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Covid vaccine: How will the UK jab millions of people?

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By Lucy Rodgers and Dominic Bailey
BBC Visual Journalism team

The UK has launched its biggest mass-vaccination programme, aimed at protecting tens of millions of people from Covid-19 within months.

In a race against a faster-spreading variant of coronavirus, ministers have pinned their hopes of ending a third national lockdown on protecting the most vulnerable groups by spring.

But there are huge challenges, not least the unprecedented scale but also the need for rigorous safety checks and deep-freeze storage as well as establishing enough vaccination centres and recruiting enough vaccinators.

What is the plan?

The government aims to offer vaccines to 15 million people – the over-70s, healthcare workers and those required to shield – by mid-February and millions more by spring.

The speedy rollout of the vaccine to vulnerable people is seen as critical to reducing the pandemic’s death toll and relieving pressure on the NHS.

But to meet this target, ministers need to deliver more than two million jabs a week by the end of January, in one of the largest civilian logistical operations launched in Britain.

Since the beginning of last month, 1.5 million people have been vaccinated, Prime Minister Boris Johnson has said. But more than 13 million people will need to receive jabs in the next five weeks. And the UK’s chief medical adviser, Prof Chris Whitty, has described such a timetable as “realistic but not easy”.

The NHS began administering a vaccine made by Pfizer-BioNTech.

But the operation is being significantly ramped up following the approval of a second vaccine, from Oxford University and AstraZeneca.

And the campaign to reach as many people as possible as quickly as possible has also been boosted by a shift in policy – to prioritise the first dose of either vaccine, with a second dose up to 12 weeks later, a bigger gap than originally planned.

On Thursday, Mr Johnson said it would require an “unprecedented national effort” but the government was throwing “everything at it” to deliver “hundreds of thousands” of jabs each day.

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Where are the vaccines coming from?

The UK is currently receiving doses of two vaccines approved by the medicine regulator. The Pfizer-BioNTech jab – the first given the green light – is being imported from Puurs, Belgium. Meanwhile, the Oxford vaccine is being made in Britain, by two biotech companies:

  • Oxford BioMedica, based in Oxford
  • Cobra Biologics, based at Keele Science Park, Staffs

Another company, Wockhardt, based in Wrexham, fills the vials and packages them for use

But the country’s initial doses of the Oxford vaccine will actually come from Europe, UK Vaccine Taskforce manufacturing lead Ian McCubbin has said.

Is there a hold-up?

There are a number of challenges in what is called the vaccine “supply chain” – the logistics of how the jab gets from manufacturers to people.

One challenge facing pharmaceutical companies globally has been a shortage of glass vials for the “fill and finish” stage of manufacture – when a vaccine is packaged for despatch. Although, unlike elsewhere, the UK is thought currently to have enough of this glassware in storage.

On top of this, Mr Johnson has referred to the “rate-limiting factor” of batch testing – the process of ensuring vaccines released by manufacturers are safe and up to standard.

The UK’s Medicines and Healthcare Products Regulatory Authority (MHRA) requires vaccines to be checked by the National Institute of Biological Standards and Control (NIBSC) to ensure they are:

  • effective
  • structurally intact
  • free of contaminants

And this process can take a long time as it has to be done twice – before the vaccine enters vials and after.

Testing a batch is sterile takes two weeks.

An MHRA spokesman said it was working closely with AstraZeneca “to ensure that batches of the vaccine are released as quickly as possible”. And the NIBSC had scaled up its capacity so “multiple batches can be tested simultaneously”. More technical staff are also being taken on.

The UK’s Vaccines Manufacturing and Innovation Centre chief executive Matthew Duchars says preparing enough vaccine is “quite a challenge” given the timeframe but “doable”.

“It’s not like we haven’t done this before,” he says. “But we’ve not done it so quickly before.”

How is the vaccine transported?

The Oxford vaccine can be stored in fridges and transported in regular refrigerated vans or cool boxes. But the Pfizer jab – made from genetic material – needs to be stored at -70C to prevent it from degrading.

This means it needs to be transported in a carefully controlled deep-freeze delivery chain, with vials placed inside special ultra-cold thermal boxes, known as “shippers”.

These boxes – fitted with temperature-monitoring devices – are taken by plane or lorry to the UK and onward to their destination. Once at a vaccination site, the consignment needs to be removed from cold storage by specially trained NHS staff and takes a few hours to defrost before being diluted in saline and given to patients.

How will people be vaccinated?

People will be vaccinated in three main ways, at:

  • local GP practices and community pharmacies
  • hospital hubs
  • mass vaccination sites across the country

About 1,000 GP sites, 200 community pharmacies, 223 hospital hubs and seven mass vaccination sites should be up and running by next week. And the prime minister says no-one should have to travel more than 10 miles for a jab.

The first seven mass vaccination centres are:

  • Robertson House, in Stevenage, Herts
  • the ExCel Centre, in London
  • the Centre for Life, in Newcastle
  • the Etihad tennis centre, in Manchester
  • Epsom Downs Racecourse, in Surrey
  • Ashton Gate Stadium, in Bristol
  • Millennium Point, in Birmingham

In Scotland, as well as GPs surgeries and hospital hubs, Motherwell Concert Hall and The Event Complex Aberdeen are being considered alongside sports venues.

So far, 80,000 people have been trained to deliver the vaccines, NHS boss Sir Simon Stevens says, with thousands more set to join the effort. The charity St John Ambulance Brigade is among those helping out.

And a further 21 quick-reaction vaccination teams will also be ready to deployed anywhere around the country, commander of military support to the vaccine delivery programme Brig Phil Prosser says.

Who will be vaccinated?

While the NHS administers about 15 million flu vaccines across the UK every year, with all four nations achieving some of the highest vaccination rates among the over-65s in Europe, the scale and speed of the Covid jab rollout is unprecedented.

The aim is to inoculate as many people as possible aged over 16 in the UK. The most vulnerable take priority, as set out in a list of nine high-priority groups, covering about a quarter of the UK population. They are thought to represent 90-99% of those at risk of dying from Covid-19.

People aged over 80, front-line health staff and care home workers have been some of the first to receive the Pfizer jab.

GPs and local vaccination centres have been asked to ensure every care-home resident in their area is vaccinated by the end of January.

Together, care home residents, their carers and the over-80s make up an estimated 4.5 million people, while front-line NHS staff make up a further 1.6 million.

Is there enough vaccine?

The UK has ordered 100 million doses of the Oxford vaccine – enough to inoculate 50 million people.

This, when combined with the 40 million ordered Pfizer jabs, will cover the entire population, Health Secretary Matt Hancock has said.

And on top of these two approved vaccines, the UK has significant orders of five other candidates.

But having vaccines on order is not the same as having them ready to go. Of the 100 million Oxford jabs ordered, only 530,000 were ready for nationwide rollout on 4 January. Although, the government has said this number will rise to “tens of millions” by the end of March.

Meanwhile, the UK has taken delivery of 22 consignments of the 40 million Pfizer jabs ordered.

And Pfizer says the number it has sent to the UK is now “in the millions”.

Design by Lilly Huynh, Irene de la Torre Arenas and Sana Jasemi. Additional reporting by Smitha Mundasad

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