COVID-19 vaccinations: supporting the roll out, Monday 21 December 2020 - Q&As

View the results of the Question and Answer session from this webinar.


Vaccination Centres

Q. There seemed to be a plan to roll out mass vaccination centres to ensure speed and volume were achieved in the vaccine roll out. However, with only 48 hours to go, the decision was taken to distribute vaccine to 50 hospitals and hold back on mass vaccination centres. Then, PCNs were provided with vaccine stock to set up separate facilities to vaccine their own patients. Mass vaccination centres are still not operating, and dates continue to be put back. When can we see Mass Vaccination Centres operating at capacity across the country so we can get the optimal number of residents safely vaccinated? Why the hesitancy?

A: The delivery models for administering the vaccines have been carefully chosen based on the most appropriate methods of delivery to the highest priority cohorts as defined by the JCVI – this has also been driven by the type of vaccine available. The initial wave of vaccination centres opened in the week commencing 11 January, and since then there has been a week-on week increase in the number of sites opening. This will continue until there is sufficient capacity across the country to deliver the vaccination programme.

Q: Will supplies of vaccinations now be diverted or concentrated to support the London districts as opposed to going to new not ready operational vaccination centre's further afield where infection rates lower?

A: Vaccine will be delivered to those who are deemed highest priority by JCVI with deployment across the country – it is not driven by infection rates but by ensuring we are able to create an equitable service across all regions.

Q: As yet, we have no vaccination centres operating in North Devon where we have a large number of senior citizens. When are we likely to get some in our rural area as travelling to Exeter or Plymouth is not easy from area?

A: Geographic coverage against population density is a key metric in determining the priority of sites to come online an deliver the vaccine programme. Regional NHS leads continue to review coverage and are working with local systems, including local councils and the LRFs to identify additional sites as need be to reduce travel time – this may be through additional hospital hubs, greater GP coverage as well as vaccination centres.

With respect to North Devon specifically – sites are opening or now open in Barnstable and Tiverton.

Q: In rural areas, like parts of Cumbria, if you want to reduce travel to get vaccinated, why not use village halls as venues to allow easier access for rural residents? I had my flu jab from my health centre at the local village hall.

A: Different types of sites are being considered to deliver the vaccine – this includes non- NHS premises where this is most appropriate and we will continue to pursue this as well as working to bring on community pharmacies where this can also help reduce travel and increase access.

Q: Will Community Pharmacy be authorised to vaccinate residents of the most rural areas?

A: Community Pharmacy has begun to be used as part of the Local Vaccination Service delivery model to deliver vaccines – both to increase coverage in rural areas as well as increase capacity in higher density population areas.

Q: Will vaccinations centres be run and paid for by the NHS proper or will they be outsourced?

A: Vaccination Centres will be commissioned by the NHS to deliver the vaccination programme, with appropriate clinical and pharmacy oversight to ensure safe delivery. Vaccination centres will be provided by an NHS Lead Provider (Hospital or Community Trust), Primary Care Network (made up of GP surgeries) or Community Pharmacies.

Rollout/time scales

Q: The first two weeks of vaccination are not at a rate that will see "most" of the population covered by mid-2021. What guarantee is there that vaccination rates will be speeded up to secure that outcome? Is the Government going to  publish daily/weekly numbers on 1st and 2nd vaccinations?

A: There are multiple factors impacting the rate of vaccination delivery – the NHS is operating by the principle of administering all vaccine as the supply becomes available.

With a second vaccine now approved and an amend to the JCVI guidance to open the period of time for the second dose to up to 12 weeks the rate of vaccination across the population has been increased. This work is well underway, supported by regional colleagues. The Government has agreed to publish data on a daily basis, covering both 1st and 2nd doses.

Q: Some residents over 80 are worried that they have heard nothing so far about getting the vaccine. Their GPs have no information to give them either. They fear that they have been forgotten. How long are we expecting it to take to get to all over 80's? When will it be available more locally to them?

A: Over 80s are a priority group and are being called for vaccination through the Primary Care Network (local vaccination services) as well as the hospital hubs and vaccination centres. There are now over 1,000 PCNs delivering vaccinations, along with a significant increase in hospital hubs and the second vaccine now being available, will ensure that all over 80s will have been offered the vaccine early in the new year.

Q: Why have some PCNs have the vaccine and have started to administer and
others not?

A: Regional NHS colleagues have been working hard with the national programme to support as many PCNs to begin vaccinating as possible prior to Christmas. The order has been through an assurance process to ensure that a site/PCN is ready, that the number going live on a given day is manageable in terms of arranging supplies and deliveries and that we create good coverage across the country.

Q: Are the London and South East PCNs going to be prioritised due to the increased rates?

A: The COVID vaccination programme will continue to prioritise cohorts deemed at highest risk, as outlined by JCVI - it is not driven by infection rates but by ensuring we are able to create an equitable service across all regions.

Q: When is the vaccination likely to be available nationally? It is not currently
available in the borough of Cheshire East.

A: Additional PCNs and hospital hubs continue to come online on a weekly basis with vaccination centres also planned from mid January. A list of sites delivering vaccinations is available on the NHS website, updated regularly, and your local vaccination lead (within your STP/ICS) will be able to provide local details on additional sites due to come online.

Imports of the vaccine

Q: Are we reliant on the Pfizer vaccine being imported from Europe, and if so will any challenges around Ports (related to Brexit) have an impact on the continued supply chain of vaccines needed to meet current deployment timelines?

A: Rigorous resilience planning for the possible outcomes of Brexit was undertaken to ensure that no outcome would affect the NHS’s ability to deliver the COVID vaccine programme.

Q: How can we protect supply chains of the vaccine in the face of ongoing disruption to freight and travel that will persist into 2021? Will our choice of vaccines have to be governed by the politics of logistics?

A: Rigorous supply chain analysis has been undertaken to ensure the continued delivery of the vaccination programme. The vaccines to be used are based on those deemed clinically suitable as per guidelines from MHRA.

Q: Given that President Macron is restricting movement through the channel tunnel for a minimum of 48 hrs, will this affect the delivery of the vaccine & our ability to roll out the vaccine programme?

A: Rigorous supply chain analysis has been undertaken to ensure the continued delivery of the vaccination programme.

Delivery / Delivery Model

Q: Will a more infectious strain require a different model of delivery ie will we
have to move to drive in rather than indoors?

A: The advice from the scientists will continue to be factored in to ensure appropriate delivery models are used.

Q: What happens if units cannot get people to fill slots can they move from Tier 1 to 2 etc? Will dispensing units be able to move between tiers to fill all slots?

A: The current focus in on priority groups 1 and 2, those deemed most at risk by the JVCI. In due course, as announced on 18 January, the programme will begin to move through the other priority groups and it is anticipated that these will overlap to ensure the vaccine is rolled out as quickly as possible.

Q: Will the vaccine be spread equitably around the UK or will it be more greatly
targeted at higher tier areas?

A: Distribution of the vaccine will be based on delivering the vaccine to cohorts deemed most at risk, as defined by the JCVI – it is not prioritised by rate of infection.

Q: How will we vaccinate people who are housebound?

A: Vaccination of care home residents has begun and is being prioritised in line with Priority Group 1. With the second vaccine now available, PCNs will also be asked to put in place plans to vaccinate housebound residents aged over 80 that fall within their local area in the first instance. Housebound patients under 80 will then be offered a vaccine as they become eligible in line with the JVCI priority groups.

Q: Specifically, what support for vaccine delivery is being looked for from lower tier local authorities?

A: District and Borough Councils are vital members of the local resilience forums and encouraged to support any local requests from health colleagues made through that route. This is likely to include support on identifying potential venues for vaccination centres (including those the local council may own), redeploying staff to support the rollout and/or supporting in recruitment campaigns and local sourcing of volunteers. Alongside upper tier authorities, lower tier authorities will also have an important role to play in encouraging vaccine take up, tackling misinformation and supporting access to the vaccine, particularly in communities who already suffer health inequalities.

Q: GP-run vaccination centres will be reliant on volunteers for making the centre work, from doormen to those inside who check credentials. Of course, volunteers will wear PPE, but will be in contact (inevitably less than 2m) with the patients coming in. Especially in Tier 4 in the new variant situation, has anyone assessed the risk of infection for those volunteers.

A: Thorough readiness checks have been undertaken on the sites, including detailed SOPs outlining how all workforce should keep themselves safe whilst working on a vaccination site.

Q: How do people who are not registered with a doctor in the UK able to obtain the vaccine. Should they register with a GP, or get in touch with the NHS?

A: Individuals should wait to be contacted by the NHS to come forward for a vaccine and we would encourage people to register with a GP where possible. Further guidance is being developed to ensure that processes are in place to support anyone not registered with a GP and this will be published in due course.

Other

Q: What worked so well with testing and antibody testing was Health and Social Care working together with the Independent and Private providers of
social care.... vaccination appears to be only the realm of the NHS... Is this going to change?

A: The NHS is working with a range of providers to ensure delivery of the vaccination programme and will continue to do this, including with colleagues in social care to ensure effective rollout in care homes and also in ensuring frontline health and social care workers are able to access the vaccine.

Q: Any plans to issue a vaccination certificate to prove you have been
vaccinated?

A: This is not currently Government policy.

Q: If there is delay in approving the Oxford/AZ vaccine is there likely to be any difficulty in obtaining regular supplies of the Pfizer vaccine which would slow
down the vaccination programme?

A: The Oxford/AstraZeneca vaccine has now been given approval by MHRA and the vaccination programme will continue its strategy to rollout vaccines in line with
available supply.

Q: Have we any idea when the Oxford vaccine is likely to be approved?

A: MHRA announced its approval on 30 December 2020.

Priority list and vaccine eligibility

Q: It is known there is a lower success rate of the Pfizer vaccine in patients on
immuno suppressants. Is the Oxford vaccine likely to be more successful in
patients on these immuno suppressants?

A: Both vaccines produce an immune response, but it is likely to be similar for both. The UK chemotherapy Board has produced guidance, but there is no differentiation between the two vaccines.

https://www.ukchemotherapyboard.org/publications

Q: Why was age used as the indicator rather than health conditions and disabilities? 6/10 people that have died from the virus have a disability, why are these people not being prioritised?

A: The JCVI have determined the priority list based on those deemed most clinically at risk if they contract COVID-19 – their report considers a range of factors and outlines the reasons for their prioritisation.

Q: Where do transplant recipients sit within the phasing of vaccination, particularly liver transplant ( non-Alcohol related ) and how are those immune systems considered?

A: We have been working with JCVI and PHE and expect guidance in the Green Book to change to recommend that vaccination to take place prior to chemotherapy or immunosuppression. This is to provide the greatest immunity in the short and longer term. We are working with Medical Royal Colleges to provide clinical guidelines in this area.

Q: The Govt are insistent that schools remain open and are going to test all
children from January. Why then, can’t we vaccinate all teachers and school
support staff as a matter of urgency?

A: Individuals are being vaccinated in priority order as defined by JCVI. Teachers and support staff aged over 50 or with an underlying health condition will be offered a vaccine during this first phase in line with the priority groups, others will be considered as part of phase 2 when JCVI are expected to advise on vaccinating cohorts owing to their occupation.

Q: When will we know if breastfeeding people can take the vaccine? Why is
there a complete ban in the UK as opposed to an informed choice (like the
US)? Is research on this group a priority?

A: JCVI updated their guidance on this on 30 December 2020

Q: When are University Students likely to be offered the vaccines given the high number of cases that came from University locations?

A: Individuals are being vaccinated in priority order as they fit into the cohorts as defined by JCVI.

Q: It is clear that frontline health and social care workers are on the priority list, but is there any update for unregulated carers such as personal assistants?

A: Personal Assistants providing direct care will be included in the definition of priority group 2 – further guidance was published in January to support employers and employees to access the vaccine.

Q: We must ensure that Children's Social Care are not forgotten, especially staff working to support vulnerable children such as children's homes - are these being considered?

A: Frontline social care workers are defined in the green book as:

  • those working in long-stay residential and nursing care homes or other longstay care facilities where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality
  • social care staff directly involved in the care of their patients or clients
  • others involved directly in delivering social care such that they and vulnerable patients/ clients are at increased risk of exposure

This includes children’s social workers supporting children with underlying health
conditions.

Q: Will the family who live with those who are CEV also be offered the vaccination?

A: They will be offered the vaccine as they fit into the priority cohorts as defined by JCVI.

Q: Will vaccine rollout to lower rated groups be held up whilst systems are being developed to work on higher rated groups such as care homes?

A: Cohorts will be vaccinated in priority order with an expectation that there will be an overlap between priority groups to ensure the efficient rollout of the vaccine. Care homes are priority group 1 and plans have already been put in place to ensure the vaccine can be delivered safely to care home residents – this rollout is now underway. To ensure no delay, priority group 2 is also being offered vaccines in parallel to group 1 to ensure all available vaccine supply reaches people as quickly as possible.

Q: Where will diabetics (insulin dependent) feature in priority?

A: The JCVI’s advice is to offer vaccination to those aged 65 years and over followed by those in clinical risk groups aged 16 years and over. Diabetes is listed as one of those risk groups, therefore those under 65 with diabetes are within priority group 6.

Q: Mortality is not the ONLY priority. If we have said as a society that we want to prioritise supporting vulnerable children and keeping schools open, the vaccine can be used to support that by keeping our workforce going. Is that not valid as a priority?

A: The priority cohorts have been defined by the independent JCVI. Teachers and support staff aged over 50 or with an underlying health condition will be offered a vaccine during this first phase in line with the priority groups. JCVI are planning to take occupations in to account in Phase 2.

Q: How will teachers and social workers who met criteria for Phase 1 be contacted?

A: Frontline social care workers are defined in the green book as:

  • those working in long-stay residential and nursing care homes or other longstay care facilities where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality social care staff directly involved in the care of their patients or clients
  •  others involved directly in delivering social care such that they and vulnerable patients/ clients are at increased risk of exposure

Further guidance will be published at the start of January to support employers and employees to access the vaccine.

Variations of the virus

Q: Do we have any evidence that the new variant is more or less virulent? (similar questions included in drop down)

Q: What is the message on dealing with the mutated covid-19 and the vaccine?

Q: How easily can we tweak the Pfizer and the Oxford vaccine if necessary due to the new variant? Would they have to go through new trials? How fast could we
deploy the tweaked vaccine ?

Q: Will the vaccine work against the new strain of the virus?

Q: If the current vaccination proves less or not at all effective on the new variant of SARS-CoV-2, will the process of creating a new vaccine be quicker?

Q: Are the current preventative actions on physical distancing (2m or 1m+) still considered to be adequate for the new Coronavirus strain?

A: The latest Government advice should continue to be followed, which will be based on the latest scientific advice. MHRA have approved two vaccines for
emergency use against Covid-19 and the JCVI prioritisation and guidance on the rollout has not been altered by the emergence of the new variant. Therefore the programme continues at pace.

Vaccine hesitancy & vaccine take up

Q: If a patient has an adverse reaction to the flu jab (e.g. and allergic reaction), are they likely to have a similar problem with the vaccine for COVID?

A: This is dependent on the vaccine – the side effects differ by vaccine.

Q: There has been criticism of the transparency of trial date, both on the
Pfizer/BioNtech vaccine (Phase 3 results still not published in peer-reviewed form) and the antigen lateral flow test (report from Liverpool delayed from publication by 15 days). Can pressure be exerted to improve this, since it is a gift to the anti- Vaxers? Hats off to Oxford/AZ who released their Phase 3 results in a published Lancet paper.

A: Publication of trial data is following the standard process.

Q: What reporting on vaccinations take up will there be and at what level? What role do you see for local authorities to promote take up?

A: The Government has agreed to publish data on a weekly basis, covering vaccinations in the Monday to Sunday of the week prior and revised historic data.

Vaccine Efficacy

Q: Various efficacy %ages have been quoted, eg 95% for the Pfizer. Is there a benchmark for a typical efficacy %age, from experience with flu, smallpox etc?

A: Both the vaccines approved for use in the UK to date have higher efficacy than the typical level for the flu vaccine.

Health Inequalities

Q: The most deprived are nearly twice as likely to die from COVID-19 than the least deprived. Besides age and occupation, should priority be given to people from the most deprived communities?

A: Analysis is being undertaken to ensure all individuals within the priority cohorts as defined by the JCVI have equal opportunity of access to vaccination.

Q: Councillors will have seen some of the myths, conspiracy theories and genuine
concerns raised about a vaccine for COVID-19. Many Black, Minority Ethnic communities have experienced health inequalities and in some instances racism which has resulted in a high level of mistrust. Given the risk to confidence in an effective vaccine, what is recommended that local councils do to ensure maximum take up of the COVID- 19 vaccine amongst residents, particularly in the BAME community which has been disproportionately impacted by COVID-19?

While age has the absolute highest risk of poor COVID-19 outcomes, many factors are associated with an increased relative risk (such as belonging to a BAME group and
being male). These are mediated by a complex web of factors which are not straightforward to disentangle and can be potentially misleading, and if misinterpreted when translated to policy, can be damaging to populations and widen health inequalities.

While prioritisation alone cannot address all inequalities in health that are rooted in social determinants, planning and implementation should as a minimum not worsen health inequalities, and present a unique opportunity to mitigate them.

Q: A new poll has found that just 57% of respondents from Black, Asian and
minority ethnic backgrounds were likely to accept a COVID-19 vaccine, compared to 79% of white respondents. How do we remedy this? What can LAs do?

Similar Q: Will an equalities impact consideration be made in terms of BAME communities,
people with Learning Disabilities and autism etc?

A: To ensure the COVID Vaccine programme addresses issues such as this an Equality Group has been established to both inform the BAME communities but also to ensure the programme meets equality principles.

Adult Social Care

Q: If there is an outbreak at a care home when they are due to have their COVID-
19 vaccine, what is the situation around 'rebooking'? Care homes often have outbreaks of one sort or another and this may result in further rollout delays.

A: Care homes will be serviced by their local Primary Care Networks (PCNs). PCNs will manage situations such as this to dynamically amend their local vaccination plan.

Q: What happens if after lots of gentle encouragement, social care staff refuse to have the vaccine? Do care staff have a duty of care to the people they look after?

A: This is a subject for the employer.

Q: It is difficult to vaccinate care home residents currently how soon are we able to ensure this happens?

A: Vaccine is currently being administered to staff and residents in care homes across the country.

Q: We have seen less than a 50% uptake of care home staff compared to 90% in the
acute sector. Are there any planned comms around this to promote the importance not only for the person but also for those that they care for?

A: A national Vaccine Comms plan is in progress and will continue to build.

Q: Would it be logical to vaccinate the informal Carers at the same time as the cared for?

A: Those aged 16-64 who are in receipt of a carer’s allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill are in JCVI cohort 6.

Q: How will the vaccine will be rolled out to social care staff ? will they be called by the NHS or it is the LA responsibility to call them?

A: Further guidance was published in early January to support employers and employees identify frontline social care workers who are eligible for the vaccine and access this locally.

Communication

Q: Social media response immediacy is key, so if someone asks something not answered in the approved Q&A can we speed up the timeline of feeding upwards for an answer/ receiving a response?

A: All questions should be passed to NHS regional RVOC and regional communications leads in the first instance.

Q: Would be helpful to get hold of artwork, (InDesign for instance) as a more appropriate vehicles for the cohorts than just social, leaflets and posters.

A: Work is being undertaken to ensure the key messages are being delivered in the right
way/medium to all individuals. All collateral is available online at the campaign centre.

Q: How is the vaccination roll out going to address the "getting vaccinated
message", whilst there are long waiting times before the vaccine, they are being told to have is many months away?

A: Explaining the situation we are in and what is causing the long wait times will help
people’s understanding. The narrative is this is a marathon, not a sprint and there we are vaccinating in line with independent guidance from JCVI. We need our partners to continue to support this message, and to share that the NHS will contact you when it is your turn. The latest script is shared regularly with LA partners and are grateful for their continued support.

Q: Some elderly people (80) are noticing younger (60) people on social media talking about getting the vaccine and are incredibly worried about not getting their dose and being forgotten about, especially with the new strain appearing and very high rates. What comms can be done to reassure people and give them some idea of when they are likely to receive the vaccine? Is there any messaging boroughs or wards to ward about when people living at home (elderly) are likely to get vaccinated?

A: All people need to be assured that the NHSEI is prioritising the distribution of the vaccine
against the JVCI phase 1 prioritisation. To ensure you are included contact your GP and ensure you are registered correctly. Around 1,000 GP led local vaccination services are now vaccinating with more opening their doors in the coming days and weeks. Community pharmacy will also be soon offer more vaccinations, prioritised for those aged 80 or older. For this age group, the national call and recall service is also inviting them for appointments if they live within 45 minutes of a vaccination. Of course, some may chose to wait until their local primary care services are offering vaccinations. Please make sure you are registered with a GP and they will contact you.

Q: Is there any targeted messaging going out to support take up of the vaccine in the
care sector? Many staff are dealing with communication fatigue, on top of exhaustion, so how can we make sure and get the message out?

A: NHSEI has targeted Comms messaging for the Care Home sector. We also need local authorities and providers to help share these messages across the care sector, given it’s size and complexity.

Q: Do you think the abrupt turn of events in Christmas restrictions has helped or
hindered trust in vaccinations overall and do comms feel they need to do more of the 'heavy lifting'?

A: The Communications team will continue to identify areas to focus on to increase vaccine uptake and ensure all communities have the information they need.

Q: Local authorities know their communities well and can help with communication - how can this be enabled?

A: NHS Regions are engaged with National colleagues. Nationally, the communications working groups focusing on supporting and enable timely and impactful cross-sector communication. At a system level, we expect all partners to work together to ensure they are effectively engaging and communicating with their local communities. All national communications material are shared with our systems via the region, and all campaign material available on the campaign portal.

Q: In Local Government we have been very restricted by the NHS about doing any comms and engagement work with our populations because they NHS wants to control all messaging. To date, we have seen the NHS doing comms on programme delivery (ie who is eligible, where they can get it). What I have not seen is anything that is trying to win over "hearts and minds" and myth busting the understandable concerns people have about vaccination. What is being done to fill this gap?

A: We need to focus effort on ensuring we have an inclusive approach to communications and engagement across the covid vaccine programme.

We know confidence in the vaccine and uptake intention across the general population is high, however we also know that some of our communities face barriers to access and have a degree of hesitancy.

This cannot be tackled alone through campaigns or traditional media and will need local partners to work together to support meaningful and respectful conversations. There are lots of examples across the country of this happening and nationally we now need to capture the work going in local communities and share it across the country.

Resources

Q: It is clear that Local Authorities have a key (and increasing) role in ensuring the effective deployment of the vaccine, however, the funding model doesn't currently recognise this. Whilst Local Authorities will of course stand up and support this effort and have already responded to mutual aid requests and taken a local leadership role in many
cases, are there any plans to change the NHS funding arrangements to recognise the vital role of local government?

A: The Vaccine Programme is consulting regions to understand how much resource is required to meet the regional requirements.

Miscellaneous

Q: Once a person has had the vaccine will they still be required to use PPE i.e. masks and hand sanitiser etc?

A: Individuals, once vaccinated, will be required to continue to follow the Government
guidelines regarding PPE and other safety measures.

Q: Once the 2nd vaccine comes on stream, we will have a choice which to have and if so, what would you advise?

A: Individuals won’t be able to choose which vaccine they have – the vaccine they are administered with will be chosen on what is best to ensure effective delivery of the vaccination programme.

Q: Vaccination certificates may become more important for international travel. Could they be incorporated into passport information?

A: This is not currently Government policy.