Fast and Fair: 5 Important Issues for Roll-Out of Covid-19 Vaccinations

The production of several safe and effective vaccines to SARS-Cov-2 (the virus causing Covid-19) in less than a year is a miracle of modern science, it is now time for the baton to be passed to the Government and the NHS.

It is critical that we get this right as it is now a race against time.

Sadly 2020 has seen a litany of policy and implementation failings, from poor pandemic preparation and the stripping bare of public services, to PPE procurement and the failure of the outsourced testing regime. We cannot afford for this to be not done well and we cannot allow for it not to be done quickly.

Normally the tendency is to offer advice after the event, medics call this the use of a ‘retrospectoscope’. This time I will offer the advice before it is too late…..

The Government’s ambition is 1 million jabs a week, this is not ambitious enough. If the supply of the vaccine is there, this should and could be rolled out quicker. Lives and communities depend on this. If we prioritise and turbo charge this, we should be aiming to do this in the next two months.

There are 5 key issues to get right, ensuring effective, rapid and fair roll out:

1. Get it out there predictably and transparently. We need the vaccine to get to the vaccinators as soon as it is made and stop any delays. There should be a clear and transparent plan with timescales for roll out. This is not a time for opacity. Reliable timescales make it possible to plan and recruit and give those giving the vaccine a fighting chance of meeting the ambition. Nurses, healthcare assistants, doctors all need to plan their lives, they will dedicate their time and energy to this but need to know the plan as soon as possible.

2. Use the NHS. The NHS has the infrastructure, expertise and experience to do this. Tried and tested processes in Primary Care should be used and vaccinating experience so far has been very positive where it has happened. We have seen how major outsourcing projects cause delay and complications, we mustn’t allow distractions and diversion of resource by setting up complicated new structures.

Staffing this effort will be a real challenge, but if this is led by the NHS, new and existing staff can be found to do this. A combination of GP practices, pharmacies, hospitals and local vaccination centres (open to all but still run by NHS organisations) can do it if allowed to work together.

There will have to be some tough decisions to support NHS staff to stop doing other work until this is done, it will be worth it, and with high Covid-19 rates it will happening anyway.

3. Make sure vaccine gets to those most at need, especially marginalised groups. There is a risk that if the vaccination programme becomes a ‘first come first served’, those most at need will miss out or get it later. There are two main angles on this.

Firstly, areas of the country that are more deprived often have less access to healthcare. This is termed the ‘inverse care law’, and there needs to be active policy to address it otherwise those in areas who will be most affected may miss out.

Secondly, the roll-out needs to continue to target those most at need (age, front line workers, medically vulnerable). To do this properly booking into vaccination centres/ GP surgeries should be controlled to be fair for all and can be managed from NHS records. Otherwise, the sharp elbowed and more mobile will get the vaccine earlier than those more unwell and less mobile. It is a credit to us all that as it stands the rich cannot bypass the system and buy the vaccine for themselves, we need to maintain this principle – universality based on need not ability to pay.

4. Work with communities to break down barriers and increase trust. We know there are concerns or suspicion about the vaccines out there, these tend to be higher in groups who have less trust in authorities and professionals generally and are more excluded, and they are also usually the groups who will benefit more. We need to invest extra time and resources to understand and address these concerns, especially making sure those communities themselves are involved in campaigning to have the vaccine. This is a time for activism not passivity from government. Local councils can help here.

5. Get rid of barriers, the NHS can be hierarchical, bureaucratic and centralised. These characteristics could be used to increase speed of roll-out, but it could also slow things down. Often innovation and speed can happen quicker locally in the NHS. Barriers can be removed but this needs to be done actively: for example, Government can offer guarantees to underwrite insurance, indemnity, costs and offer rapid training to allow rapid set up and recruitment of vaccinators.

These issues may all be dealt with eventually, but to get this mighty task done and done well, we need to get everything exactly right and everything right very soon. Every person who becomes seriously well with Covid-19 that could have had the vaccine is an individual tragedy; the clock is ticking.