Supply and planning issues threaten UK’s “world beating” vaccine achievements: PAC calls for Government to set out plans for adapting vaccine programme by end of April

In a report published today the Public Accounts Committee commends Government for its “world beating” progress buying and starting to roll out vaccines as it launched the “largest vaccination programme in the UK’s history” in response to the COVID-19 pandemic: supporting the development of potential vaccines, striking deals with pharmaceutical companies and starting to vaccinate some of the most at-risk members of society.

But the Committee warns that despite this significant achievement, supply issues are key among factors that mean there is “much to be done” to adapt to changes in the pandemic and virus itself and meet the Government’s next targets.

In January, the Prime Minister pledged that the NHS would vaccinate or offer a vaccination to around 12.2 million people in the top four priority groups across the UK by Monday 15 February – “a huge task which it appears to be on track to deliver”. NHSE&I then plans to offer a vaccine to the remaining five priority groups (around 17.7 million people) by the end of April, with everyone who wants one offered a vaccine by Autumn 2021.

At the point of PAC’s evidence session on the vaccine programme, on the 11th of January, 2.5 million of the most vulnerable people across the UK had received at least one dose of a vaccine against COVID-19. At the time of print on 10 February 2021, more than 13 million doses had been delivered: 12.6 million first doses and 516,392 second doses.

The Committee is concerned by lack of planning for the next phase of the vaccination programme, when applying lessons learned so far “will be so vital to the programme’s success”. It says that by March 2021 DBEIS, DHSC, NHSE&I and Public Health England must “have in place plans to respond to potential future developments such as changes to the prioritisation list; an annual vaccination programme; or the discovery of new variants of the virus.” High global demand for the vaccines that have been approved means it is vital government builds on momentum to date if the vaccine programme is “to be a success and have offered a vaccine to all those who want one by autumn 2021”.

Echoing its recent report on PPE procurement, the Committee says Government and its Vaccine Taskforce have “not quite struck the right balance between making decisions quickly and maintaining transparency” and there remains some uncertainty over key issues.

With misinformation about vaccines being circulated on various digital platforms clear communication from government is particularly important to maintain public confidence and take up, but the Committee says Government has at times “struggled to communicate clearly to the public about what they can expect from the vaccine programme”, risking “confusion about who will be able to access the vaccine, how and when”. As the first phase reaches its end clear communication about the next phase is vital.

Meg Hillier MP, Chair of the Committee, said “We recognise the huge efforts made by all those involved in developing, procuring, testing and delivering the vaccines. The UK has been at the forefront of the global effort to find and deliver a vaccine but now is not the time to rest on our laurels – Covid 19 remains a significant threat to our nation’s health and economy. Vaccination is a key component in meeting that threat and the Committee calls on the Government to build on this strong start, including building on work to boost the UK manufacturing base.

“Misinformation about the vaccine is rife and the Government needs to provide unambiguous information on the safety and effectiveness of the vaccine and clear messages about the groups that will be offered the vaccine over the coming months.”

PAC report conclusions and recommendations

7. BEIS, NHSE&I and PHE have made major and world beating progress in buying and starting to roll-out the vaccines, but a degree of uncertainty remains in key areas. By 4 January 2021, some 2.3 million of the most vulnerable people in England had received at least one dose of a vaccine. By 10 February the Government’s own figures are that in the UK, 12,646,486 people had received a first dose and 516,392 people had received a second dose of vaccine.¹ This is a significant achievement. We applaud the rapid establishment of the Vaccine Taskforce and we commend the efforts of everyone involved in delivering the vaccine programme to date. But the hard work is not over yet. There remains uncertainty over important areas such as: whether the vaccines stop the transmission of COVID-19; whether an annual vaccination programme will be necessary; and the reality that the virus has mutated so the vaccine programme must adapt and respond as more is learnt about the challenges ahead. There is also a strong case for asking the Joint Committee on Vaccines and Immunisations to look again at which groups should be prioritised after the most vulnerable groups have been vaccinated, especially front line key workers who are more exposed to community transmission than other groups. BEIS does not currently consider planning for the possibility of an annual vaccination programme to be an urgent or critical question owing to the number of potential doses the UK has access to. However, there is no guarantee that all of the vaccines it has signed up for will be approved or delivered, creating uncertainty over whether further vaccine purchases will be needed and how BEIS will manage potential excess doses it has committed to buying.

Recommendation: To ensure that the momentum and progress to date is not lost, by March 2021 BEIS, DHSC, NHSE&I and PHE need to have in place plans to respond to potential future developments such as: changes to the prioritisation list; an annual vaccination programme; or the discovery of new variants of the virus.

8. Despite BEIS’s confidence, concerns remain over the vaccine supply chain. Under the Government’s ambitious plans, everyone who wants a vaccination should be able to have one by Autumn 2021. This will depend on continuing vaccine supply. Whilst BEIS asserts that the UK has access to more doses than it likely needs if they all work, NHSE&I is less certain when the doses will arrive. BEIS holds detailed supply schedules up to the end of February 2021 but until recently NHSE&I was only able to provide vaccination sites with supply schedules one week in advance. There have been conflicting statements about vaccine supply. BEIS is unequivocal that supply will not be a constraint in meeting the Government’s 15 February target and on current numbers this appears to be on track. The Department is confident that, through its investment of £302 million, of a potential £519 million, in the UK’s manufacturing capacity, the UK could manufacture all the vaccine doses that it might need should this contingency be required. Yet on the same day we took evidence the Secretary of State for Health and Social Care stated that supply of the vaccine is the ‘rate limiting factor’ for deployment plans.

Recommendation: BEIS should, by the end of February 2021, write to the Committee with its assessment of the risks within the vaccine supply chain and a plan to proactively address these to ensure sufficient doses of vaccine are available through to Autumn 2021.

9. BEIS has worked quickly to secure access to vaccines but could have been more transparent about how decisions have been made. Transparency is essential to maintain public confidence and ensure taxpayers’ money is being well spent. BEIS has managed significant uncertainty and worked at pace to purchase vaccines, but it could have been more transparent about how key decisions were made. The Chair of the Taskforce was appointed directly by the Prime Minister. While we recognise that a full competition was not an option at the height of the pandemic our witnesses could not explain why she was chosen or the reasoning behind the appointment which appears to be a personal decision by the Prime Minister. Transparency and openness about such key appointments is important and helps hold decision makers to account.) Almost a fifth of the 200 individuals on the Taskforce have recorded at least one conflict of interest although most are minor. To ensure the UK could access vaccines once they were approved, BEIS has made £914 million worth of upfront payments to enable pharmaceutical companies to start manufacturing vaccines at scale, but this could be lost if the vaccines are not approved. It has also agreed to provide each pharmaceutical company with broad ranging indemnity cover against adverse effects arising from their vaccine. In evidence witnesses were clear that had the indemnities not been provided this would have put the UK behind other countries in securing vaccines.

Recommendation: BEIS should, by the end of March 2021, review its decisions about how to invest taxpayers’ money and its appointments processes to identify what it would repeat and what it will change in future. As part of this, BEIS should examine its experience of using the Taskforce model to inform its own and government’s future skills requirements and to ensure accountability arrangements are robust. BEIS should, by the end of April 2021, lay out its learning so the rest of government can improve the robustness of the cross-government emergency response. It should also assess how it will deal with indemnities for future vaccines and be clear about the benefits and risks.

10. DHSC, NHSE&I and PHE will continue to face significant challenges in making sure they can get the vaccine to the right people at the right time. Each vaccine will require different plans for deploying because each has different characteristics. Getting the vaccine to the right place to allow it to be administered is challenging. For example, the Pfizer Inc and BioNTech SE vaccine must be stored at -70°c, whereas the vaccine developed by the Astra-Zeneca Ltd – University of Oxford partnership can be stored at between 2°c and minus 8°c. BEIS considered the logistics of deployment as part of deciding which vaccines to purchase but prioritised whether the vaccine itself would work. Despite these challenges, 97.3% of vaccine deliveries so far have been made on-time and in full. The Former Chair of the Taskforce explained that the MHRA had compressed parts of the process while ensuring the efficacy and safety of the programme. NHSE&I is working to ensure any surplus vaccines are redistributed to those areas most in need and is using large vaccination sites and community pharmacies to help smooth distribution at a local level. NHSE&I is confident that it has in place the workforce it needs to meet its 15 February target, with around 80,000 people trained and ready to administer vaccines. Convenience and location of vaccine centres will be important in encouraging people to take up the offer of a vaccine, particularly in hard to reach groups. We were informed that 21 mobile army units of 101 Logistics Brigade were deployed. Local GPs and community leaders will play a crucial role in making sure people are willing and able to take up the offer of a vaccine and PHE has committed to working with local government to ensure that no community gets left behind.

Recommendation: By the end of February 2021 DHSC, NHSE&I and PHE should write to us with their assessment of the main challenges and risks to the ongoing deployment of the vaccine programme and a detailed plan for how these will be addressed.

11. There is a risk that NHSE&I and DHSC’s plans for the vaccine programme will not meet public expectations. NHSE&I recognises that its goal to vaccinate the first four priority groups by 15 February is a huge task which it appears to be on track to deliver. As no-one can be forced to have the vaccination, NHSE&I will determine the programme’s success based on the number of people offered a vaccine rather than the number of people who are vaccinated. The daily vaccination totals published by government, however, are based on the number of vaccines administered, not offers made. We are concerned that using these could create confusion among the public about progress with the vaccine programme. NHSE&I has lengthened the time between individuals’ first and second doses of the vaccine from 3 to 12 weeks. It asserts that this delay is not linked to the introduction of new lockdown measures, but “basic maths” that it is better to have more people with single dose protection than a smaller number with double dose protection. NHSE&I currently expects around 25% of people will not take-up the offer of a vaccination but is hopeful that actual take-up rates will be higher. We are nonetheless concerned about how vaccines will be deployed across parts of the country with different age demographics, local need and people with vulnerabilities. NHSE&I recognises that there is a trade-off between equity of access and the speed of deployment and that it cannot allow one part of the country to race ahead of another.

Recommendation: NHSE&I and DHSC need to immediately set out in detail what they are planning to achieve so the public has a better understanding of what the daily progress reports mean in practice. It should clearly set out: the definition of ‘vaccinated’ and ‘offered a vaccination’; and expected take up rates across both doses and across different cohorts, for example by age and ethnicity. Progress should also be reported at local, regional, devolved and UK levels in a consistent and comparable way.

12. Public confidence in the vaccine programme is crucial to its success yet some members of the public and health professionals were confused by the messaging about when and how people can access a vaccine. The number of people who choose to have the vaccine will ultimately be determined by public trust in the vaccines. Clear communication is essential to enable the public, Parliament and health professionals understand what is going on within the vaccination programme, but is challenging because the situation is evolving so rapidly. We have previously found that a lack of information during the pandemic, or repeatedly changing and updating guidance, can be confusing and frightening for those affected. NHSE&I had not yet developed a Frequently Asked Questions section for its website at the time of our evidence session nor has it put in place a rebuttal unit to deal with negative publicity or fake reporting about the vaccines. NHSE&I acknowledges it needs to be vigilant about the potential for fraudsters to take advantage of the more vulnerable in society in offering fake vaccines.

Recommendation: NHSE&I and DHSC need to immediately develop clear and straightforward communication, including comprehensive FAQs, to help the public navigate the constantly changing situation. This should be publicised to the public and those who can help inform the public such as GPs, Clinical Commissioning Groups and MPs, as well as setting up a unit to quickly rebut false claims about the vaccines