COVID-19 Vaccine Deployment in Wales
This year has seen huge challenges for us all. The constraints placed on our everyday lives have been difficult to bear and it is with great anticipation that we welcome the news that vaccines are now beginning to become available, to save lives, protect the clinically vulnerable and enable us to begin to return to normality.
We have been closely engaged in a Four Nation approach across the UK in monitoring progress on the development of vaccines since May and the health and social care sectors in Wales have been planning in earnest in readiness for the first vaccine being available. Now all this hard work is coming into fruition. Our intent is to vaccinate as many eligible people as possible, as swiftly as possible, safely, and with minimal vaccine waste. We will start with those groups most at risk of serious illness or death from COVID-19 infection, together with front line health and social care workers.
Today we received the welcome news that the Medicines and Healthcare products Regulatory Agency (MHRA) has granted the Pfizer/BioNTech vaccine temporary authorisation for use based on evidence of safety and effectiveness. 40 million doses of the Pfizer/BioNTech vaccine have been secured by the UK Government on behalf of the UK. Wales, like the other UK nations will now begin to receive its share and we will start deployment, based on advice from the Joint Committee on Vaccination and Immunisation (JCVI).
The UK Government has also pre-ordered 100 million doses of the Oxford / AstraZeneca vaccine, and having submitted its Phase III data, a decision from the MHRA is awaited for this vaccine. If approved as safe and effective for use, we are told to prepare for readiness for delivery later in December.
Both these vaccines consist of a 2 dose schedule with 4 weeks between doses. Protection is achieved by 7 days following second dose, although some protection will begin from 7 to 14 days following first dose. We will be vaccinating people who are most at-risk of catching coronavirus and developing serious illnesses first, based on the recommendations from the JCVI. They have recommended the vaccine be offered to in the first instance to care home residents and health and social care workers, alongside people aged 80 and over.
From our ongoing discussions with UK Government and the manufacturer, and from understanding the conditions under which the vaccine trials have been conducted, we are aware of the challenges of storing, distributing and handling the Pfizer/BioNTech vaccine. In particular its need for storage at very low temperatures of below minus -75ºC +/- 15ºC. Two specialist sites have been identified as appropriate delivery sites for the vaccine and local Health Boards will collect the vaccines directly from the two sites. We have been exploring suitable options for initial deployment of this vaccine, in line with the JCVI advice, bearing in mind the constraints associated its characteristics and the implications for delivery to all groups. In practical terms at this stage that we cannot deliver this vaccine to care homes.
For each candidate vaccine final deployment models will be similar across the UK. It is crucial that we all continue to work towards a Four Nations joint approach.
All NHS organisations in Wales have undertaken Wales-wide simulation exercises to test our distribution and storage arrangements and to ensure we can get effective vaccine safely to every part of Wales. On 26 November, the end to end logistics for the Pfizer vaccine from ultra-low temperature central storage to receipt by the end user was tested across NHS Wales as part of a "dummy simulation exercise". This exercise was a follow up arrangement to an initial test on the 12 November, expanding the logistics to include multiple delivery sites and aligning all the necessary consumables required to undertake a vaccination clinic.
All key stakeholders from the seven Health Boards took part along with partners and key pharmacy leads. Cold chain maintenance was maintained throughout the distribution exercise with no temperature excursions or delays. All deliveries were received at the correct locations and receipt of deliveries recorded electronically on the Welsh Immunisation System.
Wales is ready to deploy the vaccine in phases, starting with hospital sites and then community settings. People will be sent appointments with details of the location where they will receive the vaccination, dependent on where they are on the schedule and risk. There will be no need to apply for or ask GPs or pharmacists for the vaccination, as invitation will be done automatically.
The Welsh Immunisation System has been developed in Wales and can create appointments and automatically schedule second doses, send appointment letters and record vaccinations for every COVID-19 vaccine given.
Those receiving a COVID-19 vaccination will be given a credit card-sized NHS Wales immunisation card which will have the vaccine name, date of immunisation and batch number of each of the doses given handwritten on them. These will act as a reminder for a second dose and for the type of vaccine, and it will also give information about how to report side effects.
Heath Boards and Trusts, with input from primary care advisers, have developed and tested comprehensive plans for the safe delivery of vaccination in a variety of settings. This will includes using community venues and mobile teams to make the vaccine as accessible as possible for everyone who needs it. This has been done so that primary care services can continue to provide services and deliver the flu vaccine programme at the same time as the COVID-19 vaccine programme is rolled out.
Health Boards and Trusts in Wales have developed workforce deployment plans that will support their local planning and delivery requirements. This includes and identifies training and recruitment needs, how they can utilise volunteers to help with the roll out and ensuring there are enough trained and experience immunisers to vaccinate the required numbers of people, when each vaccination is safe and ready to be deployed. Health Boards and Trusts are utilising the existing workforce to fill these roles first as the early stages of the campaign, with a novel vaccine, should be initiated with experienced, trained immunisers. Additional recruitment is ongoing. The WCVA is working at local level with Health Boards and Trusts existing Volunteer Coordinators, who have established processes for volunteer deployment, to support the vaccination campaign with targeted recruitment and training of volunteers. Offers of support from St John Cymru and British Red Cross and others are being followed up.
Public Health Wales participated in a Four Nations expert training group to develop COVID 19 vaccination training materials and recommendations for all staff, including registered, non-registered, experienced, inexperienced and new staff. The training includes e-learning modules and assessments for core knowledge, Basic Life Support, anaphylaxis, guidance on work based competencies and vaccine specific data. Training and assessment of completion and competence will be also be carried out locally by Health Boards and Trusts. This will be supported by training webinars. Experienced staff and new staff have been advised to complete existing core training in advance to be ready. These training measures are a consideration for all UK nations.
Materials to provide the public and professionals with information about COVID-19 vaccines have been developed by Public Health Wales, in close collaboration with Public Health England. Guidance materials to ensure safely administration of the vaccine have also been developed, in collaboration with other public health agencies across the four nations.
The vaccine will not be mandatory and people will be able to choose whether they take up the vaccine or not. Information will be provided to people before vaccination to reassure them about patient safety and robust consent processes will be in place. As we get closer to deployment we will continue to provide clear information to the public and urge people to seek NHS advice so they have the right information to make an informed choice.