Boris Johnson is facing pressure to speed up the immunisation of England care home residents against Covid after the Scottish government announced it would start doing so on 14 December and logistical difficulties cited by the prime minister were called into question.
Care home residents were named by the joint committee on vaccination and immunisation (JCVI) as the top priority for the Pfizer/BioNTech vaccine, but Johnson and the NHS England chief executive, Sir Simon Stevens, said on Wednesday they would not come first. Health workers have also been moved down the list.
Johnson said getting the vaccine to care homes was an “immense logistical challenge”, and it would take “months” before all of the most vulnerable were protected, partly because of having to keep the vaccine at -70C.
Stevens also said limitations imposed by the Medicines and Healthcare products Regulatory Agency (MHRA), including not yet having approval for a safe way to break up packs of 975 doses, meant the vaccine could not yet be sent from hospital deep freezes to care homes. Instead, hospital inpatients aged over 80 would be prioritised, and care home staff who would be given block bookings to receive the jabs at hospitals.
But care leaders said they believed the government had enough latitude to move faster to vaccinate care home residents, more than 18,000 of whom have died from Covid in England this year.
Conditions set out by the MHRA state doses can be stored at 2C-8C for five days, during which it can be transported in two journeys of up to six hours each. Once it has been raised to room temperature it can stand for eight more hours before it must be binned.
“Getting doses to care homes needs to be urgently addressed if we are to achieve the objectives of the vaccine,” said Vic Rayner, the executive director of the National Care Forum, which represents not-for-profit care homes.
“There doesn’t seem to be enough ambition around transporting it and there hasn’t been any effort to work with the care sector to work out how this can be achieved. It seems the Scottish government has come to a different conclusion. It is not at all clear at this moment why the English government is not pursuing this path.”
Scotland’s health minister, Jeane Freeman, said on Thursday it would be possible to deliver vaccines to care homes. She told MSPs the vaccine could be transported in an unfrozen state for up to 12 hours and could be stored undiluted for up to five days. She announced it would be sent to care homes in the second week of the Scottish rollout.
“Under certain conditions we can pack down to smaller pack sizes, which makes this more usable, with minimum wastage for our care home residents and our older citizens,” she said. “So in effect we can take the vaccine to them, or close to them, and we will begin that exercise from 14 December.”
Her comments came less than 24 hours after Stevens had said the batches of 975 vaccine doses delivered from Pfizer could not be split or “packed down”.
The MHRA conditions state: “Further packing down of lots to aid deployment can occur at 2-8 degrees centigrade within the 120 hours shelf life of leaving ultra-low temperatures.”
However, an official source said the process of dividing up the vaccines had not yet been designed and would first need to be validated by the MHRA, which could take weeks. A key concern is understood to be the logistical challenge of distributing vaccines from around 50 NHS hospital hubs to more than 15,500 care homes in England.
A spokesperson for the Department of Health and Social Care said: “There will need to be flexibility in terms of operational challenges around delivery of the vaccine to those in care homes. In line with the [JCVI] advice, every effort will be made to supply vaccine and offer vaccinations to care home residents and we will deliver the vaccine according to clinical prioritisation and operational necessity.”