UK rolls out COVID-19 vaccine: Who gets the first doses?
Each batch of the vaccine – which is being manufactured at BioNTech’s facility in Belgium – is tested before being distributed. Batch testing was completed yesterday morning for the first deployment of 800,000 doses. The National Health Service (NHS) will start vaccinating from early next week.
The Joint Committee on Vaccination and Immunisation (JCVI) has set out the order of priority for vaccinations according to clinical need. Those deemed most in need – including care home residents, healthline workers and those aged 80 or over - will be called forward by the NHS.
Vaccinations will be initially be carried out in 50 hospital hubs; then later through local communities (such as GPs and eventually pharmacies as well); and vaccination centers in conference centers and sports venues.
Who gets the 2020 doses - and why?
The JCVI advises that the first priorities for COVID-19 vaccination should be preventing mortality and maintaining health and social care systems.
As the risk of mortality from COVID-19 increases with age, prioritisation is based primarily on this factor. Aged-based vaccination programs are also considered easier to implement and achieve higher uptake; while also likely to double-up in targeting people with clinical risk factors as the prevalence of these increases with age.
The priority groups for vaccination are set out in the following order. Together, the JCVI estimates these groups represent around 99% of preventable mortality from COVID-19.
1 | Residents in care home for older adults; and their carers |
2 | All those aged 80+ |
3 | All those aged 75+ |
4 | All those aged 70+ |
5 | All those aged 65+ |
6 | Individuals aged 16-64 with underlying heart conditions which puts them at higher risk |
7 | All those aged 60+ |
8 | All those aged 55+ |
9 | All those aged 50+ |
A press conference from 10 Downing Street yesterday suggests that the first and second groups above will be considerered in 2020 with the others following in 2021.
Ten million doses of the Pfizer/BioNTech vaccine (which requires 2 doses) are expected in the UK this year. However, it is estimated that there are 15 million people over the age of 65 / working in health and care sectors in the UK.
Given that the vaccine requires the second dose three weeks later, vaccination plans will have to make sure a second dose from 2021 stocks are in line for the most of December's vaccinations before approaching further people. In addition, protection cannot be expected to be at Pfizer's projected efficacy rates of 95% before the second dose is received in January.
The Pfizer vaccine is delivered in set packs of 975 doses, meaning its initial distribution will have to be via larger hubs rather than each local surgery or center. Vaccination will start with 50 hospital hubs next week across England; then brought to vaccination centers run by collective GP practices.
The JCVI did also consider other vaccine strategies: such as targetting vaccination at people most likely to transmit the virus. However, it noted that a large proportion of the population would need to be vaccinated for this transmission strategy to be effective (which is not possible at this stage); while it would also need to be supported by data that this is an effective strategy (evidence on the effects of vaccination on transmission is not currently available).
Who won’t be receiving the vaccine?
The bulk of vaccinations will be in the new year: and the reality is that the number of people vaccinated this month will be low.
The JCVI, however, has specified two groups that should not be vaccinated at this point.
The first is pregnant women: or those planning a pregnancy within three months of the first dose.
“There are no data as yet on the safety of COVID-19 vaccines in pregnancy, either from human or animal studies," notes the JCVI.
"Given the lack of evidence, JCVI favours a precautionary approach, and does not currently advise COVID-19 vaccination in pregnancy.
“Data are anticipated which will inform discussions on vaccination in pregnancy. JCVI will review these as soon as they become available.”
Children, also, are not set the receive the vaccine any time soon: based again on the lack of data (the Pfizer/BioNTech Phase 3 trial was only for people aged 16+) as well as their low risk status.
“Following infection, almost all children will have asymptomatic infection or mild disease," notes the JCVI. "There are very limited data on vaccination in adolescents, with no data on vaccination in younger children, at this time.
"The Committee advises that only those children at very high risk of exposure and serious outcomes, such as older children with severe neuro-disabilities that require residential care, should be offered vaccination. Clinicians should discuss the risks and benefits of vaccination with a person with parental responsibility, who should be told about the paucity of safety data for the vaccine in children aged < 16 years.”
Phase 2
The first phase of vaccination will provide additional data on the safety and effectiveness of COVID-19 vaccines: informing the next phase of vaccination.
This phase is likely to focus on further preventing hospitalisations.
Vaccination of those at increased risk of exposure to SARS-CoV-2 due to their occupation could also be a priority in the next phase. This could include first responders, the military, those involved in the justice system, teachers, transport workers, and public servants essential to the pandemic response.
However, the JCVI considers that priority occupations for vaccination are an ‘issue of policy’ rather than an area for the vaccine committee to set recommendations in.
The JCVI's full advice can be found here.
