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How will a coronavirus vaccine be rolled out to the UK population?

The Guardian logo The Guardian 11/11/2020 Ian Sample and Denis Campbell

CARDIFF, WALES - NOVEMBER 09: People queue outside a Primark store on Queen Street on November 9, 2020 in Cardiff, Wales. Wales' health minister said cases are levelling off after its 17-day lockdown. Pubs, restaurants, and other non-essential businesses are allowed to reopen from today. (Photo by Matthew Horwood/Getty Images) © 2020 Getty Images CARDIFF, WALES - NOVEMBER 09: People queue outside a Primark store on Queen Street on November 9, 2020 in Cardiff, Wales. Wales' health minister said cases are levelling off after its 17-day lockdown. Pubs, restaurants, and other non-essential businesses are allowed to reopen from today. (Photo by Matthew Horwood/Getty Images)

The NHS is ramping up to deliver the most important vaccination programme for decades, a mammoth task that is aimed at protecting tens of millions of people against coronavirus. But with several vaccines potentially on the verge of being approved by regulators, how will the UK manage the rollout?

Who is first in line for vaccination?

READING, ENGLAND - NOVEMBER 11: A container of liquid carbon dioxide vents gas during a part of the production process at the Dry Ice Nationwide manufacturing facility on November 11, 2020 in Reading, England. Producing dry ice in a number of forms, the company provides both coarse pellets and slabs for use in temperature-controlled pharmaceutical logistics, pathological environments and chemical laboratories, as well as for food transportation. The covid-19 vaccine developed by Pfizer and BioNTech must be kept at ultra-cold temperatures in its journey from the production line to a patient's arm. To address this challenge, Pfizer developed a suitcase-sized box that uses dry ice to keep between 1,000 and 5,000 doses for 10 days at minus 70 degrees Celsius. (Photo by Leon Neal/Getty Images) © 2020 Getty Images READING, ENGLAND - NOVEMBER 11: A container of liquid carbon dioxide vents gas during a part of the production process at the Dry Ice Nationwide manufacturing facility on November 11, 2020 in Reading, England. Producing dry ice in a number of forms, the company provides both coarse pellets and slabs for use in temperature-controlled pharmaceutical logistics, pathological environments and chemical laboratories, as well as for food transportation. The covid-19 vaccine developed by Pfizer and BioNTech must be kept at ultra-cold temperatures in its journey from the production line to a patient's arm. To address this challenge, Pfizer developed a suitcase-sized box that uses dry ice to keep between 1,000 and 5,000 doses for 10 days at minus 70 degrees Celsius. (Photo by Leon Neal/Getty Images)

The joint committee on vaccination and immunisation (JCVI) advise government on vaccination policy. Its interim recommendations are to prioritise older adults in care homes and care workers, followed by all those aged 80 and over, and health and social care workers. Next in line are the over-75s, then the over-70s, and so on down the age groups, as more vaccine shots become available.

Can people take more than one Covid vaccine?

The interim results from Pfizer this week suggest that its two-shot vaccine, developed with the German firm BioNTech, is 90% effective. The figure is based on 94 Covid cases across both vaccinated and placebo arms of the trial. More data is needed to confirm this level of protection and that is expected within weeks when Pfizer runs another analysis based on 164 infected trial volunteers. If the vaccine is proven to achieve such a high level of protection, there is no reason why someone would need a different, additional vaccine on top.

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Video: Pfizer Covid-19 vaccine ‘90% effective in preventing the disease’ (PA Media)

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However, whether people can safely have different Covid vaccines is an important question for scientists to answer. It has not been looked at yet, because the immediate priority is to find individual vaccines that are safe and effective on their own. If they can safely be used in combination, it could make rollout easier, because it wouldn’t matter which vaccine is given as the first or second shot.

Although the multiple vaccines in development are based on a number of different technologies many, including the frontrunners from Pfizer/BioNTech and Oxford/AstraZeneca, stimulate the immune system to generate T cells and antibodies against the same coronavirus spike protein. If these vaccines produce similar immune reactions and achieve similar levels of protection, they could potentially be used interchangeably.

Gallery: Second wave of COVID-19 hits Europe (Photo Services) 

Would having more than one vaccine give you more immunity?

HAVANT, ENGLAND - NOVEMBER 10: General view of the Pfizer Global Supply Site on November 10, 2020 in Havant, England. The facility has been home to production lines that package vaccines and other injectable products, but this year packaging operations transferred to Pfizer Puurs, Belgium, which will be one of two production hubs for the company's novel coronavirus vaccine. The other will be in the U.S. state of Michigan. (Photo by Naomi Baker/Getty Images) © 2020 Getty Images HAVANT, ENGLAND - NOVEMBER 10: General view of the Pfizer Global Supply Site on November 10, 2020 in Havant, England. The facility has been home to production lines that package vaccines and other injectable products, but this year packaging operations transferred to Pfizer Puurs, Belgium, which will be one of two production hubs for the company's novel coronavirus vaccine. The other will be in the U.S. state of Michigan. (Photo by Naomi Baker/Getty Images)

Trials have yet to look at the impact of using Covid vaccines in combination and it is unknown whether doing so would improve people’s protection against the virus. Some vaccines in development use the whole virus, and these are expected to produce different immune responses to those that rely on only the spike protein to stimulate the body’s defences. Using these in combination might produce an overall more robust immune response. But such combinations would have to be assessed for safety and efficacy in further trials. Some Covid vaccines may need booster shots to sustain immunity and scientists need to study whether that can be done with different products.

What do we still need to know about the Pfizer vaccine?

Soldiers carry out mass coronavirus testing in St Johns Market, Liverpool during the four week national lockdown to curb the spread of coronavirus in England. (Photo by Peter Byrne/PA Images via Getty Images) © PA Wire/PA Images Soldiers carry out mass coronavirus testing in St Johns Market, Liverpool during the four week national lockdown to curb the spread of coronavirus in England. (Photo by Peter Byrne/PA Images via Getty Images)

While encouraging, the results so far from Pfizer are preliminary. More safety data is expected soon. Important questions about the vaccine’s efficacy remain too. It is not yet known whether the virus prevents severe infections or just mild ones. Nor is it clear whether the vaccine prevents people from spreading the virus, if it is as effective in older people as well as younger people, and no one knows how long any protection lasts.

When will the rest of the population get a vaccine?

LEEK, ENGLAND - NOVEMBER 11: People are seen walking past an old mill with their shopping in the Market Town of Leek on November 11, 2020 in Leek, England. The United Kingdom will continue to impose lockdown measures until December 2 in an attempt to curb transmissions of the coronavirus (COVID-19). (Photo by Nathan Stirk/Getty Images) © 2020 Nathan Stirk LEEK, ENGLAND - NOVEMBER 11: People are seen walking past an old mill with their shopping in the Market Town of Leek on November 11, 2020 in Leek, England. The United Kingdom will continue to impose lockdown measures until December 2 in an attempt to curb transmissions of the coronavirus (COVID-19). (Photo by Nathan Stirk/Getty Images)

The first task is to immunise as soon as possible all those in the 10 groups identified by the JCVI. Together they comprise an estimated 22 million people. Besides care home residents, they include all health and care staff, the 2.2 million people on the shielding list classed as “extremely clinically vulnerable”, and then everyone aged 50 and over. This is “phase one” of the rollout.

If the vaccine is delayed until early 2021, it will be even later before the general public get the jab. Each of these 22 million people will need two doses, and because the NHS hopes to immunise 1 million people a week, everyone else is unlikely to be able to get a jab until the middle of next year at the earliest. This is “phase two” of the rollout. How long it will be before the general public can get immunised also depends on whether the JCVI, the government and NHS decide to vaccinate under-18s. That is being discussed but no decision has yet been taken.

Further discussions are afoot on how else people may be prioritised, and there could be different priority groups for different vaccines. This is similar to what is seen with influenza vaccines, where older and more vulnerable adults get a killed virus vaccine while younger people get a live, weakened virus vaccine.

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Stay alert to stop coronavirus spreading - here is the latest government guidance. If you think you have the virus, don't go to the GP or hospital, stay indoors and get advice online. Only call NHS 111 if you cannot cope with your symptoms at home; your condition gets worse; or your symptoms do not get better after seven days. In parts of Wales where 111 isn't available, call NHS Direct on 0845 46 47. In Scotland anyone with symptoms is advised to self-isolate for seven days. In Northern Ireland, call your GP.

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