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Vaccine guidance leaves UK facing challenge of supply and confidence

The NHS and ministers face two main challenges as they try to keep the UK’s vaccination rollout on track, after regulators advised that adults under the age of 30 should be offered alternatives to Oxford/AstraZeneca.

The AstraZeneca jab is the most widely used in the UK’s vaccination programme, so curtailing its use and lining up alternative supplies for young adults could have an impact on the supply chain.

The other issue is the risk that further publicity about a link between rare blood disorders and the jab will increase vaccine hesitancy in the UK, where people have been notably more receptive to vaccination than in most other European countries.

Nadhim Zahawi, vaccines minister, told the Financial Times he was confident on both counts and pointed out that the public should be reassured that the UK and EU regulators were working together to track side-effects.

“This is important in maintaining confidence in the largest vaccination programme in history,” he said. “We will follow the advice and are confident that we will meet our programme targets.”

The government said it remained committed to offering a first vaccine dose to every adult in the UK by the end of July, despite the change in guidance on the use of the AstraZeneca jab.

Jonathan Van-Tam, England’s deputy chief medical officer, said the new guidance on under-30s would require changes in the way the NHS rolled out the vaccination programme but he insisted the health service could cope.

“After talking to colleagues in the NHS, I am reassured that, because of our supply situation, the effect on the timing of our overall programme will be zero or negligible,” he said.

Rasmus Bech Hansen, chief executive of the London-based analytics company Airfinity, which monitors worldwide vaccine supply chains, agreed but warned it would make the UK more dependent on supply from the EU.

“It should be possible to shift things around and start saving some of the other vaccines [Pfizer and Moderna] for the younger age groups but this will make the UK more dependent on imports from the EU,” he said, adding that there would be a smaller margin for error if things went wrong, such as an unexpected slowdown in Pfizer supplies.

There would also be more pressure on the NHS because particular vaccines would have to be reserved for certain groups in each location — at present anyone who turns up for vaccination in the UK receives whatever shot is available. “We have seen in Europe the logistical challenges this presents,” Hansen said.

According to Airfinity, there are about 10m people aged between 18 and 30 in the UK and vaccination of this group could begin by the end of May, by which point AstraZeneca will account for half of the country’s coronavirus vaccine supplies.

Airfinity analyst Matt Linley calculated that if 75 per cent of that age group was vaccinated with two jabs, the UK would need 7.5m doses of vaccines other than AstraZeneca. Depending on their availability, this could delay by a month the UK government’s target of getting everyone their first jab by the end of July, he added.

By the summer two more vaccines could be available in the UK from Johnson & Johnson and Novavax, alongside the Pfizer, Moderna and AstraZeneca jabs already being administered.

The impact on vaccine hesitancy is much harder to estimate, scientists acknowledge. “I think people will be more hesitant about vaccination,” said Professor Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine.

Bar chart showing pros and  of the AstraZeneca vaccine by comparing potential benefits with potential harms

“AstraZeneca has had a rougher ride than the other vaccines — or has given itself a rougher ride — which has not helped the trajectory of confidence,” she added.

She said the public should “be able to draw some confidence from the regulators’ vigilance in investigating these adverse reactions” but urged GPs to remain vigilant. “For the future it will be really important for people to be treated with empathy when they report side-effects. The worst thing would be if someone goes into the clinic with a bad headache after vaccination and is told: ‘Go home and take some paracetamol.’”

The government scientific and medical advisers at Wednesday afternoon’s briefing on the new vaccine guidance were keen to stress that the benefits of a Covid-19 jab far outweighed the risks of suffering severe side-effects.

But Nicola Wainwright, clinical negligence partner at JMW Solicitors, said remarkably little specific information about the risks and benefits of vaccination was provided to people coming for a jab.

“It is imperative that the government acts quickly to share information from trusted, impartial sources about the possible side-effects of all vaccines,” she said.

Medical staff at the largest Covid-19 vaccination centre in Northern Ireland at the Odyssey SSE Arena in Belfast © Charles McQuillan/Getty

“Medical information, which is well recognised in law for good reason, should include the advantages and disadvantages, the risks involved, and the alternatives to any procedure including a vaccination.”

Even a small slowing of vaccination take-up in the UK could lead to a substantially larger third wave of the epidemic, according to scientists at Warwick university — one of three academic groups feeding Covid-19 models into the government’s Scientific Advisory Group for Emergencies.

Just a 7 per cent difference in the speed of rollout over the next 20 weeks produces a “surprisingly large difference in the profile of the epidemic”, the Warwick modellers said.

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