Right now we have a feast of vaccine. Thousands of doses arrived this week and more next week, but they have a very short shelf life so need using in the next 2-3 weeks (nobody’s fault).  Next month there will be a vaccine famine (nobody’s fault).

We’ve followed JCVI guidance by inviting people at risk first, and not offering 2nd doses until 11 weeks after the first, and we have made huge effort not to waste any doses.

We’ve invited all our eligible patients (everyone 50 years and over, and all adults with underlying conditions that put them at higher risk of Covid).

We’ve done outreach vaccination for homeless people, people with learning disabilities, asylum seekers, in a community centre and in a mosque. We have a team of people phoning patients every day; but we still have appointments available, and spare vaccine.

Now, our options are:

• Invite people for their 2nd vaccine a bit early (strongly discouraged by NHSE and it goes against the principle of vaccinating as many people as possible);
• Invite younger adults (NHSE have specifically forbidden us from doing this). We’ve got vaccine and vaccinators.
• Give it to someone else (everyone is in the same situation)
• Waste it. This would be a tragedy. We’d have to look people in the eye and say ‘sorry, we could have offered you a vaccine last month but we don’t have any now so you’ll have to wait. Oh – you’re a teacher? Well, I guess more convenient to get it after term ends ….’

What should we do?!

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Vaccine manufacturing is a complex business and from time to time you would expect to see peak and troughs in the supply chain as the product is manufactured and released.  A delay in area will lead to delays in other areas due to interdependencies.

The fact that delays have not occurred until now, is a remarkable achievement to all those involved.

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The news that vaccine supplies are due to diminish is naturally unwelcome, but ideally something that has been planned for. Whilst the letter insists that vaccinations will continue for groups 1-9, one presumes this means a single dose.

I would be concerned to prioritise that groups such as the over 80s, and clinically extremely vulnerable people with severe immunosuppression due to chemotherapy or other medication, receive their second dose of the Pfizer vaccine in a timely fashion, based upon recent studies showing this to be important in achieving high antibody titres.

Moreover, I would hold the government to their promise of being led by data, rather than dates, as restrictions are lifted. It is vital to constantly revise their strategy in the event that the supply of vaccines continue to form a bottleneck in plans to protect the UK population as a whole. It is vital that we maintain control of the virus whilst vaccine coverage is increased to the highest levels possible, such that when the harsher restrictions are eventually relaxed there is as small chance as humanly possible that they will not need to be implemented again. We must be patient and support those in society least able to manage during these difficult times.

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The reduction in vaccine supply is of course a blow to those who are expecting to receive their vaccines soon. However we can take comfort in the fact that the majority of the highly vulnerable people have received at least their first dose, and that numbers of infections are still declining. The evidence is now strong that vaccination does in fact reduce transmission substantially and as vaccinated numbers will continue to rise, barring any unforeseen circumstances (such as the emergence or introduction of new variants of concern), this trend can be expected to continue. The prioritisation of the delivery of second doses is a sensible measure since, without any prospect of herd immunity in the near future, the further protection of the vulnerable from infection afforded by that second dose rightly takes priority. It does however, emphasize the importance of adherence to restrictions while we are still trying to bring infection numbers down.

Vaccine supply was always going to be challenging – particularly at the current rates of daily vaccinations. This highlights the difficulties in manufacturing these complex vaccines along with need for stringent quality control. We are also limited by having just two approved vaccines (Pfizer/BioNTech and AstraZeneca/Oxford) currently in use. 5 million doses of the Moderna vaccine, which was approved for use by the UK Medicines regulator (MHRA) in January, were secured for delivery in the spring – where are they? We have also secured 60 million doses of the Novavax vaccine which is currently awaiting regulatory approval. We are in a very precarious situation with a significant proportion of the adult population unvaccinated (approximately 21 million in the 18-49 age group) and the continued threat of more transmissible virus variants popping up in different parts of the country. This could mean that we need to revisit the timetable for easing out of lockdown.

It’s to be expected that supply of Covid-19 will be variable, but to delay vaccination for the under-50s by a month is more than a bump in the road.  To pretend that everyone at risk has been vaccinated is misleading.  During the pandemic, more men in their 40s were admitted to Intensive Care Units than men and women over 85 and the government were clearly expecting to proceed at pace with the vaccinations, otherwise they wouldn’t need to stop appointments being made in April.

We don’t yet know exactly why the delay has occurred, but the ripple effects could last for months.  It will undoubtedly make the meeting of the target dates for lifting restrictions more difficult than they otherwise would have been.  By pushing back the under-50s first doses, their second doses are also being pushed back.  If full vaccination becomes required for holidays abroad or even more mundane things like going to the cinema, millions of younger people may end up being excluded from participating for the whole summer.

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