NEWS
26/02/2021 06:00 GMT | Updated 26/02/2021 12:52 GMT

NHS Cohort Rules Are Risking Vaccine Wastage, Medics Fear

Those giving out the jab are calling on the NHS to let them vaccinate more widely as they run out of eligible patients.

The NHS could be forced to waste coronavirus vaccines if it does not offer leeway for medics to vaccinate beyond the designated at-risk groups.

The current cohort is group seven of the Joint Committee on Vaccination and Immunisation’s priority list, which takes in 60- to 64-year-olds. Over-65s, health workers, the clinically vulnerable, and care home residents should already have been offered the jab.

But the success and speed of the vaccination programme has seen some of those delivering it left with empty clinics and spare doses after reaching the end of the list for their eligible cohorts, and now medics are asking for permission to continue vaccinating into the next group should that occur.

Pharmacist Ade Williams had been giving out the vaccine at a local church hall in Bedminster, which he set up with a capacity for 1,000 vaccinations a week.

After weeks of full take-up, the number of people attending for vaccines has slowed to a trickle and the makeshift clinic, which he must dismantle at the end of every day, is now intermittently closed when demand is particularly low.

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On days when supply outstrips demand, vaccination centres up and down the country have been known to close 

On days when supply outstrips demand, Williams is careful to ensure there is no wastage by returning to his pharmacy, checking his lists of those who are eligible and calling them in at short notice. This has proven more tricky where cohorts are older, less mobile and unable to travel quickly.

So far, he has not been left with any unused vaccine, but he is calling on the NHS to allow him to shutter the makeshift clinic and deliver a lesser number of vaccinations from his pharmacy – and permit him to vaccinate outside the cohort group.

He said: “It may be a case of having a more nuanced approach whereby we are able to open to other priority groups.”

Dr Rosie Shire, who works as a GP in Cheshire, has also been running a pop-up vaccination clinic. The uptake has been so successful that a few weeks ago, she finished vaccinating cohort 4 and asked if she could progress to cohort 5.

Dr Shire says this was refused and her clinic was informed it must help other local practices by diverting any leftover vaccines.

Diverting supplies to places in need, as the guidance states, sounds sensible but in practice it can be difficult to arrange at short notice given the vaccine’s short shelf life and the sub-zero temperatures that the Pfizer vials must be kept at.

Dr Shire, who has transported the Oxford/Astra Zeneca vaccine for home visits, said: “I believe there has been a list of limitations on moving it between vaccine sites.”

Like Williams, Dr Shire has been careful not to risk any wastage, but says she has heard rumours of places that have had to throw away doses because of these rules.

Dr Shire says there were also unconfirmed rumours earlier in the programme that anyone who reached the end of their cohort would not be paid for delivering second vaccinations ahead of the official go-ahead, and even risked losing their licences.

She said: “If you could say: ‘Well, you know what, let’s use some second vaccines in this case because there’s three people in the clinic next door who can just have it,’ then it would be done.”

She says the issue is creating bottlenecks each time a new cohort is sanctioned, before once again trickling to a halt while the rest of the country catches up.

Speaking on behalf of the Doctors’ Association, she told HuffPost UK: “We had a backup plan, we had it from early on. When you are actually holding a vial, it feels like gold. You’re so scared of dropping it because you know they are so precious. We just do not want them to go to waste – they definitely need to be used.”

Dr Shire’s clinic recently reached the end of its quota for the day and found itself in possession of a spare dose.  

She said: “The vaccine clinic I’ve worked in is in a big community building which has a library and leisure services. I had one dose left and I knew it needed to be used. I rushed around and found the manager of that building and we gave it to him. We reasoned he is going to be public-facing and he’s in a community role. I was trying to think creatively.

“It’s going to be hard for someone who finds themselves with three doses left at the end of the day. I was determined not to waste it but that was my choice. Someone else might have to go straight home at the end of the day, so what do you do?”

Several others individuals have tweeted that their clinics are running out of patients and complained that they have not been able to book in their next cohorts for “full, pre-planned clinics for efficient mass vaccination”. 

Dr Shire knows of one clinic which shut down for a week because it reached the end of its cohort. She said: “It’s not been great.”

Other clinics have been forced to close due to low vaccine uptake for less positive reasons. The John Scott Centre, in Hackney, closed early on three days in the first week of February, prompting concern about vaccine hesitancy among the borough’s BAME communities, which make up 45% of its population. 

Like Williams, Dr Shire is calling for flexibility and greater transparency about the delivery of the vaccine.

NHS England guidance states the vaccine should not be given to people outside of the designated cohorts. Official literature addressed to vaccination sites from earlier this month states: “It is absolutely permissible and indeed encouraged, to have reserve lists of recipients who can come in at short notice if vaccine is still available. However, these lists should only be drawn from eligible recipients in these cohorts.”

Dr Shire said: “If there was more information about what we were getting, we could plan better. And that’s been part of the issue. You only find out the week before. If you had enough notice you’d book the right amount and you wouldn’t have this issue.”

Asked whether she felt that medics should be allowed to vaccinate other cohorts after they filled their quotas, Dr Shire replied: “It’s going against guidance, but equally I think we’ve got to be practical. It would be worse for it to go to waste. On balance, which is worse? We know we don’t want it to go to waste – it’s so precious.”

The British Medical Association’s (BMA) stance on the matter is more flexible. A spokesperson told HuffPost UK: “The BMA believes that, above all else, vaccines must not be wasted. GPs will be doing their utmost to make sure the vaccine is given to those within the current cohorts. However, on the very rare occasions that GPs do have doses available and are unable to give the vaccine to patients in cohorts 1-6, then they should offer it to those further down the priority list rather than see vaccines wasted.” 

The BMA also points out an NHS Primary Care Bulletin dated from January which clearly stated: “Vaccines beyond the current cohorts (1-4) can be offered if there is a risk that current vaccine stock will become unviable if unused.” 

Another solution could be to decentralise the booking systems and allow those who deliver the vaccine to manage their own appointments and supplies.

Williams suggested: “It’s more effective to keep up a certain level of activity and to increase it when the time comes, rather than have a capacity that is redundant because a low level of activity.

“At the end of the day it can be soul destroying [...] and for the community as well. It can be very disheartening to see the vaccination centre closed so many days of the week.

“We need a much more consistent service model – it makes more sense to try and condense the numbers. When NHS England put forward the proposals, you had to have a plan for delivering at least 1,000 vaccinations a week. What’s happening now is the NHS appointments system is not generating 1,000 appointments a week.”

Dr Tim Whittlestone, lead clinician for the vaccination programme in Bristol, north Somerset and south Gloucestershire, said: “As we move through the priority groups, there will be natural ebbs and flows across all our vaccination settings, including pharmacy sites.

“We are working tirelessly, across our health system, to vaccinate people as quickly as possible using every potential slot and every dose of vaccine as soon as we receive it. An increase in supply is expected across the UK and we expect to be able to increase our number of clinics across our healthcare system, then.”