A Covid-19 vaccine – let me have it!

Covid kills and Covid debilitates. So a vaccine is critically needed and I for one would be very happy to be vaccinated.

The good news is that several likely candidates for effective vaccines are showing real signs of being able to protect people from the worst impacts of the virus. However, there is no evidence vaccines prevent transmission. They protected those vaccinated from the full effects of the disease. But we are some way from having the capability to mass vaccinate the whole UK population.

Vaccines will have to be fully tested, evaluated as safe and effective and licensed. Although drug companies have accelerated testing by running different tests in parallel, rather than sequentially, there are still hurdles to clear. It will be for the independent Medicines and Healthcare products Regulatory Agency (MHRA) to determine whether to license each vaccine in the UK.

It is unlikely that vaccines will become available at levels where mass vaccination of the general population is possible for some time. Pilots with the highest risk groups may start sooner, but even for most people in priority groups, it won’t be until next year that the option of having a jab will arrive. For this reason, there is need to prioritise access. Each UK country and crown dependency will make its own judgements on priorities.

In England the JCVI is an independent committee which advises ministers on whether to adopt a vaccine and who it should be offered to. Initial indications are that, at least in England, there will be a strict hierarchy starting with care homes residents and staff, followed by over 80s and health care staff (in all sectors) and then proceeding on the basis of five year age bands until 65, then under 65s at higher risk. Then people judged as at middle risk due to other conditions will take precedence over over 60s, over 55s and over 50s. Full details can be found on the UK government website

An area of significant concern is the failure of JCVI to address the risks faced by BAME communities. Despite Public Health England reporting the disproportionate impacts on people of colour, the committee has said that the reasons for this are unclear so they won’t recommend a higher priority for BAME patients, staff or communities. CSP is supporting calls for ministers to address this.

Scotland, Wales, Northern Ireland, Guernsey, Jersey and the Isle of Man are yet to indicate how they might manage prioritisation.

Vaccines are safe and save millions of lives every year. The risks of not being vaccinated are much more significant than the risks of side effects. Based on what is known about the trials, there are likely to be some minor side effects as a result of vaccination. This is the case with most vaccines. It will be for MHRA to advise on which patients should avoid which the vaccine.  Not everyone will be recommended to be vaccinated, pregnant women may be advised to avoid vaccination until after birth for example. For most of us vaccination is safe and effective.

Different vaccines will need different logistics depending on their storage needs and effective life. Pfizer’s vaccine for example will require very deep freezing. Most will need a high volume of people being seen. These factors make distribution to the highest priority groups more challenging. High throughput and bespoke storage are easier at a specially set up mass testing clinic than say in a residential or nursing home. The logistics are therefore likely to be complex.

Vaccine stocks will be managed nationally. Private practices will not be able to order stocks privately for their staff or patients. How non NHS practitioners will be able to access vaccination has not been agreed in any UK country. The CSP has been highlighting the need for all physios and physio support workers to have access at the right time, not just direct NHS employees.

An army of people will be needed to manage and administer vaccines as bulk supplies become available. In Northern Ireland the health department is already approaching staff about working as vaccinators.

England are planning to train a wide range of staff and volunteers to administer or support vaccinations. Administering vaccinations is within the scope of practice of physiotherapy. Many physios already act as flu vaccinators. There are insurance implications in some circumstances, for full advice see www.csp.org.uk/news/coronavirus/clinical-guidance/covid-19-vaccine.

How NHS physios and physio support workers may be engaged is not yet clear. It may be easier for physios in some settings and it will be particularly difficult to release physios in some roles. The CSP has highlighted the private sector as a potential source of additional capacity, and the UK government has confirmed they will engage self-employed physios to work in the English vaccination programme. You can register interest here: NHS Professionals - Join the Covid-19 Vaccine Team

Vaccination will be voluntary. But to save lives persuading those people who have concerns will be important. Countering negative anti-vax propaganda with positive messages will also be important. Shockingly there are unscrupulous commercial interests who seek to exploit concerns by publishing false information to attract people to their websites or social media accounts.

For every negative story they get seen it will be necessary for concerned individuals to see five positive messages about why they should have the vaccination. We can all play a part by sharing our own confidence in being vaccinated and highlighting the realities of the risks from Covid. What we should avoid doing is repeating or sharing anti-vax of vaccine concerned messages even to rebut them.

So when your turn comes – get your jab!

Rob Yeldham, CSP director of policy and strategy