doi: https://doi.org/10.1037/0278-7393.31.5.1155
  21. Amin M, Abubaker H. Control of schistosomiasis in the gezira irrigation scheme, Sudan. J Biosoc Sci. 2017;49(1):83–98. doi: 10.1017/S0021932016000079
  22. Schnirring L. H1N1 LESSONS LEARNED Vaccination campaign weathered rough road, paid dividends. Center for Infectious Disease Research and Policy. 2010. https://www.cidrap.umn.edu/news-perspective/2010/04/h1n1-lessons-learned-vaccination-campaign-weathered-rough-road-paid
  23. Mesch GS, Schwirian KP. Social and political determinants of vaccine hesitancy: Lessons learned from the H1N1 pandemic of 2009-2010. Am J Infect Control. 2015;43(11):1161–65. doi: 10.1016/j.ajic.2015.06.031

All-Party Parliamentary Group on Coronavirus

I was invited to join a meeting of the All-Party Parliamentary Group on Coronavirus earlier today when I was questioned on the implementation of the Covid-19 vaccination programme in the UK, vaccine hesitancy and how this can be addressed, and how we can ensure the programme is successfully completed.

The UK has made an excellent start to its Covid-19 vaccination programme and we should build on this success by supporting and investing in local primary care and pharmacy teams. The mass vaccination centres set up by NHS England may have a role but we must ensure that they do not divert staff, funding and vaccines from local vaccination centres run by primary care teams. Local centres can work flexibly and are more accessible for patients.

Finally, vaccine hesitancy is an important issue and we must work locally, as well as nationally, with the public and patients, to address this in the groups where it is highest – such as young adults, ethnic minorities, and people from poorer backgrounds.

Vdeo: https://www.pscp.tv/w/1BRKjBVaogvKw

COVID-19 Vaccination in the UK: We Need a Sustainable Infrastructure for the Programme

Earlier during the week starting on 15 February, we learned that more than 15 million people in the UK have now received their first dose of a COVID-19 vaccine, including more than 90% of people aged 75 and over. All residents of care homes have also now been offered a vaccination. This is excellent news and means that the groups that for the vast majority of COVID-19 deaths have now been immunised.

We will start to see the effects of vaccination in the coming weeks once enough time has elapsed for people to develop post-vaccination immunity. In particular, this should result in a reduced burden on the NHS as well as a lower death rate. But although we can be proud about what the vaccination achieved, we also need to remember that the programme is a marathon and not a sprint. There is a lot more work to do yet to complete the programme.

As well as continuing to offer first doses of vaccine to people, in April we will need to start offering the delayed second doses of vaccine, which will substantially increase the workload generated by the vaccination programme and place greater demands on NHS vaccination teams. We have also thus far been vaccinating the groups where “vaccine hesitancy” is generally low, such as the elderly and health professionals. As the figure below shows, from the UK Office for National Staistics, we will now start to vaccinate younger people, among whom vaccine hesitancy is at a much higher level than among older people.

Vaccine hestitancy is also more common in Black and other minority ethnic groups, as shown below, in a figure also from the UK Office for National Statistics. These groups are at higher risk of infection, severe disease and death. Hence, it is essential that vaccine hesitancy is also addressed in ethnic minority groups through sustained engagement with communities.

It’s also possible that people will need additional “booster” doses of vaccine at some point to counteract the effects of decreasing vaccine-generated immunity and to deal with new variants of SARS-CoV-2 amongst which current vaccines may be less effective. To help develop these modified vaccines, we will need continued research and it’s essential that members of the public sign up to take part in these projects; in particular, older people and people from ethnic minority groups, both of whom are often under-represented in trials.

We have made great progress in developing vaccines and implementing a vaccination programme. Congratulations to all for this; including industry, universities, government, the NHS and the public. But we are only at the start of this programme. We will need a sustainable, long-term vaccine infrastructure that will require investment and staffing, as well as continuing to update our vaccines to deal with new variants of SARS-CoV-2 if current vaccines are not fully effective against them.

THIS ARTICLE WAS UPDATED ON 17 FEBRUARY 2021: Over 15 million people in the UK have now received at least one dose of Covid-19 vaccine. The challenge will be to maintain this pace when we start giving second doses of vaccine to this group later in March, whilst also giving other target groups their first dose.

Your Covid-19 vaccine questions answered

My gran has had both her jabs. Once lockdown has ended, can I go and see her?

Once lockdown ends and the prohibition on people from different households mixing indoors stops, including for the clinically extremely vulnerable, you would be able to visit your grandmother. However, it may be some time before this happens.

I’ve been shielding on my own. Once I’ve had the vaccine will I be able to form a bubble with other family members?

You would need to continue to follow any lockdown rules that are in place in your local area even after you have had two doses of the vaccine.

I’ve had my first vaccine – can I hug my grandchildren?

One vaccination offers only partial protection. Two vaccinations are needed for maximum protection. Even after receiving two doses of vaccine, you would still need to follow any lockdown rules that were in place in your local area.

Can my employer force me to get vaccinated?

It’s unlikely that employers could force you to get vaccinated but they could recommend vaccination for staff who have public-facing roles that place them at increased risk of infection.

Everyone in my mum’s care home has had the vaccine. Should they allow relatives to visit without a screen?

Relatives will continue to need to be screened for now because the Covid-19 vaccines are not 100% effective even after two doses and some vaccinated people can still get infected. The risk of serious illness, complications and death is very high in people living in care homes and we have to be particularly cautious with this group.

Can I still be fined for breaking the rules if I show my vaccine card?

A vaccine card does not exempt you from following any local or national rules that are in place; so yes, you can be fined for breaking lockdown rules even if you have proof of vaccination.

Once everyone has been vaccinated, might there be places those who have refused the vaccine aren’t allowed?

It’s possible that some places might implement this policy. For example, some cruise companies have said they will require proof of vaccination from customers.

Will I need to show proof of my vaccine to travel abroad?

It’s possible that some countries will require proof of vaccination before allowing you to travel there but this will vary from country to country.

If I’ve had my vaccine will I still have to self-isolate if I’ve been in contact with someone who tested positive?

If you have been in recent contact with someone who has tested positive, you would still need to self-isolate for 10 days because at this point, we don’t know if vaccination stops you being infectious.

When will we know if the vaccine just stops you getting symptoms or stops you actually getting infected?

It will take some time for research to establish this. We may find out later in 2021.

If one of my employees has been vaccinated, should I consider him/her for a role that has a higher risk of infection?

Employers should risk assess staff before placing them in a specific role. My view is that vaccination should not be used as a reason for placing potentially clinically vulnerable staff in high-risk roles that expose them to a greater risk of infection.

I’m a piano teacher. Can I advertise for students using my proof of vaccination to show I’m Covid free?

Vaccination does not guarantee that you will be “Covid-free”. You would need to continue to follow any lockdown rules that are in place in your local area.

The NHS must be fully supported in rolling out the Covid-19 vaccination programme

The news today that the MHRA has approved the AstraZeneca adenoviral ChAdOx1 nCoV-190 vaccine for use in the UK is excellent news for the Covid-19 vaccination programme. The results of the vaccine trial published in the Lancet earlier in December were encouraging, even if the overall efficacy of 70% was lower than the 90-95% being reported for mRNA vaccines from Pfizer-BioNTech and Moderna. The vaccine still prevented serious cases of illness amongst the recipients.

The AstraZeneca vaccine is cheaper than the mRNA vaccines and can be stored in a conventional vaccine fridge. Hence, it is an easier vaccine to use in primary care and community settings, including in low and middle income countries. The most commonly reported adverse reactions from the vaccine were fatigue, headache, feverishness, and myalgia. More serious adverse events were rare and not believed to be directly related to the vaccine.

One caveat for all the Covid-19 vaccines is that we don’t yet know how long the immunity they generate will last. We also don’t yet know if they stop people being infectious. As more data becomes available, we will be able to better answer these important two questions.

Now that the AstraZeneca vaccine has been approved by the MHRA, we need to see it rapidly rolled out by the NHS. The vaccine is highly suited for use in UK primary care as it can be stored in the standard vaccine fridge found in all general practices; and given to patients either opportunistically when they attend for an appointment for another problem or in dedicated vaccination clinics. It can also be much more easily used for people living in care homes and for housebound patients than the mRNA vaccines.

To ensure successful delivery of the vaccination programme, it’s essential that primary care teams and general practices are given all the support they need for the Covid-19 vaccination programme. Now is not the time for penny-pinching or for repeating the many mistakes made in the other parts of the government’s Covnd-19 strategy. We also need the government to be transparent about the amount of vaccine available for use now. Although the government has ordered 100 million doses of the vaccine (enough for all adults in the UK), we need the government to be clear what the timescale is for delivering the vaccine to the NHS and how much vaccine the NHS will be supplied with during the crucial month of January.

Vaccination offers the UK the only way out of the Covid-19 pandemic. Rapid delivery of vaccines to target groups and a high uptake of vaccination amongst the public are essential if we are to start to return life in the UK to normal.

Measuring the long-term safety and efficacy of Covid-19 vaccines

The news that two UK recipients of the Covid-19 Pfizer-BioNTech mRNA vaccine suffered allergic reactions illustrates the need for accurate recording of any adverse events following administration of Covid-19 vaccines. As these vaccines are new, we don’t yet have long-term data on their safety and efficacy. This data is essential to help build public confidence in these vaccines and ensure take-up of the vaccines is high; not just in the UK but globally as well. The data will also help identify how frequently vaccination is needed to ensure vaccine recipients retain their immunity to Covid-19.

The UK is well-placed to collect this data. We have a National Health Service that has developed computerised medical records for use in general practices on a population of around 67 million people. These electronic medical records provide longitudinal data on people’s health and medical experiences. They can now also be linked to other data; such as hospital admissions records and mortality records, as well as to the results of Covid-19 tests, increasing their value for monitoring the safety and efficacy of the new Covid-19 vaccines.

The comprehensive nature of these medical records and the large population they cover mean that they can be used to look at safety and efficacy of Covid-19 vaccines in specific populations. This could be, for example, by age, sex, medical history or ethnic group. It would also be possible to look at more serious health outcomes and death rates by linkage to other data sets. Hence, planning how we would use these data is essential and needs to start now.

The use of these data will be facilitated by the recently developed clinical codes for Covid-19 vaccines for recording information in electronic medical records. These codes include, for example, codes for whether people attended or did not attend for their vaccination appointment; whether they declined to be vaccinated; and whether they had a clinical contra-indication to being vaccinated. Other codes allow recording of the specific vaccine that was administered, which will be essential for comparing the long-term safety and efficacy of different Covid-19 vaccines.

The data from electronic medical records can be supplemented by the reporting of any suspected adverse events by health professionals to the MHRA via the Yellow Card Scheme. Vaccine recipients should also be encouraged to report any reactions directly to the MHRA a well as to their doctor. This allows the MHRA to build up information on the safety profile of the new Covid-19 vaccines and advise patients and the public of any potential problems.

The AstraZeneca adenoviral Covid-19 vaccine: What potential role does it have?

The results of the AstraZeneca adenoviral ChAdOx1 nCoV-190 vaccine trial published in the Lancet today are encouraging, even if the overall efficacy of 70% is lower than the 90-95% being reported for mRNA vaccines from Pfizer-BioNTech and Moderna; and from the Russian Sputnik adenoviral vector vaccine.

The AstraZeneca vaccine is cheaper than the mRNA vaccines and can be stored in a conventional vaccine fridge. Hence, it is an easier vaccine to use in primary care and community settings, including in low and middle income countries. The most commonly reported adverse reactions were fatigue, headache, feverishness, and myalgia. More serious adverse events were rare; none of which were thought to be due to either of the vaccines used in the study.

Based on these results, once the vaccine is approved by the MHRA, I would like to see it rapidly adopted by the NHS. The vaccine is highly suited for use in UK primary care as it can be stored in general practices and given to patients either opportunistically or in dedicated vaccination clinics. It can also be more easily used in care homes and for housebound patients than the mRNA vaccines.

There is ongoing research looking at vaccine combinations and if this research shows positive results, people may benefit from a second vaccine, such as an mRNA vaccine, after receiving an adenoviral vaccine. One caveat for all the Covid-19 vaccines is that we don’t yet know how long the immunity they generate will last. We also don’t yet know if they stop people being infectious.

Covid-19 vaccination – separating fact from fiction

Covid-19 vaccinations will kick off within days but it seems some people need a sharp dose of facts first. In an article published in the Daily Mirror, Matt Roper and I debunk some of the common myths and misconceptions about vaccines.

Scepticism about vaccines has been growing throughout the pandemic and a recent survey found that one in five British adults may refuse to take a coronavirus jab – even though it is probably our only hope of a return to normality.

  1. MYTH: A vaccine produced so quickly can’t be safe

Most vaccines take years to develop, test and approve for public use but, says Dr Majeed, a global effort has meant scientists have been able to work at record speed.

He says: “Covid-19 vaccines have to go through the same process of approval as other vaccines. Funding was made available immediately and studies set up rapidly.

“There have been a lot of technological developments that allow vaccines to be developed much more quickly.”

  1. MYTH: I might be allergic but won’t know until I get it

Azeem Majeed is professor of primary care and public health at Imperial College London

“Allergies to vaccines are very rare,” says Dr Majeed. “They are given safely to millions of people every year.”

The odds you’ll have a severe reaction to a vaccine is about one in 760,000.

Being struck by lightning next year is higher at one in 700,000.

Most reactions are because of some other component of the vaccine, such as egg protein, if the person is severely allergic.

3, MYTH: There haven’t been enough tests for people with underlying conditions

Dr Majeed says: “There are many vaccine trials taking place and they are being tested in people with different characteristics, such as age, sex, ethnicity and medical history.

“Results show they are safe in all groups they have been tested in.”

  1. MYTH: Vaccines can overload your immune system

In 2018 the myth was debunked by American researchers who examined the medical records of more than 900 infants from six hospitals.

 They found no link between vaccines given before the age of two and other infections in the following years.

 “Vaccines do not overload your immune system,” says Dr Majeed. “On the contrary, they generate an immune response that helps reduce the risk of infection, complications and death.”

  1. MYTH: The vaccine could actually give me coronavirus

Some vaccines contain the germs that cause the disease they are immunising against but they have been killed or weakened to the point they don’t make you sick.

In the case of a coronavirus vaccine, “none that are in development contain a live coronavirus,” assures Dr Majeed, “and they therefore can’t give you a coronavirus infection”.

  1. MYTH: If everyone around me is immune, I don’t need a vaccine

“It’s essential to achieve a high vaccine coverage so we create herd immunity,” says Dr Majeed. “If people refuse to be immunised, we will continue to get outbreaks of Covid-19.

“If you decline to be immunised, you may get infected and also infect the people you come into contact with.”

  1. MYTH: It’s better to be immunised by catching Covid

Dr Majeed says: “Vaccines have been shown to be very safe, whereas illnesses such as measles and Covid-19 can lead to serious long-term medical complications.

 “Vaccines have saved many lives and prevented people from being left disabled.”

  1. MYTH: Vaccinated children experience more allergic, autoimmune and respiratory diseases

This is another unfounded claim that has led some parents to delay or withhold vaccinations, says Dr Majeed.

 Studies examining many vaccines have failed to find a link with allergies or autoimmune disease.

 “Vaccines protect against many diseases and substantially reduce the risk of illness and death in children,” he says.

  1. MYTH: Some of those taking part in trials died

Stories that Dr Elisa Granato, one of the first participants in the human trials of the Oxford vaccine, died shortly after being injected, were shared millions of times.

 The news was false and she gave a BBC interview saying she was feeling “absolutely fine”.

 “Only one death has been reported among people taking part in trials,” says Dr Majeed.

 João Pedro Feitosa, a doctor in Brazil, was given the placebo rather than the vaccine and died of Covid-related complications.

  1. MYTH: The swine flu vaccine left people with side effects, so why would this one be safe?

A mass vaccination programme against swine flu in the US in 1976 led to increased chances of people developing Guillain-Barre syndrome, a rare neurological disorder.

 Dr Majeed says: “Covid-19 vaccines have been carefully tested in a large number of volunteers and found to be very safe.

 “Once they are more widely used, there will be monitoring of people who have received the vaccines to identify any future problems.”

  1. MYTH: Vaccines cause autism

 The idea that vaccines cause autism has long been disproved but the claims have recently been doing the rounds again.

 Last year a massive study from Denmark found no association between being vaccinated against measles, mumps and rubella, and developing autism.

 It is the latest of at least 12 other studies that have tried and failed to find a link.

 Dr Majeed says: “No evidence has ever been found that vaccines cause autism in children.”

  1. MYTH: The Spanish Flu vaccine led to 50 million deaths

During the 1918 pandemic it was the fact there was no vaccine that caused it to infect a third of the world’s population.

 In the 1930s scientists found it was caused by a virus, with the first vaccine developed a decade later.

Vaccinating the UK against Covid-19

The global Covid-19 pandemic has led to over 50,000 deaths in the United Kingdom, disrupted health services for many other conditions, and has had enormous economic impacts that have led to massive increases in unemployment and government debt.[1,2,3] With the United Kingdom’s failure to implement an effective test, trace and isolate programme as we have seen in countries such as South Korea and New Zealand, a vaccination programme offers us the best way to finally bring this pandemic under control[4]. It is therefore essential that the Covid-19 vaccination programme is implemented well and that we do not repeat the many mistakes we have seen in the government’s response to Covid-19, such as in the Test and Trace programme.[5]

Primary care should be at the heart of the delivery of the UK’s vaccine programme. With around 7,000 general practices in England, for example, they are easy for patients to access and their staff are generally well-trusted by the public.  Unfortunately, a decade of under-investment in primary care has led to a shortage of general practitioners, very overstretched primary care teams, and reduced the ability of primary care to respond to new challenges.[6] These problems cannot be addressed quickly but the government can take some immediate actions to reduce pressures on primary care. This could include, for example, cutting the administrative burden on general practices by suspending appraisals, revalidation and CQC inspections for the foreseeable future.

To ensure smooth implementation of the vaccine programme, funding is required to pay for new vaccination centres, provide current general practice clinics with the facilities they need such as equipment for transporting and storing vaccines, and meeting the costs of administering a complex vaccination regime to patients who are housebound or living in care homes. Other required measures include funding to rapidly recruit additional staff such as general practitioners, nurses, healthcare assistants to administer vaccines; and staff to provide administrative and management support. It is also essential that primary care services for the management of acute and long-term problems, and preventive programmes such as children’s immunisations, continue to operate normally. This means that additional capacity rapidly needs to be created in primary care so that the vaccination programme does displace or delay other essential clinical work, particularly as Covid-19 vaccines are likely to take longer to administer than the other vaccines currently offered by the NHS, resulting in considerable extra work for primary care teams.

Moving on to the logistics of vaccine delivery, there are currently two types vaccines that are close to approval in the UK. Adenoviral vector vaccines such as ChAdOx1 nCoV-19 are logistically easier to deliver as they can be stored long-term in standard vaccines fridges and so could be administered by primary care teams working in the patient’s usual general practice.[7] In Contrast, mRNA vaccines have to be stored at very low temperatures (minus 70 degrees Celsius for the Pfizer / BioNTech mRNA vaccine) and have to be used within a short period of time after defrosting.[8] Hence, mRNA vaccines are more suitable for large vaccination centres with a high throughput of patients rather than the typical general practice. 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. As well as simplifying the vaccination programme, this would also 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.

Looking forwards, we do not yet know how long the immunity and protection from infection generated by vaccination will last.[9] People may therefore require booster doses of vaccine at regular intervals and the NHS should also plan for this. This requires good call-recall systems, something which general practices can provide because of their computerised medical records and experience of delivering other vaccine programmes. We also need observational studies to assess how frequently “vaccine failures” occur (i.e. how many people contract Covid-19 despite being immunised and what their characteristics are), as well as data on adverse events and safety. The UK, with its system of computerised primary care records, is well placed to generate this data, particularly if linkages can be made to other data such as hospital episode statistics and mortality records. To do this, the problems that afflicted the Test and Trace programme in its early days, such as the failure to record test results in primary care records, must be avoided.[10] This is could be successfully achieved by integrating vaccination recording at the time of vaccination administration in the patient’s primary care record and not creating a separate information technology infrastructure as was done with Test and Trace.[11]

We need to ensure the NHS, and in particular primary care, is well-prepared for the programme and that unrealistic expectations of the timescale are not created amongst the public. The Covid-19 vaccination programme is too important to the health, wellbeing and economic security of the UK to delay its implementation or to get wrong.[12] The government has invested considerable funding into other areas of the Covid-19 response, including funding the private sector to deliver services such as Track and Trace. The funding that has been allocated to the NHS for the vaccination programme is currently small in comparison. Whatever investment is needed for the successful and timely delivery of the vaccination programme should be promptly provided by the government so the programme can begin at scale, rapidly vaccinate the at-risk population of the UK, and finally allow life in the UK to start to return to normal.

This article is based on an editorial published in the British Medical Journal

DOI: https://doi.org/10.1136/bmj.m4654

References

1. 50,000 COVID-19 deaths and rising. How Britain failed to stop the second wave. https://uk.reuters.com/article/health-coronavirus-britain-newwave/special-report-50000-covid-19-deaths-and-rising-how-britain-failed-to-stop-the-second-wave-idUSL8N2I94SG

2. Maringe C, Spicer J, Morris M, Purushotham A, Nolte E, Sullivan R, Rachet B, Aggarwal A. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. The Lancet Oncology. 2020 Aug 1;21(8):1023-34.

3. Office for Budget Responsibility. Economic and fiscal outlook – November 2020. https://obr.uk/efo/economic-and-fiscal-outlook-november-2020/

4. Majeed A, Seo Y, Heo K, Lee D. Can the UK emulate the South Korean approach to covid-19? BMJ 2020; 369 :m2084.

5. Scally G, Jacobson B, Abbasi K. The UK’s public health response to covid-19 BMJ 2020; 369 :m1932

6. Majeed A. Shortage of general practitioners in the NHS BMJ 2017; 358 :j3191

7. Ramasamy MN, Minassian AM, Ewer KJ, Flaxman AL, Folegatti PM, Owens DR, Voysey M, Aley PK, Angus B, Babbage G, Belij-Rammerstorfer S et al. Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial. The Lancet. 2020 Nov 19.

8. Bower E. Which COVID-19 vaccines are lined up for roll-out on the NHS? https://www.gponline.com/covid-19-vaccines-lined-roll-out-nhs/article/1700217

9. Centers for Disease Control and Prevention. Frequently Asked Questions about COVID-19 Vaccination. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html

10. Carrell S, Garside J. Coronavirus testing hit by struggle to match results with NHS records  https://www.theguardian.com/world/2020/may/28/coronavirus-testing-hit-struggle-match-results-with-nhs-records.

11. Lind S. GPs may need to record Covid vaccinations on separate IT system, says NHS England. https://www.pulsetoday.co.uk/news/technology/gps-may-need-to-record-covid-vaccinations-on-separate-it-system-says-nhs-england/

12. Iacobucci G. Covid vaccine: GPs need more clarity on logistics and planning, say leaders BMJ 2020; 371 :m4555.