Soldiers work at The Exhibition Centre, which has been set up as a testing centre as part of the mass coronavirus disease (COVID-19) testing, in Liverpool, Britain, November 6, 2020. Peter Byrne/PA Wire/Pool via REUTERS

NHS England medical director Stephen Powis confirmed today (Nov 18) that general practitioners (GPs), pharmacies and large-scale inoculation centres could all be involved in the roll-out of Covid-19 vaccines.

He added that more details would be given in the coming days.

This means that both family doctors and some pharmacy contractors are grappling with the prospect of a seven-day service, -75 degree Celsius freezers and vaccines known as “Talent” and “Courageous” as they prepare for an unprecedented logistical challenge.

This comes after health secretary Matt Hancock set a target for NHS that it should be ready to administer vaccines by Dec 1, although he has said his central expectation is for the bulk of the roll-out to happen next year. Any distribution of vaccines would also require approval from the MHRA.

“There’s going to be some nationally organised vaccine immunisation centres, which will be large centres, probably run with military involved, etc. But GPs are well placed,” Steve Mowle, a practising GP and honorary treasurer of the Royal College of General Practitioners, told Reuters.

“The challenge of this task is even bigger than the flu immunisation programme. But I’m sure that GPs will have a very central role in delivering the Covid-19 vaccine,” he added.

Much of the delivery of vaccines will be determined at a local level, and exact practices may vary in different parts of England, let alone in Scotland, Wales or Northern Ireland, where health policy is devolved.

In the central English county of Nottinghamshire, health officials said in a briefing to medical professionals that they planned to be ready to start vaccinating frontline staff and people in care homes from Dec. 9, with large-scale Covid vaccine centres operating from Jan. 2 and more GP practice involvement from mid-January.

“I don’t think we’ll be at full capacity from the first of December. Obviously, we will have a gradual roll-out,” Mowle said.

“But… where there’s a will there’s a way, and I think there’s a huge willingness of GPs to engage in this process.”

A spokesman for the Department of Health and Social Science said that extra logistical expertise, transport arrangements and equipment had been put in place, the workforce had been expanded and £150 million pounds had been given to GP practices.

“An enormous amount of planning has taken place to ensure our health service stands ready to roll out a Covid-19 vaccine,” he said.

“We will publish further details on our deployment plans in due course.”

‘Talent’ and ‘Courageous’

Although there is still a lack of clarity over some of the details of how healthcare professionals, including doctors and pharmacists, are expected to deliver the vaccines, the GPs have been briefed on the broad outlines.

In the absence of trade names, the NHS uses code names to refer to the two vaccine candidates that are expected to be the first available.

Pfizer and BioNTech’s vaccine candidate, which uses an mRNA platform, is referred to as “Courageous vaccine”, while the University of Oxford and AstraZeneca’s is referred to as “Talent vaccine” in slides from a webinar to health professionals given by NHS England last week that have been reviewed by Reuters.

Britain has ordered 40 million doses of the Pfizer/BioNTech’s vaccine candidate, which had 95 per cent efficacy in final trial results published on Wednesday, and 100 million doses of the Oxford/AstraZeneca shot, which is expected to publish efficacy data in coming weeks.

In the webinar, doctors were told there would be 975 doses per pack of Pfizer vaccine, with two doses needed to be given 21 days apart, in line with the US drugmaker’s design specifications.

Clinics could also need to be open at weekends to make sure the doses are used in time.

“Potential Covid-19 vaccines could need to be delivered within a certain time period once they arrive at a site,” the slide said.

“So, if necessary, but not otherwise, practices will need to have the ability to deliver vaccinations between 8 am and 8 pm seven days a week to avoid any going to waste.”

Twin track

The urgency of getting vaccines delivered to people promptly after they are received stems in part from the demanding storage requirements of the Pfizer/BioNTech vaccine, which needs to be kept at around -75 degrees Celsius.

It can then be stored for five days in refrigeration but once diluted it has to be used within a matter of hours, which causes headaches for those distributing the vaccine, especially in rural areas.

“There’s some real challenges around how, how it might be used,” Richard Vautrey, a doctor and chair of the British Medical Association’s GP Committee, said.

“It’s quite different from what we would normally experience with, say, the flu vaccine,” he said, adding that details of the “twin track” strategy were under active discussion.

The onerous storage requirements of the Pfizer vaccine can be mitigated by dry ice and other temporary cooling solutions, said Anna Blakney, research fellow at Imperial College London.

“Between the purchase of new freezers and having that space, in addition to the dry ice shipments, that would probably be able to accommodate … all the vaccines that we’d be receiving,” she said.

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