In an unexpected move NHS England revealed on Wednesday that there would be a big reduction in the amount of Covid vaccines available from 29 March. The impending shortage means that no one under 50 in England will get a first dose until 1 May. Only people aged 50 or over, those who are clinically vulnerable, and those awaiting their second dose, will be able to get a vaccination at present.
Q: What does this letter say?
A: The government’s vaccines taskforce has told NHS England: “There will be a significant reduction in weekly supply available from manufacturers beginning in the week commencing 29 March, meaning volumes for first doses will be significantly constrained. They now currently predict this will continue for a four-week period, as a result of reductions in national inbound vaccines supply.”
Q: What impact will that have on the rollout of the Covid vaccines?
A: Vaccination sites will not be administering vaccines to anyone under 50 during all of April. The letter, written by two senior NHS England officials, Emily Lawson and Nikita Kanani, says jabs will only be “permissible in exceptional circumstances”. It adds: “Those aged 49 or younger should not be offered vaccinations unless they are eligible via a higher cohort because they are, for example, clinically vulnerable, or unpaid carers, or frontline health and care workers.”
The change affects the 1,700 or so vaccination sites run by GPs, hospital trusts and pharmacists. Immunisations can only proceed for people in the cohorts labelled one to nine – that is, everyone aged 50 or over or who is in a vulnerable group, as defined by the Joint Committee on Vaccination and Immunisation.
Q: So the under-50s will have to wait for their first dose until May?
A: Yes. The letter adds: “From today [17 March] the supply constraint means vaccination centres and community pharmacy-led vaccination services should close unfilled bookings from the week commencing 29 March and ensure no further appointments are uploaded to the national booking system or local booking systems from 1 to 30 April.”
Q: Why has this “significant reduction” in supply of the Covid vaccines occurred?
A: The letter does not say. It just refers to the “result of reductions in national inbound vaccines supply”. It is understood to involve the AstraZeneca/Oxford vaccine and not the Pfizer/BioNTech vaccine. AstraZeneca is thought to have experienced what one NHS official called “manufacturing capacity problems”. One NHS source said: “The letter is unusual. But remember that these are biological products that are being manufactured for the first time and at pace, therefore things could always go wrong.”
There was speculation Wednesday evening that the impending shortfall was caused by delays in delivery of 10m doses of the AstraZeneca doses from India. This product is particularly important because it makes up about 75% of the vaccines so far administered in the UK; the Pfizer vaccine accounts for the remaining 25%. AstraZeneca produce about 2m doses a week but the amounts can vary. Initial deliveries of a third vaccine, made by the American firm Moderna, are due in April.
Q: What might this mean for the government’s target of offering a first dose to all over-50s by 15 April and to every adult by the end of July?
A: Matt Hancock, the heath secretary, maintained that the 15 April deadline would be honoured and Whitehall officials have said that everyone aged 18 or over will still be offered their first jab before the end of July. “Timescales have not changed,” said an official.
But while the NHS Confederation called Hancock’s pledge over over-50s “reassuring”, it warned that “putting an embargo on new first-dose bookings for a whole month due to supply constraints will make this an even taller order”. It added, in reference to European countries which have stopped using the AstraZeneca vaccine over claims about blood clots: “This is particularly true given that the events in Europe have knocked some patients’ confidence in confirming or attending their scheduled appointments.”
There is also speculation that some GPs could now decide not to take part in the extension of vaccinations to the under-50s, whenever it comes, as they have patients to see at their surgeries who need help with medical problems. Primary care networks have until Sunday to opt in or out of that phase of the deployment.
Q: How significant is this interruption to the vaccine programme?
A: There have been shortages before. For example, in a letter on 3 April, Lawson and Kanani warned vaccination sites that there would “be minimal allocations of new vaccine in the first part of the week commencing 8 March”. That led, for a time, to sites opening for fewer hours or days. In contrast, this week vaccine supplies have been plentiful, allowing more people to have their first or second jab. The slowdown during April will clearly reduce the headline total of vaccinated people that the government has regularly lauded.
Q: Will the supply dip affect the roadmap for reopening the economy?
A: A key criterion for unlocking, set out by the prime minister, included continued successful vaccine deployment. Given the expectation that most vulnerable groups will largely have been vaccinated by 12 April, when pubs can serve outdoors and shops can reopen, it seems likely that the roadmap dates will not alter unless there are other significant challenges.