COVID-19 vaccination programme in the United Kingdom

The COVID-19 vaccination programme in the United Kingdom is the world's first mass immunisation campaign to protect against SARS-CoV-2 using vaccines developed in response to the COVID-19 pandemic.

GP-led vaccination centres were in operation by 15 December 2020
Distribution of the 8,369,438 total cumulative vaccine doses, as at 28 January 2021.[1][2]

Vaccinations began on 8 December 2020, shortly after the British regulator, the Medicines and Healthcare products Regulatory Agency (MHRA), granted emergency authorisation to the Pfizer–BioNTech vaccine, an RNA vaccine. On 30 December 2020, the MHRA gave approval to a second vaccine, the Oxford–AstraZeneca vaccine, and vaccinations began on 4 January 2021, with a third vaccine, the Moderna vaccine, approved on 8 January 2021.

The first two vaccines currently in use were developed by partnerships between Pfizer and BioNTech (Comirnaty) and between the University of Oxford and AstraZeneca (AZD1222), while the third was developed by Moderna (MRNA-1273). As of 8 January 2021, there were four other COVID-19 vaccines on order for the programme, at varying stages of development.

Phase 1 of the rollout prioritises the most vulnerable, in a schedule primarily based on age. The delivery plan was adjusted on 30 December 2020, delaying second doses so that more people could receive their first dose. A preliminary target – giving everyone in the top four priority groups their first dose by the middle of February 2021 – was announced on 4 January 2021.

As of 3 February 2021: 10,021,471 first doses and 498,962 second doses, of either the Oxford–AstraZeneca or the Pfizer–BioNTech vaccine, had been administered across the UK.

Vaccination sites include GP practices, care homes and pharmacies, as well as hospitals. As of 29 January 2021, there were 1,462 vaccination sites operating in England. As of 2 February, there were over 400 vaccination sites in Wales.[3][lower-roman 1] Additional sites, including large venues such as sports stadia, entered the programme from 11 January 2021, with seven mass vaccination centres opening in England initially and seven opening in Wales also.[4]

New guidance for allergy sufferers, antibody tests and the new variant of SARS-CoV-2 (Variant of Concern 202012/01) has been issued during the programme.

The programme also includes procurement of vaccines for British Overseas Territories and Crown Dependencies.[5][6][7]

Progress, as of 31 January 2021, with daily change
Home nation Doses administered per 100 people
 United Kingdom
14.66(+0.48)
 England
15.18(+0.52)
 Scotland
10.68(+0.18)
 Wales
13.23(+0.41)
 Northern Ireland
13.01(+0.40)

From official vaccination[2] and 2019 ONS[8][9][10][11] data.
(Doses may not equate to no. people if more than one dose received.)


Background

Responsibility for COVID-19 vaccine deployment

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]

Vaccines on order

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

History

Regulatory approvals

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]

Timeline

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]

Emerging guidance

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.

Organisations involved

In the months before approval of the first vaccine, the Joint Committee on Vaccination and Immunisation (an independent group of experts) gave advice to the Vaccine Taskforce on the groups of people that should be prioritised for vaccination.[37][38] The taskforce was formed in May 2020 to lead efforts to develop, manufacture and procure vaccines for the UK and globally,[39] and was led until the end of 2020 by biotech venture capital manager Kate Bingham.[40]

As with other licensed vaccines, the National Institute for Biological Standards and Control (part of the MHRA) reviews the production process and the manufacturer's quality control, and tests each batch of vaccine.[41]

Rollout schedule

Delivery plan

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.

Delivery targets

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]

Phase 1

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.

Order Priority group Number eligible (estimated)[49]
1 residents in a care home for older adults and their carers 1.1m
2 all those 80 years of age and over, and frontline health and social care workers 5.1m
3 all those 75 years of age and over 2.3m
4 all those 70 years of age and over, and clinically extremely vulnerable individuals 3.3m
5 all those 65 years of age and over 3.4m
6 all those aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality 2.2m
7 all those 60 years of age and over 3.8m
8 all those 55 years of age and over 4.4m
9 all those 50 years of age and over 4.7m

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

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]

Phase 2

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]

Progress to date

By the end of the first full week of the programme, up to 15 December 2020, 137,897 people had been vaccinated with the first dose in the two-dose regimen: 108,000 in England, 7,897 in Wales, 4,000 in Northern Ireland and 18,000 in Scotland.[52][53]

By 5 January 2021, 1.3 million people across the UK had received their first dose of either the Pfizer or Oxford–AstraZeneca COVID-19 vaccine, which included more than 650,000 people over 80, representing around 23% of that age band in England.[54]

As of 31 January 2021, a cumulative total of 9,296,367 people had received the first dose: 8,082,355 in England; 221,809 in Northern Ireland; 575,897 in Scotland and 416,306 in Wales. In addition, a cumulative total of 494,209 people had received the second dose: 460,907 in England; 24,612 in Northern Ireland; 7,849 in Scotland and 841 in Wales.[2]

Government vaccination updates increased from weekly to daily, from 11 January 2021.[54]

Latest 24-hour new and cumulative doses, by dose type, as at 31 January 2021[2]
Latest DAILY figures  England Northern Ireland Scotland WalesUK TOTAL
Date DoseNewCumulativeNewCumulativeNewCumulativeNewCumulativeNewCumulative
31 Jan 2021 1st289,3598,082,3557,208221,8099,628575,89712,843416,306319,0389,296,367
2nd2,757460,90728924,612557,849558413,156494,209
Total292,1168,543,2627,497246,4219,683583,74612,898417,147322,1949,790,576

Scotland and Wales only report their data on weekdays.[2]


Weekly new and cumulative doses, by dose type, as at each week-ending date[2]
Previous WEEKLY figures  England Northern Ireland Scotland WalesUK TOTAL
Date DoseNewCumulativeNewCumulativeNewCumulativeNewCumulativeNewCumulative
13 Dec 2020 1stnot available[lower-roman 2]not available[lower-roman 2]3,6233,62318,96718,9678,1818,18130,77130,771
20 Dec 2020 1st570,199570,19912,44516,06840,86559,83215,39423,575638,903669,674
27 Dec 2020 1st265,276835,47514,94831,01634,34194,17312,37735,952326,942996,616
03 Jan 2021 1st326,2671,161,7429,66940,68521,316115,48913,97949,931371,2311,367,847
2nd20,46720,4671,2711,2714444262621,80821,808
Total346,7341,182,20910,94041,95621,360115,53314,00549,957393,0391,389,655
10 Jan 2021 1st940,9272,102,66938,39579,08050,920166,40940,76790,6981,071,0092,438,856
2nd376,807397,27412,28713,5582,7892,8335985391,942413,750
Total1,317,7342,499,94350,68292,63853,709169,24240,82690,7831,462,9512,852,606
17 Jan 2021 1st1,573,5883,676,25746,637125,717103,753270,16266,689157,3871,790,6674,229,523
2nd38,376435,6508,76822,3261,1073,94011319848,364462,114
Total1,611,9644,111,90755,405148,043104,860274,10266,802157,5851,839,0314,691,637
24 Jan 2021 1st2,115,9025,792,15933,925159,642145,107415,269120,303277,6902,415,2376,644,760
2nd4,775440,42538722,7132,0005,9403585567,520469,634
Total2,120,6776,232,58434,312182,355147,107421,209120,661278,2462,422,7577,114,394

Vaccination centres
Marshalling for COVID-19 vaccines at a medical centre in Wetherby, West Yorkshire.

More than 70 sites across the UK were in operation at the end of the programme's first full week (15 December 2020). Whilst hospitals formed the centres initially, GP-led centres also started later in that week.[55]

Care home locations in England entered the programme on Wednesday 16 December. "Hundreds" of residents received the first dose in seven care homes in Slough, Aintree, Herne Bay, Thanet, Chalfont St Peter, Droitwich and Cheltenham.[56] Larger care homes (50 to 70 beds) were to be prioritised.[56]

The Chelsea Pensioners received their first dose at the Royal Hospital Chelsea on 23 December.[57]

Large venues such as sports stadia and exhibition centres started to be used as mass vaccination centres from 11 January 2021,[54] with seven such centres opening in England at Millennium Point, Birmingham; Ashton Gate Stadium, Bristol; ExCeL London; Manchester Tennis and Football Centre; Centre for Life, Newcastle; Robertson House, Stevenage; and Epsom Downs Racecourse, Surrey.[58] Seven mass vaccination centres were initially opened in Wales with that number increasing to 34 by February alongside 17 acute and community hospital sites.[4][3]

Over 400 GP-led centres were rolling out the vaccination in Wales by the start of February. [3]

High street pharmacies in England started to administer the vaccine from 14 January 2021, with 6 chosen for the roll out initially.[59]

Places of worship also started to be used as large vaccination centres, with Salisbury Cathedral[60] and Lichfield Cathedral[61] among the first to make provisions from 15 January 2021; with the Al-Abbas Islamic Centre in Balsall Heath, Birmingham becoming the first mosque to offer the service on 21 January 2021.[62]

Locations

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]

Number of vaccination sites in England, by region and type, as at 29 January 2021[63]
RegionHospital hubsLocal vaccination servicesMass vaccination centresPharmaciesTotals
East of England231378168
London541086168
Midlands3918211232
North East and Yorkshire371765218
North West431375185
South East391786223
South West191109138
Region not specified130130
Grand Total2541,028501301,462
  • Vaccination site locations in Wales, as at 15 January 2021
  • Vaccination site locations in England, as at 29 January 2021
  • Vaccination site locations in Scotland, as at 14 January 2021

See also

Notes
  1. As of the stated date, location data for Scotland, Wales and Northern Ireland has not been published by the respective devolved authorities.
  2. England vaccination uptake data not published until 15 December 2020, so carried forward to next week ending

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