NAO report flags up concern over flu and COVID vaccination staffing “bottleneck”

A new report highlights concern that the almost doubling of numbers being vaccinated against the flu, co-inciding with the rollout of the COVID-19 vaccination programme, could create a “bottleneck” due to staffing issues.

In a report on its investigation into preparations for potential COVID-19 vaccines, the National Audit Office (NAO) notes that “the scale of the vaccinations needed will require a significant additional workforce at a time when shortages exist and there are concerns about staff well-being due to their ongoing efforts responding to the pandemic”.

Alongside the COVID-19 vaccinations, NHS England and NHS Improvement (NHSE&I) is also delivering an expanded flu vaccination programme to up to 29.5 million people in 2020-21 (double the previous year.)

The NAO report states that the Department of Health and Social Care “does not consider this additional workload to have increased the risk to deployment activities but recognises that staffing concerns could create a ‘bottleneck.’”

The report is the first from the NAO (the UK’s independent public spending watchdog) on preparations for COVID and it covers the period from April to 8 December 2020.

It notes that the Department for Business, Energy & Industrial Strategy (BEIS) is responsible for securing the supply of vaccine for the UK.

This includes supporting the research and development of potential vaccines and selecting which of them to purchase, as well as developing manufacturing capacity to ensure supply. 

A Vaccine Taskforce was created in April 2020 to deliver this on behalf of BEIS.

BEIS is purchasing several different types of vaccines because of the uncertainty over which ones will be approved as safe and effective. 

It decided to purchase different types of vaccines from different pharmaceutical companies “to create a diverse set of options”. 

In April 2020, the Department identified there were around 190 vaccines in development globally. A short-list of 23 potential vaccines was created.

Of these 23, the Taskforce prioritised starting due diligence checks on 12. BEIS then started commercial negotiations with six companies and continued discussions with others.

The NAO points out that as there was no common quantitative scoring mechanism, it has proved difficult to compare how each vaccine was selected. 

The Government has invested up to £619 million in global efforts to find a vaccine, for both UK and international supply.

The government has joined COVAX, which acts as an international platform to accelerate the global development, manufacture and equitable distribution of COVID-19 vaccines.

BEIS has signed contracts with five pharmaceutical companies, providing access to 267 million potential doses at an expected cost of £2.9 billion.

Contracts are in place for the vaccines being developed by:

• Astra Zeneca UK Limited and the University of Oxford for 100 million doses, signed in August 2020
• Valneva SE for 60 million doses, signed in September 2020
• Pfizer Inc and BioNTech SE for 40 million doses, signed in October 2020
• Novavax Inc for 60 million doses, signed in October 2020
• Moderna Inc for 7 million doses, signed in November 2020

By December 8 BEIS had committed £302m to provide manufacturing capacity for vaccines within the UK including:

• £127 million to purchase, convert and run a Cell and Gene Therapy Catapult Manufacturing Innovation Centre in Braintree, Essex, now due to start vaccine production in June 2021
• £93 million to accelerate the completion and expand the role of the Vaccine Manufacturing Innovation Centre (VMIC) in Oxfordshire where two vaccines against COVID-19 could be mass produced. This project was originally due to be completed in summer 2022 but BEIS now expects VMIC to start operating by the end of 2021 and be fully operational in the first quarter of 2022. It will have the capability to produce up to 70 million vaccine doses in four to six months.

The NAO report acknowledges that Government has had to work at speed and, until recently, without any certainty that an effective vaccine would be found.

Accelerated timetable

Vaccine development typically takes a minimum of 10 years. BEIS has been working to an accelerated timetable to make a vaccine available within 12-18 months.

NHSE&I has planned on the assumption that 75% of people who are offered the vaccine will take it. An estimated 25 million people could be vaccinated against COVID‐19 in England throughout 2021 (provided sufficient doses of vaccine are available).

The Department of Health and Social Care (DHSC) requested some funding to be fast-tracked to enable it to develop the technology and communications needed to deploy the vaccine and to support the seasonal flu vaccination programme.

The Treasury approved £180m for technology and public communications in September with a further £476m approved in November to cover the expected costs of deployment in 2020.

NHSE&I is inviting individuals for vaccination through a combination of letters, emails, text messages and phone calls.

NHS Digital is responsible for the effectiveness of the COVID-19 vaccination information systems and technology.

The report notes that public trust in the vaccine will determine numbers choosing to have it.

In June 2020, Public Health England emphasised the need for attitudinal research to inform the communications strategy. However in August 2020 it reported that this research would not be completed in time for the first vaccinations.

The NAO notes that the DHSC claims it is continuing to work on the public perception of COVID-19 vaccines, including understanding changes in people’s intentions to receive the vaccine.

But the report adds: “It is not clear how this is being used to inform its communications strategy and assumptions on take-up rates among all parts of society.”

Staffing numbers

An NAO report in March this year, The NHS nursing workforce, said that between July and September 2019, there were 43,590 unfilled nursing vacancies.

In September 2020, before any vaccine was approved by the regulator, NHSE&I calculated that it may need up to 46,000 staff (26,000 vaccinators and 20,000 administrative staff) to deliver the COVID-19 vaccination programme based on a 75% take-up rate.

The intention is to obtain these staff from “a combination of existing primary care staff and targeted local recruitment campaigns”.

A copy of the full report is available here