The Times - UK (2020-12-03)

the times | Thursday December 3 2020 2GM 11

News

people with lifesaving clinical skills and

the confidence to use them, every day.”

He said that more than 2,000 St John

volunteers had signed up for the pro-

gramme in just over a week, with the

first cohort ready to be deployed.

The use of volunteers was made poss-

ible by changes to the Human Medici-

nes Regulations in October, which

expanded the list of who could give the

jabs beyond the usual healthcare

professionals, provided they had un-

dergone a robust training programme.

The same changes gave the Medici-

nes and Healthcare products Regulato-

ry Agency the legal power to grant tem-

porary authorisation of new vaccines

and treatments, as they have done for

the Pfizer/Biontech vaccine.

An NHS spokeswoman said: “Given

Q&A

Midwives, dentists and airline staff

trained to give jabs may be recruited.

GPs will play an important part

through what will effectively be an

expansion of the annual influenza

vaccination campaign. NHS England

has asked family doctors to put “all

hands to the pump”. GP and health

leaders have warned that this could

mean significant disruption to routine

services. The NHS Confederation said:

“Delivery of a vaccination programme

on this scale from scratch means

‘business as usual’ is not feasible.”

Can I receive the Pfizer jab privately?

No. The company has said that it will

only supply governments “during the

initial pandemic stage”.

How about storing the Pfizer vaccine

— is it complicated? Yes. The vaccine

will have to be kept at about minus 70C

during shipping and Pfizer has

developed a special container, which

will be packed with dry ice and can

keep the doses ultra-cold for up to 15

days. However, it has said that the

doses will have “an effective life of up

to five days” when stored between 2C

and 8C, which can be in a normal

fridge. It can also be kept for six hours

in a special cool bag. The scientists

behind the vaccine envisage small

batches of the vaccine being couriered

in these bags by motorcycle.

This could make life far easier for GP

surgeries and other vaccination centres

but the logistics will still be demanding.

How does it work? A tiny amount of

genetic material — mRNA — is injected,

which prompts human cells to produce

the spike protein found on the surface

of the coronavirus. This trains the

immune system how to fend off a real

infection. This is the first mRNA vaccine

ever to have been approved.

Can it help people who are already

infected and in hospital? No. Vaccines

are prophylactic. They will not help

people who have caught the virus.

How much does the Pfizer vaccine

cost? The government has not said how

much it is paying but in July the US

government ordered 100 million doses

for $1.95 billion. That indicates a price of

roughly $40 (£30) for the two shots

required per person. The Oxford

vaccine, which is being developed with

the British drugmaker Astrazeneca, is

understood to cost between $6 and $

for the two injections.

What about the other Covid-

vaccines? The MHRA is assessing two

others, from Oxford-Astrazeneca and

the American company Moderna. If the

pace of the Pfizer approval is a guide, it

is possible that Oxford-Astrazeneca and

Moderna will also be approved by the

end of the year.

It is slightly more than three weeks

since Pfizer announced, on November

9, that its final trial had reached a stage

where scientists could be confident that

the jab worked. Moderna hit the same

milestone a week later, on November

16. Oxford came a week after that.
    The first doses of the Moderna jab
    will be set aside for the US and supplies
    are expected to be ready for the UK in
    the spring. The Oxford-Astrazeneca
    vaccine would be available sooner, with
    about four million doses expected to be
    ready for the UK by the end of the year.
    The Oxford team are confident that
    their vaccine is safe and effective in
    preventing severe disease. Questions
    have been raised about how effective it
    is in preventing symptomatic Covid-19.
    The most optimistic assessment of 90
    per cent is based on a relatively small
    group of 2,700 volunteers who were
    first given half a dose then, a month
    later, a full dose. A bigger sub-trial,
    involving about 9,000 people who
    received two full doses, showed that it
    was 62 per cent effective. The MHRA
    will scrutinise the data. It may approve
    only one dosing regimen.

Who will be vaccinated first? Care

home residents and the staff who work

with them are at the top of the priority

list drawn up by the independent Joint

Committee on Vaccination and

Immunisation (JCVI), followed by the

over-80s and health and social care

workers (Rhys Blakely and Kat Lay

write). Logistical hurdles will dictate

otherwise, however. The Pfizer-Biontech

vaccine must be kept at “ultra-cold”

conditions and each storage site will

have to be approved by the medical

regulator, meaning care homes will not

be able to take doses initially. In

practice, NHS staff at hospitals that are

certified to store the jabs could be

vaccinated first along with over-80s

and care home residents who already

have hospital appointments.

Do I need to apply for a vaccine or will

I be notified when it is my turn? The

Welsh government has told its citizens

to sit tight and wait for a call. The

expectation is for something similar in

the rest of Britain.

Which underlying health conditions

make people eligible for the jab?

“Clinically extremely vulnerable”

individuals are people who have been

shielding from coronavirus. This group

includes blood cancer patients and

others with suppressed immune

systems. They will be invited at the

same time as the over-70s.

The group to be invited after the

over-65s have health conditions that we

know increase the chances of severe

disease if they are infected by

coronavirus. The JCVI says that among

the relevant underlying conditions are

chronic respiratory disease, including

chronic obstructive pulmonary disease,

cystic fibrosis and severe asthma,

chronic heart disease, severe learning

disabilities and morbid obesity.

What will being vaccinated involve?

Are there side-effects? People will

need two shots of the Pfizer vaccine,

three weeks apart, administered via a

traditional needle in the arm. Protection

develops about a week after the second

injection, so the process takes about a

month in total. You may be asked to

stay at the vaccination site for 15

minutes after an injection to make sure

you are OK.

Trial volunteers did experience side-

effects, including sore arms, fever and

muscle ache, but nothing dangerous.

The Medicines and Healthcare products

Regulatory Agency (MHRA) will monitor

for anything more serious. The

volunteers enrolled in the clinical trials

will be followed for up to two years.

How many doses will Britain receive

and when? The UK has ordered

40 million doses of the Pfizer vaccine,

enough for 20 million people, with the

first 800,000 expected to arrive by air

within days from a plant in Belgium.

How well does it work? Trials indicate

it is 95 per cent effective in preventing

symptomatic Covid-19 and works well in

people over 65. We do not yet know

whether it prevents transmission or

how long protection lasts. It does not

completely rule out the risk of severe

disease: one person who was

vaccinated in the trial became seriously

ill with Covid-19, compared with nine in

the placebo group. The trial had 43,

participants in total.

Who will administer it? The

government has outlined three main

routes of delivery. Teams will take the

vaccines to care homes to inoculate

residents and staff.

Big vaccination centres will also be

set up and are expected to include

drive-through lanes where people

receive the jab sitting in their cars.

News

How Pfizer’s mRNA

vaccine works

Antibody

Spike protein

Human cell

The genetic code, or

mRNA, that produces the

“spike protein” of the

coronavirus is

identified

1

The vaccine

injection contains

copies of the

mRNA code, which

are taken up by

human cells

2

The cells

produce the spike

protein, which

stimulates the

immune system. It

creates antibodies

and other defences,

which can later fend

off the real

pathogen

3

Genetic

code

March

January

All those aged 65-

All individuals aged 16 years to 64 years with underlying health

conditions which put them at higher risk of serious disease and mortality

All those aged 60-

All those aged 55-

All those aged 50-

4.6m

4.5m

3.9m

3.4m

at least 4m

5

6

7

8

9

65

60

55

50

!

How some of the Covid-19 vaccines compare

Everyone aged 18-

After these groups, the rest of

Britain’s 30 million adults

could start to be offered

vaccination. By this time it is

hoped that the protection

given to the elderly could

have eased pressure on the

NHS substantially and

allowed the relaxation of

many social distancing rules

Everyone aged 65-

from early January

All under-65s at high or

moderate risk January or February

Everyone aged 60-

January or February

Everyone aged 55-

offered vaccination by late winter

Everyone aged 50-

vaccinated by spring

Company Oxford-

Astrazeneca

Type

Efficacy*

Moderna Pfizer-

Biontech

Gamaleya

(Sputnik V)

Viral vector mRNA mRNA Viral vector

Storage Regular fridge

temperature,

2C-8C

Minus 20C up

to six months

Minus 70C,

can be kept in

normal fridge

for five days

Regular fridge

temperature

(in dry form)

62-90%** 95%

Doses 2 doses, 4

weeks apart

2 doses, 4

weeks apart

2 doses, 3

weeks apart

2 doses, 3

weeks apart

Cost per

dose

£

($4)

£

($33)

£

($20)

£7.

($10)

*preliminary phase three results, not yet peer-reviewed ** depending on dose regimen

Source: Respective companies, WHO

95% 92%

train thousands of jab volunteers

the likely phasing of vaccine supply

from the manufacturers, most Covid

vaccination for high-risk people is like-

ly to take place between January and

Easter, so extra vaccinators are being

recruited and trained for that period in

line with the regulations set by parlia-

ment, and volunteers will have the op-

portunity to help support NHS staff

and patients at vaccination services.

“All staff who administer a vaccine

will receive comprehensive training de-

veloped by PHE, expert assessment

and clinical supervision."

The NHS is seeking to recruit three

types of volunteers. The roles include

“volunteer vaccinators”, who will be

trained to administer the coronavirus

vaccine and to react in case a patient

has an adverse reaction. Also called to

aid the health service are “vaccination

care volunteers”, who will support

patients at the centres. NHS “patient

advocates” will focus on the welfare of

patients in vaccination centres and be

responsible for getting help with any

medical emergencies that arise.

The NHS wants

volunteers to

administer the

vaccines and also

look after the

welfare of

patients