UKH

It seems vaccination for everyone will take months. Why?

There are about 1m medical staff in the UK. If they all did 70 people, couldn’t we have this wrapped up by Christmas? (And is there any reason I can’t inject myself?)

Do you have 70 million doses in your back pocket? 

Then again, it is Matt Hancock and his chums organising it.

More seriously, it isn’t the 10 seconds it takes to jab it in your arm, it’s getting it imported to order, distributed on dry ice, stored at -70, distributed again, diluted at the right place with patients waiting - and that’s assuming it’s ready.

The stockpiles and logistics would be a bit easier for the AZ-Oxford vaccine, because we have more doses on order, they‘ve been making it for months, and it can be stored at 4C.  It’s just not yet through the double-blind, controlled trial and not yet approved.

I’m confident it will be though, and it would be my choice, if I have the luxury of choosing.

Everyone needs two doses of the Pfizer vaccine, so you need to double your numbers.

The vaccine isn't effective immediately, so the givers and receivers of the vaccine need to keep socially distanced so that the process doesn't harm more people than it helps.

From being defrosted, the vaccine has a shelf life of about 4 hours before it has to be binned. This needs some very careful flow control of patients, slick processes, reliable delivery. Crucially people need to turn up at the right time and place to be vaccinated.

The second dose needs to be a set number of days after the first, so once we are busy doing the second doses, we can't do as many first doses as we don't want to miss the follow-up window and have to start again.

There aren't 1 million people trained in giving injections. Training them up will take time, and they need oversight so that this is done safely and with minimum vaccine wastage.

Doses don’t seem to be the problem though.

I was thinking more of the Oxford one, yes.

Surely all doctors and nurses (and vets) are at least? 

Talk me through it then.

First, are you going intra muscular or sub cutaneous?

What's the technique for each?

How do you know if you've hit something you shouldn't have?

What size needle are you using and why?

And most importantly, what are you going to do if you go into anaphylactic shock?

A person who was connected with the vaccination said on r4 today you can thaw it and keep it in normal vaccination fridges for 4 days. Not 4 hrs, which gives them masses of flexibility. I'm sure there are challenges, whilst covid, track and trace etc are all new, vaccinations aren't. 

I think the administration will be the challenge, contacting people, booking time slots, even identifying them etc..  There are vunerable in care homes who don't even know their own name so who ever has assumed responsibility for their care might need to authorise etc.. 

I was going to get a packet with instructions and follow them.

Die, at worst. But fewer people will die that way than will from delays to being vaccinated 

and dentists too.

Cool, get yourself a copy of this while you're at it. You'll never have to queue at A&E again (maybe)

https://www.amazon.co.uk/Nancy-Carolines-Emergency-Care-Streets/dp/12841372...

Perhaps. Get yourself a copy of this:

https://www.amazon.co.uk/Champion-embalminga-systematic-comprehensive-embal...

....and one of these:

https://www.amazon.co.uk/Stanley-FATMAX-Fiberglass-D-Handle-Garden/dp/B07RY...

....and you can bury yourself too.

Is it more technical than the flu jab?  A pharmacist did mine.

You are being a bit silly. Plenty of people inject themselves without disaster (e.g. diabetics). If it’s impractical for a vaccine, fine, say why, but pretending giving an injection requires encyclopaedic medical knowledge is clearly wrong.

I don't think so. There just needs to be some joined up records system, so folk aren't missed out. Local, then regional coordinators who are actually capable of organising the proverbial piss up in a brewery. 

Insulin injections are sub cut (little chance of hitting a blood vessel), a relatively benign substance that's naturally occurring in the body and administered by people that are trained by medical professionals and are experts in the procedure as they've been doing it daily since diagnosis.

Can't they just put it in the water supply ...

Not sure how realistic this is

The order of people in line for the vaccine, according to the leaked plans, is as follows:

Care home residents and staff, healthcare workers -  from beginning of December;

Ages 80 plus  - from mid-December;

Everyone aged 70-80  - from late December;

Everyone aged 65-70  - from early January;

All high and moderate risk under 65s  - from early January;

Everyone aged 50-65  - from mid January; and

Everyone aged 18-50  - from late January; but with the bulk of this group vaccinated during March.

 That’s quicker than I thought. I can see with the older vulnerable groups there are lots of potential difficulties.

Sort of can't believe I'm responding to this... the biggest single issue is that there simply aren't enough doses going to be manufactured this year. Secondly, you can't expect every medical worker to stop treating patients solely to give vaccinations. People are still getting ill with things other than covid19. You also mentioned the Oxford vaccine, which hasn't even finished phase 3 trials yet, so isn't ready for wider use. 

Are you sure? They have been i production since July. If they work, I don’t think supply is the issue

No, but 70 injections over a month is only a couple of days work.

But will be very soon.

Some of the issues, just off the top of my head:

Cold chain training and accreditation: if there’s a break anywhere along the chain, is that dose you’ve given actually effective. Particularly if it needs kept at -70!

Documentation of doses given, access to patient notes for possible contra-indications. Effective recall systems. 
 

Potentially PPE for the givers, adequate space, parking, facilities etc.

Time!! Many of those medical professionals are already more than fully occupied.

Cost, as always. All the above probably equates to much more than £12 a dose currently offered, and a private company would likely ask for a lot more. 

Discussion and informed consent: will likely take much longer than giving the injection. This isn’t a vaccine we’ve used for years and are familiar with, with known side effect profile. Particularly with understandable concerns from many, and a burgeoning anti-vaccine movement worldwide. 
 

Yes, I'm sure. Remember this is bigger than just the uk. The doses manufactured to date will be spread across the world (not evenly, unfortunately). 

Take the flu jab as an example. This is a well established vaccination that they have all year to prepare that about 20-30% of the population receive, and we still ran low this autumn. We need to vaccinate 80% of the population with a vaccine that hasn't even been approved yet. These covid vaccinations are an astonishing feat of medicine and science  They would normally take a decade and we've produced them in a matter of months. So let's be grateful for what we have whilst also being realistic about timelines. It will be well into next year before a sufficient proportion of the population receive the vaccine. 

I'm no expert, but other posters on here have said that Bull's semen it transported at -70 and that's just a case of dry ice and a cool box

for many would it be drive through similar to giving flu jabs and covid tests?

Agreed, but how many flu jabs have been done? How long would it take to train people to give a vaccine jab?

In the current climate that sort of money is a bargain.

Concentrate on the who want it at least initially.

How much bulls semen do you think gets transported? I rather hope it's less than the 140 million vaccine doses we'd need...

To be fair, the Pfizer vaccine is the only one that needs this treatment, and labs routinely ship enzymes on dry ice, so in developed nations it shouldn't be an insurmountable barrier. Other vaccines in development are easier to ship and store. 

Kate Bingham is the vacinne coordinator:

“We’re going to have more vaccine than we’ll be able to deploy is my expectation,” Bingham said. “I don’t think vaccine supply is going to be the limiting step.”

To be fair, whacking in a few mls i.m. isn’t anything anyone sensible couldn’t learn in about 10 minutes.

s.c. in 5 minutes at a pinch.

Shhh.... Pay review in April!

Edit: and in all honesty, I've had a shit tonne of vaccinations and I could probably count the number that have been done properly, by the book, on the lateral aspect of one upper deltoid.

It's a new vaccine. Unlike the flu jab, everyone that gets it is going to need observing for 15-20 minutes afterwards, in a socially distanced manner. This massively limits the throughput of the vaccination system. (Flu jabs at a GP surgery in a typical flu clinic are booked at something like 3 minute intervals, no observation, with multiple vaccinators - and this is only to cover the vulnerable and over 65s) . Notwithstanding the likely supply of enough vaccinations to cover maybe 5 million at best before Christmas, it's going to take some time.

But not before Christmas.

Just ignore all the answers you don’t like, and keep on repeating your OP. It’s great fun for all! 

So you could train 6 people per hour, that's only 1.6 million hours to train the population.

Myself I would rather it takes a little bit longer to deliver but be done by trained medical people. 

The Mrs is type 1 diabetic and injects her self with a tiny needle twice a day, looks to be about 10mm or 15mm long or so, sometimes her skin reacts as she hits blood. When I got my flu jab I looked at the needle and I would guess it was about 40mm long. I'm pretty sure you don't want novices sticking that in each other. 

Well it was in part lighthearted but a) it seems plans are quicker than I thought,  b) I have engaged with most points and c) I haven't repeated anything.But glad you are enjoying things.

I'm actually impressed at the speed of it looking at that schedule (caveat the clowns of this governent have not met a self-imposed deadline/target since they told their mums they'd be tidying the room 'tomorrow', in 1964, so i know where my money is).

Assuming the vaccinations are done on a Monday to Friday working day type of thing, 140,000,000 injections, even if they were to be done over a full year, would still mean administering 551,181 inoculations a day. Fat chance for that, even fatter for doing it over the space of 3 to 4 months.

I don't suppose that 1m medical staff are currently just sitting around picking their noses.

Seeing as there will be huge numbers of vaccinations perhaps experience will mean the observation time would soon be greatly reduced if no complications arise. They usually ask me to wait 5 mins after the flu jab and this year they let me leave immediately (perhaps pandemic separation measures played a part).

I used to work in an experimental pathology lab and non-medical technicians would often take venal blood for controls and to test techniques. I think they were just shown how by other technicians. 1970s and 80s mind.

I had to make do with venous blood when I was doing it but I think venal blood is more common these days.

Yes, but subcutaneous... at a pinch...

Never mind.

Pharmacists too.. we roll out the flu vaccine to millions annually.

I think we can get a significant number (assuming they have been manufacturing it) done by May/June.

"We need to vaccinate 80% of the population with a vaccine that hasn't even been approved yet."

we don't.

1. We dont need herd immunity. We just need to reduce pressure on hospitals and protect the at risk.

2. If we get more than 60% of people to want to vaccinated this year I'd be amazed. And that's in the UK. The right have been systematically attacking the public's faith in science for years. Ergo.. the public don't trust science. 

I haven't said that even once!

You’ve strongly implied it. Ok I’ll leave this now (without flouncing off in a huff or a sulk!), I have better things to do than to get into a nit-picking argument with an Internet stranger who has tried to be funny and has come a bit unstuck. 

You can hire -65°C shipping containers, the food industry move stuff like oily fish around the world at -40 to -50 as a matter of routine.

Injecting 70 million people all at once with an experimental vaccine which has had about 3 months testing seems like a pretty reckless thing to do.

Assuming that everything is going to be fine just because we are in a hurry and we really want it to be fine is almost always a really bad idea when dealing with new technologies.

Even if we could inject everyone in a month, it would be far smarter to go gradually so that young and healthy people who have less to gain and most to lose if there is a problem do not get it until there is more information about efficacy and longer term side effects.

I wonder if third wold countries and aid agencies have experience of mass vaccination that we could tap into.

Very funny. Well, a bit funny.

I was thinking about your 5 or 10 minutes comment. Entirely accurate and probably a bit longer than it takes to show someone how to tie on. But how long before you'd be happy leaving someone to tie on unsupervised? And once they were competent on the day, would you trust them to tie on properly a week later?

That's  a reasonable point but not one I have really heard.

That’s fair comment.  I think the proposal was that, in view the urgency of the situation, anyone with some relevant training and basic medical background knowledge (paramedics, nurses, vets, dentists, pharmacists with specific training etc) could be roped in.  Basically anyone used to injecting things and who could reliably identify a deltoid.

I remember being given a short lecture on the basics of phlebotomy, being assigned a fellow student and told to go and practise on each other.  I was pretty good at it.  He wasn’t.  Still, no real harm done apart from my life-long needle phobia...

I think if you wanted to inject a lot of people fast, at least for the ambulatory population, then  Borrowing the later cohorts of medic/dentist/nursing/vet/ agriculture students for a few weeks in the new year would probably give you a reasonable sized workforce.

the academic year has been so screwed up they may as well do something practical. The RCVS might even count it as EMS..

I’ll suggest it to our daughter.  It might at least get us to the front of the queue.

So basically you're saying that anyone can be trained to do this as a drill, adequate supervision should be in place to monitor quality, and the vaccine is delivered with a single sized needle as a kit risk minimised, and correct medical provision to deal with anaphylactic shock is on site comparable to what you get in a GPs surgery. 

Not a self injection job because it would be a waste of time to train and money to train an individual to administer one vaccine, but if you can be trained to do it so can almost anyone else because training someone to achieve a single task with a limited number of permutations is pretty easy. 

I've seen pulp fiction, you just need a mate standing by, ready to give you a shot of adrenaline directly into the heart 🙂

In the UK there are 12,000 pharmacies and presumably most can give the flu shot. So the can be used. Set up a few mass vaccination centers, use schools and then obviously GP surgeries. It's not a massive task to get 20-30 million vaccinated. It's about the same number they will try to vaccinate with the flu shot this year.

https://exchange.iseesystems.com/public/isee/h1n1-flu-outbreak/index.html#p...

A friend was involved in developing this model for H1N1. If we vaccinate 40-50% with a 90-100% effective vaccine (that we have) we reduce the prevalence by around 75% or more, but we'll also vaccinate the high risk so the reality is we will reduce the pressure on health care services by a good 90% or so. Even just 10% vaccinated will have a very large impact. And the thing with herd immunity is, it isn't a sudden appearance, it slowly starts to have an impact on the R value as more have had it and more are vaccinated. Less severely ill people, less spread too. Mayo Clinic have almost 1000 healthcare workers who have tested positive in the last two weeks. Just vaccinating all the at risk (elderly and those with pre-existing conditions) will have a massive impact on our day to day lives.

With an effective vaccine we will rapidly cut into this. In the US it''s very likely we start vaccinating patients and front line covid health care workers this year. By April we should have 10's of millions vaccinated.

It's certainly a huge undertaking and one that should be entirely manageable if people choose to step up.  Pharmacies and GP surgeries are private businesses and since March the majority of GPs have taken several big strides back from actual patient contact.

Lets hope it's better organised than the wife's flu jab. She turned up yesturday for the pre-arranged time slot at the Doctors surgery, and joined the socially distanced queue outside. After waiting 30 mins she gets to the front of the queue to be informed the nurse giving the jabs left 30 mins ago ! We are informed the nurse left at 1200 and had asked the person at the front  of the queue if they were there for a flu jab. As they said no she appears to have decided her responsibilities were over and went home! Wife's appointment was 1158 and she joined the queue at about 5 mins before that. Brilliant!

I work in a hospital and have gone through the training to become a flu vaccinator this year. It was quite straightforward. Had to do a fair amount of online reading, attend a mornings course on how and where to inject, and what to do in case of anaphylaxis. It probably took a day and a half to get it all done and signed off by the relevant people. The practical element was in a dummy arm initially, then just observed a real patient (my colleague) being jabbed, before going solo whilst being observed.

Where I work have trained loads of additional vaccinators this year, initially for flu jabs, but presumably we will be called upon for covid vaccines once they arrive.

We have 4 vaccinators in our department of about 50 staff, so the idea of getting every nhs worker trained to vaccinate seems a bit unrealistic in my opinion, for many reasons. 

Some are a law all of their own, I had a 1600 appointment, turned up at 1558 and was told the doctor had gone home for the day because I was not there. Apparently at my doctors you are supposed to turn up 10 minutes early. 

Ps it's the only time I have not had a 20 to 30 minute wait after my appointment time. 

Remind me what kate Bingham’s background is, venture capital or some such?

Thank you for this serious reply, that is dearly informational! 

I still think Maccy D's have the answer to deal with the numbers...

Part one, care homes etc will need deployment of the vaccine at their premises for the most vulnerable. 

The bulk of the rest...(local example...)

Close M5 northbound from Exeter for a week. Give population time slots and have a set up 3 lanes wide between junct 29 and 28 giving vaccine both sides of each lane to all vehicle occupants. Queue for vaccine and remain in vehicle at all times.

Near Hele there is a secured access to the motorway so logistics,  staff etc can access there. Form further holding point immediately before Junction 28 to hold for 15mins to monitor contra indicators. Cars of vaccinated occupants leave at junct 28 or further north if they want to.

Given how important all this is to stopping people dying x50,000 more maybe, a bit of lateral thinking needed. Yes my idea has loads of holes in it,  please shoot more if you like!

In healthcare. So relevant experience, which is refreshing.

I am amazed. I think our entire training for both IM and SC consisted of a 90 minute lecture. As far as the practical element goes, it's observation only in a branch of healthcare where IM/SC is pretty rare. Students aren't officially permitted to push the plunger on even a saline flush with patients. Ridiculous, considering students are permitted to cannulate and intubate. 

Consequently, the very first time I administered IM, it was in the middle of the night while stood up in the back of an Ambulance that was negotiating a twisty country lane at some speed, on a very panicked patient who was convinced he was going to die and who was violently convulsing every 30 or 40 seconds as his internal defibrillator repeatedly and randomly fired off. So, not ideal.

Since March? 

Pre-Covid I though standard GP procedure was:

a. Tell patient to go see a pharmacist.

b. If more serious refer patient to NHS specialist.

c.  If very serious tell patient to go to A&E

It will be a challenge mostly because you can be sure the government will centralise everything under they control and make an arse of it.

That was pre covid. Now if there are any covid symptoms (and that covers a lot of ground) GP's standard go to seems to be an ambulance crew to assess. 

My first thought on this is that if the vaccine needs two shots, 3 weeks apart you'd aim to do the entire cohort of 20 million over 3 weeks and then repeat.

That would mean vaccinating a million people a day. 

If it takes 5 minutes or so for each shot that means each operator will do roughly 100 shots a day.

That works out at 10000 vaccinators across the UK which doesn't sound unreasonable.

Presumably a number of vaccinators would share each cold store so again the number of cold stores required would not be that great, perhaps 1000.

I wonder if the government has finally decided to drop the "world beating" crap and now make predictions cautiously and hope to over deliver. It's what most project managers try to do.

The German government plan 70 distribution centres/cold stores, why  would you need 1,000? Surely Tesco et al get by with less.

Quite possibly I was just making a guess. It really depends upon the difficulties in keeping the vaccine viable after it leaves the cold store I'd have thought. Tesco don't need to keep stuff at -70 and the consequences of some of their frozen produce going a bit off aren't so serious.

Can you explain to me the scientific basis for vaccinating everyone?  Is there any solid evidence that the vaccine has a lasting efficacy and that it will prevent propagation?  Do we need to vaccinate under 50s who are in good health and if so why?  is the long term safety data sufficient to advocate for such large scale vaccination?

Interrupt asymptomatic spread or spread by those with mild symptoms. Alternatively prevent anybody getting seriously ill if they catch it.

Is there any solid evidence that the vaccine has a lasting efficacy and that it will prevent propagation? 

90% efficacy is 90% fewer serious infections but so far the trials do not detect if what would have been serious cases have been turned into undetected asymptomatic spreaders.

Do we need to vaccinate under 50s who are in good health and if so why? 

Interrupt asymptomatic spread or spread by those with mild symptoms. Alternatively prevent anybody getting seriously ill if they catch it.

is the long term safety data sufficient to advocate for such large scale vaccination?

Possibly yes in comparison to the known risk of covid. 

"Can you explain to me the scientific basis for vaccinating everyone?  Is there any solid evidence that the vaccine has a lasting efficacy and that it will prevent propagation?  Do we need to vaccinate under 50s who are in good health and if so why?  is the long term safety data sufficient to advocate for such large scale vaccination?"

Protect the vulnerable and long covid.

If your parents are 80 and you've not had the vaccine and they have, the British one is 70% effective. Would you not want to have it?

Also in the US Pfizer's is 95% effective at preventing covid, but looks like almost 100% effective at preventing serious covid. Would you not want it?

Herd immunity.  Those with good and primed immune systems protect those without.

As a healthy adult in their early 40s I’d take the Pfizer/BioNTech vaccine if there was enough to justify giving it to me (I doubt there will be for quite some time) as I know healthy people in their early 40s who’ve been really clobbered by it.

Also, the fewer people the bloody thing is circulating in, the less likely it is to find a still lethal mutation of the spike protein that breaks the vaccine given immunity, taking us back to square 1.

Such data will exist I think by the time such large scale vaccination (of those not at immediate and personal risk) is possible, and then that question can be asked of the data.  We can infer something of the long term risk from the shorter term data given the exceptionally large number of people tested to date, but it’s not substitute for the passage of time.