Analysis

The COVID-19 vaccine roll-out: what you need to know

Nurses are playing a leading role in the programme, in hospitals, care homes and the community

Nurses are playing a leading role in the UK’s mass vaccination programme, in hospitals, care homes and the community

  • The UK's COVID-19 vaccination programme is now underway, following the approval of the Pfizer/BioNTech and Oxford/AstraZeneca vaccines
  • A third vaccine – the Moderna vaccine – has also been approved, but doses will not be available until the spring
  • We look at who is being given priority in the vaccination programme, as well as logistics and the role nurses are playing

This article was updated on 8 January

The COVID-19 pandemic and subsequent approval of vaccines has sparked the biggest vaccination programme in the history of the NHS.

Nurses are playing a leading role in the UK’s mass vaccination programme, in hospitals, care homes and the community

  • The UK's COVID-19 vaccination programme is now underway, following the approval of the Pfizer/BioNTech and Oxford/AstraZeneca vaccines
  • A third vaccine – the Moderna vaccine – has also been approved, but doses will not be available until the spring
  • We look at who is being given priority in the vaccination programme, as well as logistics and the role nurses are playing

This article was updated on 8 January

Image of the Pfizer/BioNTech COVID-19 vaccine and a syringe
Picture: Alamy

The COVID-19 pandemic and subsequent approval of vaccines has sparked the biggest vaccination programme in the history of the NHS.

Nurses are at the forefront of this programme, not only administering the vaccine but as one of the priority groups to receive it.

So far more than 1 million people in England have received their first dose of a COVID-19 vaccine, with the government pledging to vaccinate 14 million by February.

Here, we take a look at the vaccines available, delivery and administration logistics and the implications for nurses.

What COVID-19 vaccines have been approved and how do they work?

The first vaccine approved for use by the UK medicines regulator the Medicines and Healthcare products Regulatory Agency (MHRA) was the Pfizer/Biontech vaccine. Jointly developed by American pharmaceutical corporation Pfizer and German biotechnology company BioNTech it is known as a messenger RNA (mRNA) vaccine.

Traditional vaccines are produced using weakened forms of a virus, but mRNA vaccines use only the virus’s genetic code.

40 million

doses of the Pfizer/BioNTech vaccine have been secured by the UK government

Source: UK government

As no virus particles are needed to create an mRNA vaccine, the rate at which it can be produced is dramatically accelerated and it is cheaper to produce. One downside, however, is that it needs to be stored at ultra-cold temperatures and cannot be transported easily.

How safe and effective is the Pfizer/BioNTech vaccine?

Analysis suggests the vaccine can prevent 95% of people from getting COVID-19; 94% in older age groups.

It was tested on 43,500 people from six countries and no safety concerns were raised.

However, the MHRA imposed a requirement for a 15-minute observation period for patients who receive a dose of the Pfizer/BioNTech vaccine, following allergic reactions in NHS staff who were among the first people to receive the vaccine last month.

The MHRA has also recommended that people with a history of significant allergic reactions should not be given the Pfizer/BioNTech COVID-19 vaccine.

An MHRA announcement of the COVID-19 vaccine approval
An MRHA announcement for its approval of the Pfizer/Biontech vaccine

What about the Oxford/AstraZeneca vaccine?

The Oxford vaccine was approved for use in the UK by the MHRA in late December 2020.

A genetically modified virus vaccine jointly developed by Oxford University and AstraZeneca, it has 62% efficacy when one full dose is given followed by another full dose, trial data published in The Lancet indicated.

But when people were given a half dose followed by a full dose at least a month later, its efficacy rose to 90%. The combined analysis from the two dosing regimens resulted in an average efficacy of 70.4%.

Clinical trials do not suggest any significant safety concerns.

Both this and the Pfizer/BioNTech vaccine require two doses: the second Pfizer/BioNTech vaccine may be given between three and 12 weeks after the first dose, while the second dose of the Oxford/AstraZeneca vaccine can be given between four and 12 weeks after the first dose.

When will the Moderna vaccine be available?

A third COVID-19 vaccine was approved for use in the UK on 8 January, but doses will not be available until the spring.

It has been developed by American biotechnology company Moderna. It is another mRNA vaccine and trials suggest it is 94.5% effective.

The government has purchased an additional 10 million doses of the vaccine on top of its previous order of 7 million, taking the total to 17 million.

Supplies will begin to be delivered to the UK from spring once Moderna expands its production capability, the Department of Health and Social Care said.

How have the COVID-19 vaccines progressed through clinical trials so quickly?

Image showing the Pfizer/BioNTech vaccine
Picture: Alamy

Normal vaccine development is split into clinical trial phases.

Phase one clinical trials are small studies, generally involving 100 adults, focusing on safety and dosage. Phase two trials are medium-sized studies involving several hundred people to determine if a vaccine can generate an immune response.

If successful, trials move to phase three, usually involving several thousand participants. These will show whether a vaccine generates antibodies but also protects people from disease. Safety assessments take place throughout.

If a vaccine is successful at every stage, its creators then send their trial data for review by regulators. Once approved, large-scale production and distribution begins.

Development process condensed from years to months

The entire process, including the initial research and development of a vaccine, usually takes years. However, for the COVID-19 vaccines, it has been condensed into months.

This has been achieved by the companies developing potential vaccines submitting data on each of their clinical trials to regulators as each phase is complete, rather than waiting until the end of the entire process.

This process is known as a 'rolling review' and means regulators are getting the scientific data on the vaccines’ safety and efficacy far earlier in the process than they normally would.

How is the vaccine programme progressing and what role are nurses playing?

The programme has been designed to deliver the vaccine in three key ways: via dedicated hospital vaccination hubs, in the community via GP surgeries, care homes and pharmacies, and in dedicated vaccination centres set up to treat large numbers of people.

The RCN says the roll-out is a ‘huge logistical operation’ where nurses will play a pivotal role.

‘They already administer the majority of vaccines in the UK and will be fundamental in its safe and effective delivery, including the training and supervision of support staff,’ says RCN general secretary Dame Donna Kinnair.

At University Hospital, Coventry, on 8 December, matron May Parsons became the first healthcare professional to administer the Pfizer/BioNTech vaccine at one of the hospital hubs.

The programme was extended to GP surgeries on 14 December, with each local area – organised into primary care networks – asked to nominate a practice to deliver the vaccine. Nurses from all the local practices work together to run the clinics.

The UK’s first dose of the Oxford/AstraZeneca vaccine was administered by Oxford University Hospitals NHS Foundation Trust chief nurse Sam Foster on 4 January.

Community vaccinations in England using the Oxford/AstraZeneca jab started on 7 January, with the aim of 1,000 sites delivering vaccines by the end of first week.

How are the vaccines stored and distributed?

The Oxford vaccine can be stored at normal fridge temperatures, unlike the Pfizer jab, which requires storage at -70°C.

But there have been reports that surgeries are experiecing teething problems getting supplies of vaccines for their patients. This risks causing disappointment for those at the front of the queue for vaccination, Royal College of General Practitioners chair Martin Marshall has warned.

The COVID-19 vaccine in transport, during which it has to be stored at a very low temperature
The Pfizer/BioNTech vaccine has to be stored and transported at a very low temperature
Picture: PA

Seven mass vaccination centres will open from the week of 11 January, in London, Newcastle, Manchester, Birmingham, Bristol, Surrey and Stevenage.

High street pharmacy Boots says it hopes to offer vaccinations at several sites in England from 11 January. It will set up three vaccination sites initially – in Halifax, Huddersfield and Gloucester – but the company is working with the government to expand its operations.

Other businesses, such as supermarket chain Morrisons, professional sports clubs and hospitality venues in London have also offered facilities to assist with the roll-out.

95%

efficacy was recorded by Pfizer/BioNTech in trials of the vaccine

Source: Pfizer

In what order are people being vaccinated?

A priority list for phase one of the COVID-19 vaccination programme was drawn by the Joint Committee on Vaccination and Immunisation (JCVI), which advises UK health departments on immunisation.

The first four priority groups are:

  • Care home residents and staff
  • Over-80s and NHS and care staff
  • Over-75s
  • Over-70s and people who are extremely clinically vulnerable

The government has said the aim is that people in the first four groups will recieve their first dose of a vaccine by mid-Feburary.

Read the full priority list

Which health and social care staff are being vaccinated first?

JCVI guidance recommends that front-line staff at high risk of acquiring infection, at high risk of developing serious disease, or at risk of transmitting infection to multiple vulnerable people or other staff in a healthcare environment should be a higher priority for vaccination than those at lower risk.

A care worker speaks to a resident in a care home
Residents and staff in care homes were put at the top of a priority list by the Joint Committee on Vaccination and Immunisation
Picture: Shutterstock

Is the vaccine compulsory for healthcare staff?

No. The RCN ‘actively encourages’ all members to have the COVID-19 vaccine to help protect themselves, their patients, their families and the wider community. However it does not support mandating vaccination to staff as it says this would not be effective.

How quickly will people be vaccinated?

NHS England chief executive Sir Simon Stevens said on 7 January that there will be a ‘huge acceleration’ in the vaccination programme over the coming weeks.

He said we will see increases in supplies of the vaccine, the numbers of places where it is being delivered and the numbers administering the jabs.

'We need a huge acceleration if we are, over the next five weeks, going to vaccinate more people than we typically vaccinate over five months during a winter flu programme. We have got 39 days to do it,' he told a Downing Street press conference.

He said the 'bulk' of the vaccinations would be carried out at GP surgeries and pharmacies, but that the number of hospital hubs and large-scale vaccination centres were also being increased.

£6 billion

has been spent by the UK government in helping to develop and procure COVID-19 vaccines

Source: UK government.

Does the UK have enough doses to vaccinate the entire population?

The UK has secured 40 million doses of the Pfizer/BioNTech vaccine, and some 100 million doses of the Oxford/AstraZeneca vaccine – enough for two doses for the entire UK population of 66.8 million people.

View our COVID-19 resources centre

How is vaccine safety monitored after roll-out?

MHRA chief executive June Raine has said no vaccine will be authorised unless it meets the highest standards of both safety and efficacy.

‘The safety of the public will always come first,’ Dr Raine said. ‘Our job is to work to the highest standards and rigorously evaluate the data for quality, safety and effectiveness and no vaccine will be authorised unless it meets those standards.’

The Yellow Card scheme allows health professionals and members of the public to report on safety concerns about medicines, medical devices and e-cigarettes that the MHRA then investigates.

RCN resources: COVID-19 vaccination

June Raine, MHRA chief executive
June Raine

Nurses are the ‘driving force’ in COVID-19 response

Dr Raine had a message for nurses about their role in vaccination at the outset of the COVID vaccine campaign.

‘For many people, nurses are the face of the healthcare system and nurses have always been a big part of vaccination programmes, which have saved millions of lives worldwide.

‘Your hard work, professionalism and compassion will continue to be the driving force behind the COVID-19 response.

‘By working together, we can contribute to the essential work needed to protect public health in the UK and ensure patients have access to safe, quality medicines.’

Sign up to continue reading for FREE

OR

Unlock full access to RCNi Plus today

Save over 50% on your first three months:

  • Customisable clinical dashboard featuring 200+ topics
  • Unlimited online access to all 10 RCNi Journals including Nursing Standard
  • RCNi Learning featuring 180+ RCN accredited learning modules
  • NMC-compliant RCNi Portfolio to build evidence for revalidation
  • Personalised newsletters tailored to your interests

This article is not available as part of an institutional subscription. Why is this?