COVID-19 vaccination in the United Kingdom

GP-led vaccination centres were in operation by 15 December 2020

The COVID-19 vaccination programme in the United Kingdom is the world's first mass immunisation campaign to protect against COVID-19 using the Pfizer–BioNTech vaccine, in response to the pandemic in the UK.

Vaccinations began on 8 December 2020, shortly after the UK's regulator (MHRA) became the first to grant emergency authorisation to the vaccine. As of 2 December 2020 there were six other COVID-19 vaccines on order for the programme, at varying stages of development.

Phase 1 of the rollout prioritises the most vulnerable first, in a schedule primarily based on age. By 20 December 2020, the first of two doses of the RNA vaccines had been administered to 616,933 people throughout the UK. Vaccination sites include GP practices and care homes, as well as hospitals. As of 23 December 2020 there were 613 vaccination sites operating in England.

New guidance for allergy sufferers, antibody tests and the new variant of SARS-CoV-2 has been issued during the programme.

Background

Responsibility for COVID-19 vaccine deployment

On 28 November 2020 the new role of Minister for COVID Vaccine Deployment was set up by the government, with Nadhim Zahawi the first to take office.

Vaccines on order

There are several COVID-19 vaccines at various stages of development around the world. As of 2 December 2020 the UK government had placed orders for a combined total of 357 million doses across 7 different vaccines. This does not equate to the number of people that can be immunised as some vaccines require more than one dose. The breakdown of the vaccines being considered for the UK vaccination programme is as follows:

Vaccine	Progress	Doses ordered	Approval	Deployment
Tozinameran (Pfizer–BioNTech)	phase 3 clinical trials	40 million	2 December 2020	8 December 2020
Oxford/AstraZeneca	phase 3 clinical trials	100 million	Pending	Pending
Moderna	phase 3 clinical trials	7 million	Pending	Pending
Novavax	phase 3 clinical trials	60 million	Pending	Pending
Valneva	pre-clinical trials	60 million	Pending	Pending
GSK/Sanofi Pasteur	phase 1 clinical trials	60 million	Pending	Pending
Janssen	phase 2 clinical trials	30 million	Pending	Pending

Vaccine announcements

On 23 December 2020 the Health Secretary, Matt Hancock, announced that the Oxford/AstraZeneca vaccine had finalised its submission to the regulator for approval, with the The Sunday Times reporting on 27 December 2020 that its approval will be within "days".

History

Regulatory approval

On 2 December 2020, the UK became the first country to give approval for use to the Pfizer–BioNTech vaccine. 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. 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 UK.

Launch

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. William Shakespeare (who bears the same name with the world-famous poet), 81, from Warwickshire became the second person, and the first man, to be vaccinated. Both vaccinations took place at University Hospital Coventry.

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:

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. The two people affected were quickly treated and recovered well.

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.

As of 20 December 2020 Public Health England say there is "no evidence" to suggest that the recently identified 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. 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 recently formed Vaccine Taskforce on the groups of people that should be prioritised for vaccination.

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.

Rollout schedule

Vaccine priority groups

Phase 1

The Joint Committee on Vaccination and Immunisation advised the government on how to prioritise the rollout. The top priority for the programme was to prevent deaths and to ensure that the NHS would not be overwhelmed. As older people are more at risk of hospitalisation or death from COVID-19, prioritisation was primarily based on age.

The following table shows the vaccine priority groups for the first phase of the roll-out:

Order	Priority group
1	residents in a care home for older adults and their carers
2	all those 80 years of age and over and frontline health and social care workers
3	all those 75 years of age and over
4	all those 70 years of age and over and clinically extremely vulnerable individuals
5	all those 65 years of age and over
6	all individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality
7	all those 60 years of age and over
8	all those 55 years of age and over
9	all those 50 years of age and over

"Clinically extremely vulnerable" is defined as:

• solid organ transplant recipients
• people with specific cancers:
  • people with cancer who are undergoing active chemotherapy
  • people with lung cancer who are undergoing radical radiotherapy
  • people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
  • people having immunotherapy or other continuing antibody treatments for cancer
  • people having other targeted cancer treatments that can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
  • people who have had bone marrow or stem cell transplants in the last 6 months or who are still taking immunosuppression drugs
• people with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD)
• people with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell disease)
• people on immunosuppression therapies sufficient to significantly increase risk of infection
• problems with your spleen, e.g. splenectomy (having your spleen removed)
• adults with Down’s syndrome
• adults on dialysis or with chronic kidney disease (stage 5)
• other people who have also been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs.

Women who are pregnant and children under 16 are not defined as clinically extremely vulnerable for the purpose of the vaccination programme.

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:

• 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.

Progress to date

COVID-19 vaccination take-up: the number of vaccinations each week, by UK country

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.

By week-ending 20 December 2020, a cumulative total of 616,933 people had received the first dose: 521,594 in England, 22,595 in Wales, 16,068 in Northern Ireland and 56,676 in Scotland.

• Number of people vaccinated, each week, by UK country

  Week-ending	England	Northern Ireland	Scotland	Wales	TOTAL
  Sun 13/12/2020	108,000	3,623	18,800	7,852	137,897
  Sun 20/12/2020	413,594	12,445	37,876	14,743	479,036

• Cumulative totals, as at each week-ending, by UK country

  Week-ending	England	Northern Ireland	Scotland	Wales	TOTAL
  Sun 13/12/2020	108,000	3,623	18,800	7,852	137,897
  Sun 20/12/2020	521,594	16,068	56,676	22,595	616,933

Vaccination centres

More than 70 sites were in operation as at the end of the first full week (15 December 2020). Whilst hospitals formed the centres initially, GP-led centres also started later within that week.

Care home locations in England entered the programme on Wednesday 16 December 2020. "Hundreds" of residents received the first dose in 7 care homes in Slough, Aintree, Herne Bay, Thanet, Chalfont St Peter, Droitwich and Cheltenham. As the rollout direct to care homes continues, larger premises (50 to 70 beds) will be prioritised first.

The Chelsea Pensioners received their first dose, at the Royal Hospital Chelsea on 23 December 2020.

Locations

As of 23 December 2020 there were a total of 613 vaccination sites operating in England, an increase of 139 on the previous week (up to 18 December). These were made up as follows:

Region	Hospital hubs	Local vaccination services	Totals
East of England	8	57	65
London	14	49	63
Midlands	13	82	95
North East and Yorkshire	11	111	122
North West	13	70	83
South East	12	100	112
South West	8	65	73
Grand Total	79	534	613

See also

• Timeline of the COVID-19 pandemic in the United Kingdom (July-December 2020)
• British government response to the COVID-19 pandemic

External links

• COVID-19 vaccination programme (Gov.uk website)
• COVID-19 vaccination programme (NHS England website)
• Coronavirus (COVID-19) vaccine (NHS Scotland website)
• Coronavirus (COVID-19) vaccination programme (Gov.wales website)
• COVID-19 vaccination programme in Northern Ireland (nidirect.gov.uk website)