Monday 9th November brought encouraging, preliminary reports that the Pfizer/BioNTech vaccine provided more than 90% protection against COVID-19. Only a week later, Moderna announced efficacy of 94.5% for their COVID-19 vaccine candidate. With first results from Phase 3 trials of other potential COVID-19 vaccines also on the horizon, this breakthrough raises hopes that vaccination will eventually provide a way out of the crisis. For now, we must wait for more safety and efficacy data, as well as the outcome of regulatory reviews.

Across the UK, healthcare teams are gearing up for the huge logistical challenge of delivering a COVID-19 vaccination campaign, alongside an expanded roll out of flu vaccine, all amid a pandemic. We take a look at relevant plans and guidance on offer for general practice this winter 2020/21.

GPs to lead delivery of COVID-19 vaccination programme

The BMA General Practitioners Committee in England has agreed with NHS England and NHS Improvement on the details of a plan for general practice in England to lead delivery of the COVID-19 vaccination programme. Groups of practices are expected to work together to provide this enhanced service, while other providers such as NHS trusts may also be commissioned to deliver a regional immunisation service.

The BMA offers guidance, including details of what to expect and the practical considerations. Practice groups that opt to participate will prepare to deliver vaccines at designated sites from 1st December, pending availability of an approved vaccine.

The expectation is that initially small numbers of vaccinations will be given to high priority groups, with more delivered in early 2021 as vaccine stocks increase.

At this stage, many questions remain about the vaccine(s) and logistics. As Professor Martin Marshall, Chair of the Royal College of GPs (RCGP) commented: “We need to understand which tasks should be prioritised to make capacity for any involvement in the Covid vaccination programme – and how it should sit alongside the flu vaccination programme”.

Number of flu vaccinations expected to double in 2020/21

Every year, general practice is the main provider of a mass seasonal flu vaccination programme. Typically, this reaches over 15 million people across the UK. But with the need to relieve pressure on the NHS and protect at-risk groups during a second peak of COVID-19, an expanded flu campaign has been launched for 2020/21. The aim is to vaccinate over 30 million people, including households of shielded patients and the 50–64 age group.

Free flu vaccine will be offered to:
• people on the shielded patient list and their households
• children aged 2–11 on 31 August 2020 (for the first time, including all year 7 pupils)
• people aged 65 and over
• pregnant women
• people with certain pre-existing conditions including at-risk infants under 2
• frontline health and social care workers
• people aged 50–64, who will be invited later in the season.

Delivering this expanded vaccination campaign would be a challenge in any year, but this year general practice must contend with additional pressures: the need for social distancing, PPE provision, reduced staffing capacity, as well as increasing demand for NHS services.

In the event that a COVID-19 vaccination programme is rolled out in parallel, this will need to be carefully coordinated so that priority groups are appropriately vaccinated for flu and COVID-19.

RCGP provides useful guidance about the practicalities and challenges of delivering such mass vaccination programmes in the current pandemic: Delivering Mass Vaccinations During COVID-19.

Despite early concerns over anecdotal reports of flu vaccine shortages amid high demand, the Public Health England (PHE) states that there is enough flu vaccine for all eligible people. Guidance is available for GPs who need to order extra vaccine from the government-secured stockpile.

Childhood vaccination programme should be maintained

In England, falling rates of routine childhood immunisation have been a concern for some time. In particular, coverage has fallen for DTaP2/IPV/Hib3 and MMR4 vaccinations, resulting in a doubling of measles and mumps cases. Unsurprisingly, disruption early in the COVID-19 crisis led to further falls.

PHE has produced guidance with the RCGP and Royal College of Paediatrics and Child Health on maintaining immunisation programmes during COVID-19, including appropriate PPE.

The guidance for general practice includes:
• The routine immunisation programme should be maintained
• Non-scheduled vaccinations should still be given (e.g. for control of disease outbreaks and opportunistically for missed doses)
• Anyone whose appointment was cancelled due to the COVID-19 response should be invited for vaccination as soon as possible.

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