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22 September 2020

Why a Covid-19 vaccine is only the start

How do you deliver a mass immunisation programme?

By Samir Jeraj

Earlier this month, the Covid-19 vaccine trial run by the University of Oxford and pharmaceutical firm AstraZeneca was halted – and then restarted – after one of the test subjects fell ill. It was a setback for one of a number of vaccines under development across the world.

The UK, with a population of 66 million, has already ordered 250 million doses of four potential vaccines. Several manufacturers have plans to provide up to nine billion doses by the end of 2021, reports consulting firm McKinsey. The global population is currently 7.7 billion. But while the focus has been on who gets there first, there has been less attention on what happens next. How do you get a vaccine to everyone?

In the UK, the scrapping of Public Health England (PHE), the body which ran national immunisation programmes and health promotion campaigns, could be a big challenge. The new National Institute for Health Protection, which PHE is to be partially replaced by, is likely to carry on these responsibilities, but there has been little detailed information to date. Even if it does, institutional change is difficult at the best of times, let alone during a major health crisis.

[Read more: The race for a Covid-19 vaccine]

How a Covid-19 vaccine is delivered to over 66 million adults and children needs careful planning. While schools could vaccinate the young, the nearest thing to a population-level immunisation programme among adults in the UK is
the free seasonal flu shot, available to 25 million people.

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The indications are that a Covid-19 vaccine will probably require two or more doses. People who move around a lot or who are unable to prioritise their health will be less likely to get both. Vaccination may also need an annual refresh –replicating the challenge yearly.

Certainly at first, it is unlikely that there will be enough vaccines to immunise everyone at the same time. Specific groups – the elderly, key workers, and people with long-term conditions – will need to be prioritised. It is also possible that more than one vaccine will be licenced at once. It will be important to track who has had which vaccine in order to monitor its effectiveness.

A significant number of people will likely be resistant or reluctant to getting vaccinated. Broader trust in the healthcare system is a challenge for marginalised groups most at risk from Covid-19, too. Black and minority ethnic and migrant communities often have good reasons to distrust health services, including fears of information on immigration status being shared with the Home Office.

But there is also the knock-on effect of a mass-immunisation programme. Turning over factory production to Covid-19 vaccines could mean a shortage of treatments or vaccines for other illnesses and losing ground in the fight against childhood diseases in particular. “We don’t want to throw out the very highly effective and well-established childhood-immunisation programme in return for a Covid vaccine,” says Professor Beate Kampmann, director of the Vaccine Centre at the London School of Hygiene and Tropical Medicine, “we wouldn’t be doing ourselves any favours.” 

This article originally appeared in the Spotlight report on healthcare. Click here to download the report.

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