2021-01-31 10:15:37 | The priority list for the Covid vaccines

How will the storage requirements of the Pfizer vaccine affect the programme?

The vaccine must be stored at -70C to be effective, meaning it can only be delivered to GPs with the facilities to keep it at that temperature.

It will be difficult to administer in care homes. Deputy chief medical officer professor Jonathan Van-Tam said: “This is a complex product. It is not a yoghurt that can be taken out of the fridge and put back in several times.”

The vaccine will be rolled out to elderly residents in care homes with more than 50 registered beds in England within the next few weeks.

It is understood the vaccine batches are being broken down into doses of 75, and the focus over the next fortnight will be on elderly residents and staff in homes with more than 50 beds to avoid wastage.

The Oxford vaccine does not need to be stored in such cold conditions – it can be kept at temperatures between 2C and 8C.

This means it could be more mobile than the Pfizer jab and therefore more easily deployed into care homes of varying sizes and into private homes for individual doses.

Experts believe the Oxford jab will be easier to deploy beyond formal healthcare settings, in part because it does not need to be stored at such cold temperatures as the other approved vaccine.

Will people receive vaccines 24 hours a day? 

On Jan 18, the Vaccine Minister, Nadhim Zahawi, confirmed on Sky News that 24/7 inoculations will be trialed in hospitals “by the end of January”.

Mr Zahawi said that 8am-8pm inoculations will remain to continue for those in the over-80s age group, but as more people in other age groups begin to receive the vaccine, “it becomes much more convenient for people to go late at night and in the early hours.” 

Mr Zahawi added that he expects the scheme to be in operation in hospitals around London, and 50 vaccination centres, by February. 

Additionally, three hospitals in Birmingham will begin offering 24 hour vaccinations for health and social staff from the night of Jan 20.

Offering vaccinations overnight will speed up the rollout, and allow the Government to reach their goal of vaccinating 32 million people – 60 per cent of the UK adult population by spring, which was announced on Jan 11. 

What other problems does the vaccination programme face? 

The EU has threatened to block exports of the Pfizer vaccine following a row with the vaccine company, AstraZeneca. 

On Jan 26, Brussels decided to impose tighter controls on exports after reacting with fury to the news that AstraZeneca will deliver 50 million fewer doses to the EU than it had expected.

The EU has said that it will “take any action required to protect its citizens”, leading ministers to worry that the delivery of Pfizer vaccines to the UK will – at best – be delayed by extra paperwork.

Two of the first NHS staff to get the jab suffered allergic reactions and the Medicines and Healthcare products Regulatory Agency warned the vaccine should not be administered to people with a history of ‘significant’ allergic reactions.

Prof Stephen Powis said that this was common for new vaccines and the staff have recovered well.

On Dec 13, news that up to 40 per cent of care home staff may not have the jab sparked new fears that the vaccine rollout may not be successful. 

This research, from the National Care Association, suggested that as many as 20 per cent of care workers are adamant they won’t receive the jab. Furthermore, 20 per cent of other care workers are unsure and may follow their example. 

Nadra Ahmed, a representative from the charity, revealed that “between about 17 and 20 per cent of staff in-services are saying they definitely won’t have it, and then you have the rest who are waiting to see”.

“So, we are looking at potentially 40 per cent who decide not to have it.”

Vulnerable people suffering from rare diseases are also being forced to wait for a coronavirus vaccine because of an algorithm used to determine the risks, according to a member of the expert committee that advises the health department.

The QCovid algorithm was used by the Joint Committee on Vaccination and Immunisation (JCVI) to identify who was most likely to die if they catch coronavirus and therefore who should be prioritised in the government’s vaccine roll out. 

Although vulnerable people have been given priority in the Government’s vaccine rollout, committee member Jeremy Brown, a professor of respiratory infection at University College London, said the QCovid algorithm was likely to underestimate the risk coronavirus poses to people suffering from rare diseases.

“There are limits to the detail,” said Mr Brown. “The data for cancers is grouped as all cancers rather than different cancers and it is quite likely that some cancers are much more of a problem than others.” 

He added that people who are suffering from rare illnesses and have been shielding successfully are also unlikely to show up in the data.

What about the new variant of coronavirus? Will the vaccine still protect us?

The South African variant and the Brazilian variant have threatened to undermine the vaccine and testing gains of recent months.

The Medicines and Healthcare products Regulatory Agency (MHRA) is expecting some vaccine tweaks to be needed as it has already begun to look at how quickly an altered jab could be approved, and Matt Hancock has said he is “very worried”.

However, on Jan 25, Moderna Inc announced that its vaccine was effective against the Kent and South African variants. Deliveries of the vaccine will take place in the spring.

Sir Patrick Vallance said on Jan 22 that there is “increasing confidence” that the UK variant will be susceptible to the vaccine.

And now Britain is on the brink of approving a fourth coroanvirus vaccine, after a jab trialled in the UK was shown to be highly effective against the Kent variant in what the Health Secretary hailed as a “breakthrough”.

60 million doses of the Novavax jab have been secured by the UK.

The Novavax vaccine, which Mr Zahawi was himself injected with as part of the trial, was shown to be 89.3 per cent effective in preventing coronavirus in participants.

Professor Paul Heath, the Novavax Phase 3 trial chief investigator, said he believed that vaccines could be adapted “at pace” to target new variants of coronavirus after the Novavax jab was found to be effective against the Kent variant.

Crucially, it was shown to be highly effective in preventing infection from the Kent variant which Boris Johnson said on Jan 22 could be up to 30 per cent more deadly than the original.

Prof Neil Ferguson, who sits on Nervtag, the Government’s virus advisory committee, said the latest data showed up to 13 in 1000 people aged 60 who contract the variant strain could die, compared with 10 in 1000 who caught the original variant. 

“It is a realistic possibility that the new UK variant increases the risk of death, but there is considerable remaining uncertainty,” Prof Ferguson told ITV. 

“Four groups – Imperial, LSHTM, PHE and Exeter – have looked at the relationship between people testing positive for the variant vs old strains and the risk of death.”

The professor said the data available on the new variant is patchy, but there is a “signal” that there is a “1.3-fold increased risk of death”.

However, most promisingly, on Jan 16, The Telegraph exclusively revealed that Britain would have the capacity to vaccinate the entire nation against new coronavirus strains within four months, once a new “super-factory” opens this year.

The factory- which is worth £158m, will produce 70m doses of an emergency vaccine in the UK, Dr Matthew Duchars, chief executive of the Vaccines Manufacturing Innovation Centre (VMIC), shared. 

Speaking to The Telegraph, Dr Duchars revealed: “New Covid variants are absolutely part of the thinking. We probably will need to make seasonal vaccine variants because there may well be mutations in the virus, as well as vaccines for other diseases. You never know what’s coming next.”

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