1/18 From early next week, probably Tuesday, 50 of our NHS hospital trust members will start to administer Pfizer vaccine. Who will they vaccinate, where, and what are issues involved? Explainer thread follows. Spoiler alert – large, complex, important logistical challenge!
2/18 Despite challenge, key to remember we’re lucky to be one of the first countries in the world to be able to start mass COVID-19 vaccination at this point. However challenging the actual delivery of the vaccination will be, this is a fantastic development we need to welcome!
3/18 At a top level, the challenge is to match yesterday’s JCVI prioritisation of who should receive vaccine first with yesterday’s @MHRAgovuk conditions of authorisation. This authorisation sets out complex requirements on how the vaccine can be transported, stored and used.
4/18 For those who prefer to use the source material. The JCVI prioritisation can be found here: gov.uk/government/pub…. And the detailed @MHRAgovuk conditions of authorisation can be found here: assets.publishing.service.gov.uk/government/upl…
5/18 JCVI prioritisation clear. Care home residents & their carers. Then over 80s and frontline health/care workers. Prioritise latter by risk of acquiring infection, individual risk of developing serious disease or risk of transmitting infection to multiple others.
6/18 @MHRAgovuk conditions also clear. At top level (more detail below) Pfizer vaccine has to be transported and initially stored at minus 75 degrees C. It can only be moved four times. Two doses need to be administered three weeks apart. It comes in boxes of 975 doses.
7/18 This means that vaccine needs initial storage in appropriately sized -75C fridges. Currently only realistic place for this is hospital hubs hence strong current focus on using 50 hospitals as initial point of distribution for this vaccine. Other vaccines will be different.
8/18 @MHRAgovuk and NHS currently validating / working on process to enable splitting of boxes of 975 doses into smaller parcels. Vaccine can be stored before final use at 2-8 degrees C but only for five days. This would make vaccine suitable for administration by primary care.
9/18 The other key context is forward vaccine dose availability. We know the number of Pfizer doses for December and January but not beyond that. We don't know when / if the two other vaccines at front of queue - Oxford and Moderna - will receive authorisation. This means....
10/18 …We therefore have to work on the precautionary basis that this initial batch of 800,000 could be the only batch we receive for some time. On that basis, it is vital that hospitals seek to vaccinate as many of JCVI’s highest priority groups as possible in initial phase.
11/18 Yesterday’s combination of JCVI prioritisation/MHRA authorisation conditions therefore changes previous, unofficial, assumption hospitals would concentrate initially on staff. Priority is to vaccinate care home residents, their carers, then over 80s & most at risk staff.
12/18 So, over the next few days, the 50 hospitals will be doing the following three things. First, they will be working with local care homes and local authorities to maximise the number of care home carers / workers coming into hospital hubs for vaccination.
13/18 Second, hospitals will identify as many patients over 80 as possible that they can vaccinate. Obvious candidates would be those attending outpatient appointments and those receiving inpatient treatment. Trusts calculating these numbers over the next few days.
14/18 Third, they’ll see if they can vaccinate care home residents. This won’t be easy though. Working assumption is we’ll have to wait for @MHRAgovuk authorisation of box splitting and primary care distribution for mass coverage of care home resident population.
15/18 If there are vaccine doses left over, hospitals will then vaccinate staff based on defined risk/already booked. Hospitals will ensure all of above who get a first dose will be available for a second dose three weeks thereafter. Vital to ensure all doses used effectively.
16/18 Once the 50 hospitals are clear what volume of doses they can use for the target groups in their footprints, this can then feed into national level allocation between the 50 sites. This will also help ensure that the vaccines used as efficiently as possible.
17/18 Worth pointing out this is all in addition to underlying tasks of getting the right workforce in place; getting that workforce trained; getting the vaccines transported and stored; effective public communications so everyone who needs vaccine knows what to do when etc..
18/18 A very significant logistical task to be done at pace. But this is what NHS is good at. And why we benefit hugely from having a National Health Service, as creation of 33,000 beds for coronavirus patients in first phase showed. Trusts will deliver this vital task!

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More from @ChrisCEOHopson

4 Dec
1/9 Just to give a sense of how the 50 hospital hubs are actually managing their covid-19 vaccination campaigns, here's an anonymised plan from one trust we have been talking to today. Gives good picture of complexities, inter-dependencies and huge effort at pace involved.
2/9 Their local CCG and GPs are providing the hospital with a list of over 80s who are able to attend the hospital site. The hospital's appointment bookers will then ring those people to book them into a timed 15 minute slot. Number of people per slot will obviously vary by trust
3/9 Vaccination will take place in a separate dedicated clinic building. This is deliberately sited next to a car park to allow easy access by car for over 80s. This is obviously, and importantly, separate from main clinical space where there may be covid-19 patients.
Read 9 tweets
4 Dec
1/5 Today's COVID-19 vaccine logistics question is how and when will it be possible to break down the "large pizza boxes" of 975 Pfizer vaccines into smaller batches to use in care homes? Our latest understanding set out in short thread below.
2/5 This is a complex, highly specialised, task that can only be done in large sized -75C fridges. These are not usually found on hospital sites. So it needs to be done by appropriately expert wholesalers. In an analogy from the increasingly legendary Jonathan Van Tam....
3/5 It's not like taking a six pack of yoghurt out of your home fridge, breaking it up on the kitchen worktop, putting one in your bag, taking it to work and then storing it in the work fridge. Obviously vital to protect integrity of vaccine in this batch creation process.
Read 5 tweets
4 Dec
1/4 Just to clarify this: telegraph.co.uk/news/2020/12/0…. I said in my twitter thread: "We therefore have to work on the precautionary basis that this initial batch of 800,000 could be the only batch we receive for some time." ....
2/4 ...The key words are "precautionary basis" and "could". The principle is that we should act on the basis that this could be the only batch we receive for some time. We are all hoping and are very confident that there will be a lot more doses than 800k.
3/4 Every day that goes past, we become more confident we will get a lot more and get them soon. But acting on a precautionary basis means that we should use the initial batch as much as possible for care home staff / residents and over 80s - the JCVI priorities.
Read 4 tweets
29 Nov
1/21 Parliament votes on the new tiered restctions on Tuesday. A lot of comment in today’s papers on what’s happening in the hospital sector. Important questions on NHS capacity, demand, preparedness, Nightingales etc. Thread below sets out NHS hospital trust perspective.
2/21 Have deliberately concentrated in thread on hospitals as this is where current public debate ahead of Tuesday’s vote is. But many of same issues apply to community, mental health and ambulance trusts, all of whom are under the same current level of pressure as hospitals.
3/21 Running a hospital at the moment is much more complex & difficult than normal due to COVID-19. That often doesn’t show up in usual national data that some are currently quoting (e.g. NHS capacity levels below last year / not under real pressure so where's the problem?)
Read 21 tweets
27 Nov
1/17 Important new @NHSEngland consultation paper on speeding up integration of health and care and system working at local level issued yesterday: england.nhs.uk/wp-content/upl…. Some initial thoughts in my new tweet thread below. @NHSProviders briefing here: nhsproviders.org/media/690574/2…
2/17 Document sets out detailed proposals for how health & care integration should work on ground going forward, from April 2021. And legislative options for NHS Bill next year on how to put ICSs on statutory basis (from April 2022?) Therefore triggers a very important debate.
3/17 Universal support for the need to speed up integration of health and care at local level, so strong agreement on the strategic direction of travel. Important to remember this as there will be different views, some of them strongly held, on the details of how to do this.
Read 18 tweets
20 Nov
1/19 What should happen on December 3? My new blog: nhsproviders.org/news-blogs/blo…. Covered in today's Times: thetimes.co.uk/edition/news/m…. Tweet thread below sets out why the NHS is worried about the risk of trading looser restrictions for Xmas for a third phase of covid over winter.
2/19 Where are we now on infections rates and admissions levels? Welcome signs that rate of hospital admissions in Liverpool/Manchester finally starting to slow down. But this hasn’t yet happened consistently in rest of country. Worrying rates of increase in some places......
3/19 ...It’s therefore still too early to tell if our current national lockdown will have the consistent effect that’s needed. The working assumption is that it will do, but the next five to seven days will be crucial in confirming that.
Read 19 tweets

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