Vaccine nation

It’s as if a race is on between the dreadful, worsening numbers of people who have been infected, hospitalized and died from COVID-19 and the rising numbers of those who’ve been vaccinated. The UK is in the grip of its third national lockdown just as the weather reaches its coldest this season. These months are always the toughest of the year but the extreme hardship of this coronavirus winter is an assault on the spirit as well as the health of people here.

Prime Minister Boris Johnson has set the National Health Service (NHS) the task of delivering 13.9 million COVID vaccines to the most vulnerable by mid-February, or administering around 2 million doses a day. Experts have said that the goal is achievable but there are a lot of possible challenges.

Take, for example, the much publicized rollout of the homegrown Oxford/AstraZeneca vaccine outside hospitals for the first time. The Health Secretary, Matt Hancock, made a visit to a London general practice (family doctor) clinic to promote the launch but had to endure the embarrassment of finding out only on arriving that the clinic had not yet received supplies of the vaccine. The GP doctor said Hancock was “quite surprised actually to learn that we don’t know when all of our deliveries are coming, they’re very ad hoc.” It was later reported that the vaccine supplies did turn up but after Hancock had left. It would have been a moment of brilliant farce, if only it were a laughing matter.

To be fair, it’s difficult to overstate the magnitude of the program. In order to meet the ambitious target, the British Medical Association has called for each of the approximately 8,000 GP surgeries in the country to join the vaccination effort. They’re set to run mass vaccination clinics while keeping up with their day jobs – which means something has to give, says the British Medical Association.

They’ll get some back-up from ordinary pharmacies (the equivalent of Mercury Drug or Watsons) which will soon start to offer shots of the Oxford/AstraZeneca vaccine as part of the push to dramatically scale up the process. Pharmacies are already major players in programs to provide flu and travel vaccines and only those that have been approved by the NHS will be able to take part in the coronavirus program. There are reportedly more than 12,900 community pharmacies in the UK, many of which could join the effort.

So far, most of the vaccinations that have been delivered were of the earliest approved Pfizer/BioNTech version. A GP who spoke to the BBC described the enormous relief and emotion that people showed when she vaccinated at care homes in her area. These shots are offering people the chance to see their families and friends after nearly a year of shielding. The first dose of the COVID-19 vaccine should already give good protection from coronavirus, though two doses are still necessary for longer lasting protection.

The NHS says reports of serious side effects, such as allergic reactions, have been very rare; no long-term complications have been reported.

The actual mechanics of the process, which are happening every day of the week across the country, are tricky, not only because it needs to be stored at very low temperatures, but also because teams of vaccinators need to know how to dilute it, invert it and not move it around before it’s administered. The GP said that her teams worry about wasting any vaccine if they get any of the steps wrong.

The Oxford/AstraZeneca vaccine is less fiddly to handle but there are still multiple possible challenges to the mass rollout. Two companies are manufacturing it, with staff at one of them working 24/7 shifts. It said it is on target to deliver according to its contract with AstraZeneca, which is for “tens of millions” of doses.

The vaccine is delivered in frozen form to a plant in Wales, where the vaccine is packed into vials, some containing eight doses and others 10, in order to speed up the process. But each batch must be quality-approved by the National Institute for Biological Standards and Control (NIBSC) and the government says that this is where the delays lie. Vaccine testing can usually take as long as 20 days, but it’s trying to bring that down to five days. The testing is normally carried out in two phases, first by the manufacturer, which then sends the data to inspectors at the NIBSC. The NIBSC carries out its own tests, including when the vaccine is being put into vials. The tests are happening in parallel to release the vaccine as quickly as possible.

Once the most vulnerable people have been protected, seven mass vaccination centers will be set up at places like sports stadiums and exhibition centers.

The UK isn’t alone in trying to surmount all these obstacles. Around the world, the introduction of newly approved coronavirus vaccines has been marked by delays, shortages and bureaucratic issues. It’s become clear that many governments will miss their targets for mass inoculation.

The initial optimism that came with the approval of the new vaccines is coming up against reality. The vast scale of the effort by pharmaceutical companies to produce and package doses is already straining against shortages of “fill and finish” materials such as the glass vials used for the vaccine.

Other chokepoints include the capacity of regulatory authorities to approve packaged batches of vaccine, as with the UK, as well as the effectiveness of national systems for vaccination, and local requirements for advising, monitoring and logging the data of recipients, most of which is more time-consuming than giving the injection.

One and a half million people have had a first vaccine dose already, according to the Prime Minister; but more than 52,000 new infections have been recorded in the past week and there’s been a 37 percent increase of patients admitted to hospital with COVID-19. At the heart of the story are the healthcare workers on whom everything rests. Veteran emergency doctors are speaking about this as the worst winter they’ve ever experienced.

Filipina emergency care nurse Estrella Catalan spoke about her struggle with COVID-19 in a BBC News television report. She was in tears as she spoke about how badly she wants to help her colleagues but instead she is struggling with her sense of helplessness now that she’s caught the virus.

It’s going to be a very long winter.