Coronavirus: vaccine deployment – a race against the virus

Published 12/01/2021   |   Last Updated 12/01/2021   |   Reading Time minutes

The pace of vaccination roll-out in the fight against coronavirus in Wales has come under criticism from some politicians. The First Minister Mark Drakeford MS has insisted that the vaccination programme is gathering momentum, with more than 86,000 people having received their first dose of the vaccination. However, Wales currently lags behind all the other UK nations in the number of people it has vaccinated. It is also unclear how many of 86,000 doses have been administered to care homes residents and those aged over 80 in Wales – people at highest risk of severe illness or death from the virus. This article looks at the key issues so far.

Vaccine supply

On 2 December 2020, the first coronavirus vaccine – the Pfizer/ BioNTech vaccine - was approved for use in the UK. 40 million doses of the vaccine were secured by the UK Government on behalf of the UK, with Wales getting its allocation based on its population.

Wales was the first country in the world to receive supplies of the vaccine – almost 40,000 doses in the first wave of deliveries.

The first Pfizer/ BioNTech vaccines were administered in Wales a week later on 8 December 2020 In a written statement on 14 December, the Health Minister Vaughan Gething MS said that over 4,000 doses of the vaccine had been administered within 48 hours, and by the end of the first week, this had risen to 6,000 people receiving their first dose of the vaccine.

The NHS in Wales had been planning in readiness for the vaccines since June, and Ministers said health boards would move as swiftly as possible to vaccinate people most at risk of serious illness or death from COVID-19 infection, together with frontline health and social care workers.

Whilst optimistic, the First Minister had remained cautious, making clear we still had a long and difficult journey ahead. However, three weeks after the approval of the first coronavirus vaccine, public expectations were raised with news on 30 December, that the UK Medicines and Healthcare Products Regulatory Agency (MHRA) had approved the Oxford/ AstraZeneca vaccine.

With the Pfizer/ BioNTech vaccine already being administered to frontline health and social care staff, as well as care home residents and people aged over 80, the addition of the Oxford/ AstraZeneca vaccine was described by Dr Gillian Richardson, the senior officer responsible for the coronavirus vaccine programme in Wales as a “real game changer”, stating it would speed up vaccination programme roll-out considerably.

The UK Government had pre-ordered 100 million doses of the Oxford/ AstraZeneca vaccine. In a statement on 31 December, the Health Minister confirmed that Wales will receive its population share of this vaccine in the weeks and months to come. Roll-out of the Oxford/ AstraZeneca vaccine began in Wales on 4 January 2021.

Then, on 8 January came the news that a third coronavirus vaccine has been approved for use in the UK – made by the US company Moderna. This vaccine works in a similar way to the Pfizer/BioNTech vaccine. The UK Government has pre-ordered 17 million doses of this vaccine, though supplies are not expected to arrive until the Spring.

In total, the UK has now ordered 367 million doses of vaccines to protect against coronavirus, though it isn’t known what the precise figure is for Wales.

Eligibility for a vaccine

The coronavirus vaccination programme will be delivered in phases, based on a UK-wide priority system. The groups to be prioritised to receive a coronavirus vaccine first, are centred on the advice of the Joint Committee on Vaccination and Immunisation (JCVI) at a UK level.

The JCVI advises that the first priorities for the coronavirus vaccination programme should be the prevention of mortality and the maintenance of the health and social care systems. As the risk of mortality from coronavirus increases with age, prioritisation is primarily based on age. The priority list is as follows: 

  1. Residents in a care home for older adults and their carers 
  2. All those 80 years of age and over and frontline health and social care workers 
  3. All those 75 years of age and over 
  4. All those 70 years of age and over and clinically extremely vulnerable individuals 
  5. All those 65 years of age and over 
  6. All individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality*
  7. All those 60 years of age and over 
  8. All those 55 years of age and over 
  9. All those 50 years of age and over 

* Including adult carers in receipt of a carers’ allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer fails ill, along with younger adults in long-stay nursing and residential care settings.

The JCVI states that the second phase of the vaccination programme could include vaccination of those at increased risk of hospitalisation and at increased risk of exposure to coronavirus due to their occupation, or those delivering key public services.

In his statement on 31 December, the Health Minister said he was aware of particular interest in the prioritisation of key workers beyond health and social care.

The Police Federation has called on government to prioritise the coronavirus vaccine for police officers, stating officers risk their safety to enforce lockdown rules. Similarly, teaching unions argue that teachers and education staff in Wales should be prioritised for the vaccine to help get children back to school.

The Welsh Government’s response has been that it is following the priority groups set out by the JCVI, and its priority is to get all people in the highest priority groups – those most at risk of serious disease and mortality, immunised as quickly as possible;

“Those over 50 or with particular health conditions will be captured within this first phase of vaccination, when it is their turn according to the JCVI prioritisation.  If large groups of workers were prioritised at an earlier point it would deprioritise other groups of people who are more vulnerable to harm. Those under 50 will receive their vaccination as part of the second phase of deployment in due course”.

However, on 8 January the Welsh Government stated it was extending the coronavirus vaccine to all staff providing intimate personal care for learners with complex medical needs in special schools, schools and colleges. The prioritisation of occupations for vaccination is a policy decision for the Welsh Government.

There are currently no plans to vaccinate under 16s. The JCVI advise that following infection, almost all children will have asymptomatic infection or mild disease. They are not due to be vaccinated, and the vaccines have not been tested on children.

Data on the number of vaccinations given in Wales

The Health Minister reported that within the first three weeks of the start of the vaccination programme (by the end of 27 December 2020), over 35,000 people in Wales had received the first dose of the Pfizer/BioNTech vaccine. By the 3 January, just over 49,000 people had received their first dose of this vaccine.

Figures published by Public Health Wales on 10 January 2021, which include both the Pfizer/BioNTech and Oxford/AstraZeneca vaccines, show that the number vaccines (first dose) administered in Wales by 10 January was 86,039.

From 11 January, Public Health Wales will publish data on the number of people vaccinated in Wales daily. The Royal College of Physicians has also called on the Welsh Government to publish data showing which groups of people have been vaccinated, with patient-facing health workers prioritised over other colleagues.

There are currently no details on the number of people in each of the different priority categories receiving doses – for example, the Public Health Wales data doesn’t tell us how many of those receiving the first dose are residents in a care home, or those 80 years of age or over – the most at risk of serious disease and mortality. We don’t know what proportion are frontline health and social care workers.

According to BBC reports, NHS England have been able to confirm that 60% of doses given in England have gone to people aged over 80.

The Health Minister has said that “every health board in Wales will receive an allocation of the vaccine in proportion to the size of its priority population and ability to deliver”. There are currently no plans to prioritise getting the vaccine to those living in hotspot areas, such as Bridgend, Wrexham or Merthyr Tydfil, which have some of the highest case positivity rates of the virus in the UK. Each health board will be allocated a share of doses depending on how many individuals in their area are classed as the most vulnerable to becoming severely ill from the virus.

The Public Health Wales figures are broken down by health board and show how many Welsh residents in each part of Wales have been given their first dose. By 3 January, Powys Teaching Health Board had vaccinated 3% of its local population, compared to 0.8% by Betsi Cadwaladr University Health Board.

Vaccine schedule

Those receiving either of the two coronavirus vaccines currently available in Wales will need two doses between four and 12 weeks for maximum immunity. The advice from the JCVI, endorsed by all 4 Chief Medical Officers across the UK, is that the dose interval of the two approved vaccines can be longer than the four week gap between doses originally thought.

The Health Minister set out in his statement on 4 January, that he has approved an interval of up to 12 weeks between first and second doses of both vaccines. He explains that this decision is based on the assurance of short term protection from the first dose, and the opportunity it provides to protect a greater number of vulnerable people in the shortest period of time. In practice, it means that most second dose appointments will not be received as quickly as they were originally scheduled, with the second dose going instead to protect another person who is at risk of contracting and becoming seriously ill from the disease. The Health Minister has sought to reassure people that they will receive their full course of the vaccine and will be protected by the first dose in the meantime.

Figures published by Public Health Wales show that by 10 January, of the doses given nationally, 86,039 were first doses and 79 second doses.

Is Wales lagging behind with vaccine roll-out?

As well as increasing the supply of vaccines, the Oxford/ AstraZeneca vaccine is able to be stored at normal vaccine fridge temperatures, and so it is easier to deploy in the community; it has fewer cold storage and transportation issues than the Pfizer/BioNTech vaccine (as well as the Moderna vaccine when that arrives). This in turn means that the vaccination programme can more easily be extended into care homes and into primary care settings like GP surgeries.

With fewer logistical challenges compared to the Pfizer/BioNTech vaccine, expectations for a speedy roll-out of the Oxford/ AstraZeneca vaccine have been high. However, the Welsh Government has been criticised by opposition parties for being too slow in rolling-out the vaccination programme.

On 4 January, Dr Gillian Richardson explained that “pace will be governed by supply, which will start slowly but build vastly over the coming weeks and months”.

It has been reported that Wales has received a total of 327,000 doses of the two coronavirus vaccines to deal with the pandemic. By 10 January, health boards in Wales had administered more than 86,000 of the 327,000 doses. At his press conference on 11 January, the Health Minister explained that stock had been held back originally to offer the second dose of the vaccine, but as the advice on this from the JCVI and CMO changed, Welsh Government was now able to step-up roll-out of the vaccine more quickly.

Comparisons are naturally being made on the number of vaccinations administered by the four nations of the UK.  The latest data published on 7 January, shows that Wales has vaccinated a smaller percentage of its population than England, Scotland and Northern Ireland. As at 7 January, the percentage of the Welsh population vaccinated was 1.6%, compared to 1.9% in England, 2.1% in Northern Ireland and 2.1% in Scotland.

It isn’t clear why the roll-out of the vaccinations in Wales is behind the other nations. The logistical challenges of roll-out, and the change in advice over the time period between first and second doses will be challenges faced across the UK.

On 9 January, the Welsh Government stated;

“In the coming weeks, the vaccine will reach more people, more quickly. We started with 7 vaccine centres. We now have 22, and will have 35. By the start of next week, 75 GP practices will be vaccinating. By the end of the month, 250 will. 14 mobile units are in place across Wales to vaccinate in care homes. Our roll-out will continue to get faster. It’s our way out of this pandemic”. 

Transparency and targets

This is only the beginning of a vaccination programme that will span many months. But the urgency and priority to get the most vulnerable vaccinated as quickly as possible is clear to all.

Whilst the UK Prime Minister Boris Johnson MP has set a target to offer vaccination slots to 15 million in the top four priority groups – including all over 80s – by 15 February, Wales’ Health Minister has asked for patience as the NHS in Wales focuses “on delivering the vaccine programme quickly but effectively, safely and equitably”.

In his press conference on 8 January, the First Minister described the roll-out as “not a sprint” and “not a competition”.

The Welsh Government published its coronavirus vaccination plan on 11 January. The plan sets out a series of ‘milestones’ for the vaccine roll-out in Wales. The Welsh Government has said that everyone over 70 and everyone who is clinically extremely vulnerable, all care home residents and staff and frontline NHS workers will be offered the first dose of a vaccine by mid-February. All over-50s and everyone who is at greater risk from coronavirus because they have an underlying health condition will be offered a vaccine by the Spring. Ministers hope all eligible adults in Wales will be vaccinated by the Autumn. It matches plans in the rest of the UK.

Article by Sarah Hatherley, Senedd Research, Welsh Parliament