COVID-19 vaccination programme in the United Kingdom

On 28 November 2020 the new role of Parliamentary Under-Secretary of State for COVID-19 Vaccine Deployment was set up within the Department of Health and Social Care in the Government of the United Kingdom, with Nadhim Zahawi the first to take office.[12]

There are several COVID-19 vaccines at various stages of development around the world. As of 7 February 2021 the British Government had placed orders for a combined total of 457 million doses across 8 different vaccines.[13][14][15][16] This does not equate to the number of people that can be immunised as most vaccines require more than one dose. The breakdown of the vaccines being considered for the vaccination programme is as follows:[17]

Vaccine	Progress	Doses ordered	Approval	Deployment
Pfizer–BioNTech	phase III clinical trials	40 million	2 December 2020	8 December 2020
Oxford–AstraZeneca	phase III clinical trials	100 million	30 December 2020[18]	4 January 2021[19]
Moderna	phase III clinical trials	17 million[14]	8 January 2021[14]	Pending
Novavax	phase III clinical trials	60 million	Pending	Pending
Valneva	phase I/II clinical trials	100 million[15]	Pending	Pending
GSK/Sanofi Pasteur	phase I/II clinical trials	60 million	Pending	Pending
Janssen	phase III clinical trials	30 million	Pending	Pending
CureVac	phase III clinical trials	50 million[16]	Pending	Pending

On 2 December 2020, the UK became the first country to give approval for use of the Pfizer–BioNTech vaccine,[20][21] later branded as Comirnaty.[22] This was in the form of a temporary authorisation given by the Medicines and Healthcare products Regulatory Agency (MHRA) under Regulation 174 of the Human Medicines Regulations 2012.[23] Regulatory approval is reserved under the devolution settlement. The first batch arrived in the UK the next day and was initially stored at an undisclosed central hub before being distributed to hospital vaccination centres across the country.[24]

On 30 December 2020, the UK also became the first country to approve the Oxford/AstraZeneca vaccine.[18]

On 8 January 2021, the Moderna vaccine was approved as the third vaccine to enter the programme.[14]

On 28 January 2021, the results of the Novavax vaccine trials, which were undertaken in the UK and in South Africa, showed it was 95.6% effective against the original SARS-CoV-2 strains and 85.6% against the Variant of Concern 202012/01, then prevalent in the UK. The company stated it had begun the process of requesting clearance for use in the UK.[25] The Novavax vaccine was the first to be tested in clinical trials for efficacy against the UK's prevailing Variant of Concern 202012/01.[26] In clinical trial subjects without HIV infections, the vaccine was also 60% effective against the 501.V2 variant, a SARS-CoV-2 strain first detected in South Africa.[26]

On 8 December 2020, Margaret Keenan, 90, became the first person in the world (outside trials) to receive the Pfizer–BioNTech vaccine, as the rollout of vaccinations began.[27] William Shakespeare, 81, from Warwickshire became the second person, and the first man, to be vaccinated.[28] Both vaccinations took place at University Hospital Coventry.

On 4 January 2021, Brian Pinker 82, became the first person (outside trials) to receive the Oxford–AstraZeneca vaccine. The vaccination took place at the Churchill Hospital, Oxford.[19] England Health Secretary, Matt Hancock said this was a "pivotal moment" in the programme as this vaccine was easier to transport and store, requiring only ordinary fridge temperatures. Six hospitals in England began the Oxford vaccine rollout using the first batch of around 530,000 doses.[29]

The Queen, 94, and Prince Philip, 99, received their vaccinations within their Windsor Castle residence on 9 January 2021.[30] Prince William cited their example, a week later, to encourage everyone to take up the vaccine[31] after hearing that a degree of vaccine hesitancy had set in.

The rollout to the over 70s and clinically extremely vulnerable began on 18 January 2021,[32] representing the fourth priority group and the final group needed to complete the government's initial 15 February target.[33] The prime minister, Boris Johnson, was quoted as saying this was a "significant milestone".[32]

On 9 December 2020, the MHRA issued updated guidance, after two cases of anaphylaxis and another case of a possible allergic reaction following the vaccination. In the statement, June Raine, MHRA Chief Executive said:[34]

Any person with a history of anaphylaxis to a vaccine, medicine or food should not receive the Pfizer/BioNTech vaccine. A second dose should not be given to anyone who has experienced anaphylaxis following administration of the first dose of this vaccine.

Raine went on to say that such side effects have been known to happen with any vaccine but are "very rare". She continued to confirm that existing appointments should not be cancelled but people with a history of serious allergies should discuss this beforehand. Furthermore, she expressed confidence in the safety, assessment and monitoring of the vaccine. Guidance was given that vaccine recipients should be monitored for at least 15 minutes after vaccination and centres must be prepared for such events including the availability of an anaphylaxis pack.[34] The two people affected were quickly treated and recovered well.[34]

The Department of Health and Social Care confirm that although the vaccine triggers the creation of antibodies, vaccination does not affect the result of an antibody test to detect whether someone has previously contracted the virus. This is because there are differences between the antibodies triggered and those being tested for.[35]

As of 20 December 2020, Public Health England say there is "no evidence" to suggest that the recently identified Variant of Concern 202012/01 (a new variant of SARS-CoV-2) would be resistant to the Pfizer–BioNTech vaccine currently being used in the programme, and people should still be protected.[36] Further laboratory work is still being prioritised to increase current understanding of this.

During the rollout of the Pfizer–BioNTech vaccine first doses, the UK government announced on 30 December 2020 that future deployment would focus on that initial dose, rather than giving the required two doses as quickly as possible. The announcement of this plan coincided with the approval of the Oxford–AstraZeneca vaccine, and so represents the strategy to rollout the two vaccines. The government stated that prioritising the first dose was on advice from the Joint Committee on Vaccination and Immunisation (JCVI) and further assured that everyone would still receive their second dose within 12 weeks of their first.[18] Despite this, Margaret Keenan, who was the first person outside of trials to receive a dose of the Pfizer–BioNTech vaccine, returned to hospital on 29 December 2020 for her follow-up injection. This was exactly three-weeks after her first, in accordance with the original plan until the announcement of the new strategy. By receiving her second dose, Keenan has completed the vaccination process.[42]

The new plan to increase the gap between first and second doses from 3 to 12 weeks, was criticised as "unfair" by the British Medical Association (BMA) on 31 December 2020, as appointments booked for 4 January 2021 or later would have to be rescheduled.[43] In response, all four Chief Medical Officers (CMO), plus England's Deputy CMO Jonathan Van-Tam, signed an open letter explaining the policy shift.[44] They said by prioritising first doses, more people would have substantial protection faster, and the second dose adds relatively minor additional protection in the short term. They went on to say that for every 1,000 people given the second 'booster' dose, 1,000 new people would not be able to have up to 70% protection and would instead remain totally unprotected.

During his address to England on 4 January 2021, Boris Johnson indicated a preliminary target for the vaccination programme, saying:[33]

By the middle of February, if things go well and with a fair wind in our sails, we expect to have offered the first vaccine dose to everyone in the four top priority groups identified by the Joint Committee on Vaccination and Immunisation.

He went on to confirm this would include all elderly residents of care homes and indeed everyone over the age of 70, as well as all frontline health and social care workers, and all those who are "clinically extremely vulnerable".

Vaughan Gething, Minister for Health and Social Services in the Welsh Government, matched England's targets by announcing that all people in groups 1–4 would be offered a first dose by mid February.[45]

A vaccination plan was published by the Scottish Government on 14 January.[46] Part of this plan, subsequently withdrawn after objections from central government, projected the numbers of doses of vaccines delivered weekly to Scotland from the British Government until May, estimating that by mid-March there would be enough doses there to supply every person in the priority groups with their first doses, and enough doses by July to supply every adult with both doses.[47] Extrapolating from these figures, Sky News estimated that supply for the UK overall would be sufficient to meet the British Government's aim of immunising all 15 million priority individuals in the country by mid-February, and vaccinating all adults in Britain with their first dose by mid-July.[47]

The JCVI advised the governments on how to prioritise the rollout. The top priority for the programme was to prevent deaths and to ensure that the National Health Service (NHS) would not be overwhelmed, and as older people are more at risk of hospitalisation or death from COVID-19, prioritisation was primarily based on age.[48]

The table shows the priority groups for the first phase of the roll-out.[48] An estimate of the number of people in each group in the United Kingdom is also shown,[49] but should be read with care as people who fall into more than one group are counted more than once.

"Clinically extremely vulnerable" is defined as:[50]

• solid organ transplant recipients
• people with specific cancers:
  • people with cancer who are undergoing active chemotherapy
  • people with lung cancer who are undergoing radical radiotherapy
  • people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
  • people having immunotherapy or other continuing antibody treatments for cancer
  • people having other targeted cancer treatments that can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
  • people who have had bone marrow or stem cell transplants in the last 6 months or who are still taking immunosuppression drugs
• people with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD)
• people with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell disease)
• people on immunosuppression therapies sufficient to significantly increase risk of infection
• people with spleen problems, e.g. splenectomy (spleen removal)
• adults with Down's syndrome
• adults on dialysis or with chronic kidney disease (stage 5)
• other people who have also been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs.

Women who are pregnant and children under 16 are not defined as clinically extremely vulnerable for the purpose of the vaccination programme.[48]

Polish group Omni Calculator developed a tool which estimates when individuals will receive the vaccine, based on age, employment, and health status.[51]

Whilst further details are still subject to a final decision, as safety and effectiveness data comes in from the first phase, phase 2 vaccinations may prioritise those at increased risk of exposure to the virus due to their occupation. Such occupations could include:[48]

• first responders
• the military
• those involved in the justice system
• teachers
• transport workers
• public servants essential to the pandemic response.

Pregnant women and children under 16 could also be included at this stage, dependent upon further trials in these groups.[48]

As of 29 January 2021, there were a total of 1,462 vaccination sites operating in England,[lower-roman 1] an increase of 121 since 22 January. These were made up as follows:[63]