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Vaccine Progress, Approval, and Deployment

Yew

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With multiple vaccines now releasing results, I thought it could be useful to have a place to discuss their approval, deployment, and effects on society. Here's a section from the BBC's article to set the tone I was thinking of:


In the UK there are four million doses ready to go, with another 96 million to be delivered.
But nothing can happen until the vaccine has been approved by regulators who will assess the vaccine's safety, effectiveness, and that it is manufactured to high standard. This process will happen in the coming weeks.
However, the UK is ready to press the go button on an unprecedented mass immunisation campaign that dwarfs either the annual flu or childhood vaccination programmes.
Care home residents and staff will be first in the queue, followed by healthcare workers and the over-80s. The plan is to then to work down through the age groups.

More details are surfacing about the rollout plan; apparently, the NHS is hoping to give out a million doses a week. That would mean over a year for a full-population vaccination programme; and starts to raise questions about when we should begin to lift restrictions.

Thousands of hospital staff will join the drive to vaccinate all adults in England against coronavirus and will be deployed at mass vaccination centres, each of them aiming to give the jab to up to 5,000 people a day, NHSofficials involved in the plans said.

The NHS intends to use football stadiums, town halls and conference buildings in England to inoculate at least 2,000 people per centre each day. In urban areas, there will be a network of these centres.

The new facilities will be additional to the 1,560 community-based vaccination centres run by GPs, which will each dispense 200 to 500 jabs a day. Other forms of vaccination are also planned, including mobile vans and visits to homes and prisons. All the venues will do temperature checks on people before entry allowing space for social distancing and a 15-minute recovery time.

Neither NHS England nor the government has so far published an overall projection for how many vaccinations all these venues and methods of delivery will carry out daily in total. NHS England is expected to publish its “deployment plan”, outlining the rollout, next week.

However, seconding personnel from already under-staffed hospitals to aid the vaccine rollout could lead to patients having to wait longer for care. The NHS is already facing a massive backlog of cases due to its decision to suspend most non-Covid care provision in the spring.

NHS England has asked health service heads across England to be ready to vaccinate many numbers of people at large sites not in use because of the pandemic.

The details emerged as government figures showed the UK’s Covid-19 death toll has surpassed 50,000, adding to the pressure to roll out a comprehensive vaccination programme as soon as possible.

The centres are also expected to play a key role in immunising the general public in a second phase of the vaccination programme, following the dispensing of two doses each to the estimated 22 million, including carehome residents, NHS staff and those aged 50 or over, considered a priority.


A Whitehall official explained the centres’ key role, saying: “We are looking to vaccinate as many people as is humanly possible as quickly as possible. We want to get the country back to normal as soon as possible, which would allow us to open up the economy.”

Staff from every hospital will be seconded to the vaccination campaign, which ministers see as vital to achieving their aim of reviving the economy and normalising life.

The staff, however, could be absent from their normal duties for several months, which could affect hospital services. But many NHS workers are thought to be keen to play their part in combating the virus.

Jonathan Van-Tam, England’s deputy chief medical officer, said on Wednesday that he would happily give up his free time to help administer the vaccine. “This is one of the most important, if not the most important, vaccination programme we’ve done for decades,” he said. “If I can help with this in some evenings and weekends, doing some extra vaccinations sessions myself, then I’m going to.”

District nurses, health visitors and other health professionals who do not work in hospitals will also be drafted in to help, amid concerns that, while GPs are playing the lead role in the immunisation effort, there are too few of them to deliver the NHS target of vaccinating a million people a week.
 
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nlogax

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More details are surfacing about the rollout plan; apparently, the NHS is hoping to give out a million doses a week. That would mean over a year for a full-population vaccination programme; and starts to raise questions about when we should begin to lift restrictions.

The sooner the better. Is there a suggested population percentage that is needed for herd immunity which is specific for C-19? It does vary between diseases.

Shouldn't be forgotten that there's an 'official' head start of ~1.5m cases across the UK since this reared its head.
 

Yew

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Given that the plan vaccinates the most vulnerable, I don't know if we need vaccine-induced herd immunity to start easing things off. It doesn't matter if it spreads if the vulnerable are protected?
 

Domh245

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Is there a suggested population percentage that is needed for herd immunity which is specific for C-19? It does vary between diseases.

The herd-immunity threshold is a function of the base R rate of a disease, which based on the estimated R0s of SARS-COV2 is between 60% and 75%. Like you also note, it's not that we need to vaccinate 60-75% of people, it's that we need 60-75% of people to have immunity - a large portion of which will have arisen due to previous infection.

I agree with Yew though, given the targeted distribution the appetite for continued restrictions will be limited. It'll be hard to get buy in from the population for continued restrictions when hospitalisations and deaths start dropping off massively
 

yorkie

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The sooner the better. Is there a suggested population percentage that is needed for herd immunity which is specific for C-19? It does vary between diseases.

Shouldn't be forgotten that there's an 'official' head start of ~1.5m cases across the UK since this reared its head.
I agree the sooner the better; the future of our society depends on it.

It is difficult to calculate the threshold needed for "herd immunity"; furthermore the term seems to be used in different ways, with a strict definition of the term refers to the level at which the virus cannot spread at all and leads to zero cases. However many people use the term to mean reaching a level of "endemic equilibrium" which means it is still there but due to many people having some level of immunity, it does not grow exponentially and becomes just another seasonal virus, alongside the 4 pre-existing coronaviruses, and many rhinoviruses and 'flu strains that circulate.

As for how much pre-existing immunity we have, that is also very complex. I doubt anywhere close to only 1.5m people in the UK have had exposure to Sars-Cov-2; the true figure is likely far higher. I agree that the vast majority of people who have been exposed will develop long-lasting immunity. Many people who are exposed to Sars-Cov-2 appear to have T-cells which can already recognise and destroy the virus, presumably due to the relative similarity between it and other Coronaviruses, and these people not only don't get ill but don't necessarily need to develop any antibodies and may not necessarily test positive in a PCR test.

But the restrictions need to go urgently. I am sure some hysterical people will be demanding punitive restrictions remain until nearly everyone has been vaccinated but that is totally unrealistic and ignores the bigger picture.

Given that the plan vaccinates the most vulnerable, I don't know if we need vaccine-induced herd immunity to start easing things off. It doesn't matter if it spreads if the vulnerable are protected?
I think that as time goes on, the picture will become clearer. It will depend on what the 'aim' is: is it to reduce pressure on the NHS? If so, the answer is likely to be that we only need to vaccinate the most vulnerable (though defining the cut off point may be tricky) and it doesn't matter if younger people get it, but I am sure that the hysterical brigade will call for us to go much further than that if they see any sign that is achievable.

But it does raise moral questions: for example, should young, fit and healthy people with no pre-existing conditions in the UK take priority over vulnerable people in other countries? Arguably the answer is probably no, but I suspect that's an argument that will crop up at some point. It's too early to say at the moment what might happen.
 

Dent

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But it does raise moral questions: for example, should young, fit and healthy people with no pre-existing conditions in the UK take priority over vulnerable people in other countries? Arguably the answer is probably no, but I suspect that's an argument that will crop up at some point. It's too early to say at the moment what might happen.
What "moral" case is there for making it a priority to waste the vaccine on people who don't even need it over giving it to people whose survival may depend on it?
 

cuccir

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Given that the plan vaccinates the most vulnerable, I don't know if we need vaccine-induced herd immunity to start easing things off. It doesn't matter if it spreads if the vulnerable are protected?

I can only imagine that this is the plan. Every new iteration of covid-19 lockdown is getting harder and harder for the government to get through. I think people are just about willing to accept that restrictions will be needed through the 20-21 winter flu season ie until March or April (depending on the weather: let's hope for a warm March!). I think the current tier legislation is due to end at the end of March, by which time we won't have vaccinated everyone of course! But I think it's important to see the route out as vaccinations + treatment + testing, not just based on any one of these. So I don't think herd-immunity is the point at which covid-19 measures will go.

But it does raise moral questions: for example, should young, fit and healthy people with no pre-existing conditions in the UK take priority over vulnerable people in other countries? Arguably the answer is probably no, but I suspect that's an argument that will crop up at some point. It's too early to say at the moment what might happen
I don't particuarly think that this question is up for grabs is it? Governments don't own the vaccine; private companies do. So it's primarily a question of who those companies will accept orders from, but the WHO has a programme for obtaining vaccinations for countries which can't otherwise afford it.


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New post:


The Guardian are now reporting that vaccinations could start between 7th-9th December, with NHS staff likely to now get it before those in care homes

NHS bosses said hospitals in England could expect to receive their first deliveries of a vaccine produced by Pfizer/BioNTech as soon as Monday 7 December, with regulatory approval anticipated within days.

According to sources at several hospitals across the country, NHS England said they should expect to get stocks of vaccine on 7, 8 or 9 December.

Initially only NHS staff are set to be given the jab, with care home residents and the over-80s having to wait. This is despite those two groups being classed by the government as top priorities for Covid immunisation, as they have the greatest risk of death from the disease. Care sector chiefs reacted angrily, warning that the move would be seen as a “betrayal”.....

But the nature of the Pfizer vaccine appears to have forced a rethink of who gets it first. Its composition means it should be moved only a limited number of times, experts believe, and as such it cannot easily be transported by healthcare staff such as GPs to care homes and older people’s private residences.
 
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brad465

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Looks like there'll be a minister directly responsible for the vaccine rollout (oh dear):


Deployment of the Covid vaccine will be led by Business Minister Nadhim Zahawi, Number 10 has announced.

Mr Zahawi, MP for Stratford-on-Avon, was appointed by the prime minister to oversee distribution of the vaccine until at least next summer.

Health Secretary Matt Hancock said he was "delighted", adding in a tweet there was "an enormous task ahead".

Mr Zahawi's primary focus will be on delivering the vaccine, with most areas of his business portfolio put aside.

In a tweet, he welcomed his new post but said the rollout would be a "big responsibility and a big operational challenge".

He added that he was "absolutely committed to making sure we can roll out vaccines quickly - saving lives and livelihoods and helping us #buildbackbetter".
 

Mag_seven

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Looks like there'll be a minister directly responsible for the vaccine rollout (oh dear):


Remember the PPE fiasco and the appointment of a "PPE Tsar", Lord Deighton? Thought not! This like the appointment of a "PPE Tsar" does not fill me with confidence!
 

Yew

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Apparently Nottinghamshire, with a population of 800,000 people is planning to do 80,000 vaccinations a week, which would presumably vaccinate the whole county in 10 weeks.

Covid: Target for 80,000 vaccinations every week by January in Nottingham and Nottinghamshire | West Bridgford Wire

Dr Andy Haynes, Executive Lead, Nottingham and Nottinghamshire Integrated Care System updated the media at today’s weekly virtual Covid briefing.

Speaking about the possible upcoming vaccines, Dr Haynes said:

‘I’m optimistic about the vaccine, and we are well-placed in Nottingham and Nottinghamshire to carry out this work.

‘For example this year’s flu vaccination programme is already further ahead now than in all of last Winter, we are vaccinating 25,000 patients every week for flu.

‘Our target for any authorised Covid vaccination is 80,000 per week by January.
 

HSTEd

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adc82140

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In addition there are no plans anywhere to vaccinate the under 55s, certainly not in the first round anyway.
 

island

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The NHS is advertising for temporary staff to administer the vaccinations. No clinical experience necessary, just 2 A-levels.

 

Mag_seven

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The NHS is advertising for temporary staff to administer the vaccinations. No clinical experience necessary, just 2 A-levels.

I'm not really keen on the idea of any injection being administered by anyone other than a medial professional.
 

HSTEd

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I'm not really keen on the idea of any injection being administered by anyone other than a medial professional.

Why?

Injections are not hard to give and only require minor training.
Much better to save the medical professionals, which are in short supply, for supervisory and emergency support roles.

All that matters is the vaccination rate is driven as high as possible.
 

Mag_seven

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Injections are not hard to give and only require minor training.

I was just under the impression that a doctor or a nurse is the best person to administer it as they do it day in day out. The thought of some 18 year old just out of school trying doing it just to earn some beer money does not appeal - sorry.
 

matt

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I don't see an issue as long as they are properly trained. As HSTEd says it will allow doctors and nurses to concentrate on other health issues.
 

Darandio

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So here we are, the biggest vaccination program in history using vaccines only allowed for use because of emergency use approval. We have no idea about long term safety or how long protection lasts. To top it off we are going to pay a load of temps £11 per hour to give you it.

Apologies for not being more enthused.
 

adc82140

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Giving an intramuscular injection is one of the easiest things to do, medically. It's nigh on impossible to screw it up. Dose checking etc will be done by a qualified person anyway, there will always be two people present. Anything injected must be cross checked by at least one other person.

Many IV cannulations in hospitals (which require significantly more skill than IM) are carried out by previously untrained healthcare assistants. I know that because I train them.

But in actual fact I reckon the casual staff will be ticking names off lists and showing people where to sit.
 

HSTEd

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I know that because I train them.

Indeed the most important factor in this scenario is probably making the people giving the injections comfortable with requesting assistance if for some reason something unusual is happening.
 

adc82140

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Having read thoroughly the job ad, these are NVQ3 healthcare assistants they are recruiting, not people off the street.
 

island

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Having read thoroughly the job ad, these are NVQ3 healthcare assistants they are recruiting, not people off the street.
The job ad asks for NVQ3 or equivalent, one of the equivalents of NVQ3 is two passes at A-level.
 

DustyBin

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So here we are, the biggest vaccination program in history using vaccines only allowed for use because of emergency use approval. We have no idea about long term safety or how long protection lasts. To top it off we are going to pay a load of temps £11 per hour to give you it.

Apologies for not being more enthused.

Therein lies the problem (perceived or otherwise). I think just about enough people will come forward for vaccination for the programme to be deemed a success, but were it not for the fact we’re effectively being held to ransom, I suspect most wouldn’t touch it with a barge pole!
 

adc82140

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The job ad asks for NVQ3 or equivalent, one of the equivalents of NVQ3 is two passes at A-level.
It says NVQ3 in a relevant subject. So an A level in cookery and geography won't cut it.
 

Mag_seven

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The Covid Pfizer vaccine has been approved for use next week in the UK.

Covid Pfizer vaccine approved for use next week in UK - BBC News

The UK has become the first country in the world to approve the Pfizer/BioNTech coronavirus vaccine for widespread use.
British regulator, the MHRA, says the jab, which offers up to 95% protection against Covid-19 illness, is safe for roll out.
Immunisations could start within days for people in high priority groups.
 

Bantamzen

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Just heard the news! The fightback starts....
As does all the social media squealing as people who will have to wait a long time to be invited to get a vaccine because they are not in the most vulnerable groups find out they are not going to be at the front of the vaccine queue. (And yes, this has already started!)
 

YorkshireBear

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Good news to wake up to. Fingers crossed its the beginning of the end although I expect even next Christmas will be affected in some way, maybe even quite a lot.
 

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