Sometimes, in the eye of the storm, it is difficult to see clearly. But many of the unforced errors that have occurred during the covid-19 pandemic could and should have been foreseen. It was unforgivable to discharge older patients from hospital wards, untested for covid-19 and without any quarantine period, back into the community and into care homes, when we knew of their vulnerability to covid-19. There have been errors, at every turn and in many quarters, in the procurement and distribution of personal protective equipment (PPE), in the roll out of test and trace. But now there is a new kid on the block—the vaccine rollout—and all eyes should be on this. We can’t afford to make errors now.
Vaccines beyond our wildest hopes have been developed and delivered at unprecedented speed. They provide remarkable protection and have remarkably few side effects. It is truly more than most of us could have hoped for. So what are we waiting for? Where is the action plan? The 24 hour vaccination centres? Where are the volunteers, the nurses, doctors, pharmacists, the medical students, military, and firemen? We knew this day was coming. At this stage, as the government promise the big roll and set ambitious targets, surely we should have been informed, enrolled, engaged, and ready for action as soon as supplies hit the ground. Regional centres should have been identified, and a trained workforce signed up around the clock to deliver the vaccine. Patients could have had their appointments made in readiness; older and vulnerable people could have been allocated into protected daytime slots, with key workers (nurses, teachers, doctors, policemen, bus drivers—all those for whom we clapped) booked in online throughout the day and night by signing up in person. We should have a rolling programme which is ongoing for everyone else, in turn, on and on until it is done. But there is nothing of this—there seems a bewildering lack of urgency and of understanding at the top of what could be.
So far, from what many of us have seen and reported, the logistics and access (for people to be vaccinated and doctors to volunteer to help out) seems barely thought through. It is too patchy, too slow, too cumbersome to book and lacking in ambition in the delivery. The barriers to volunteering are almost insurmountable and the red tape yet to be stripped away—why was this not done months ago? Current rollout is also patchy, by region and in speed. Too much depends on individual enterprise at a time when many GP practises are struggling to keep their heads above water with their current workload. The NHS, already overstretched with covid, has said repeatedly that it has made no commitment to delivering the doses required.
So it seems to most that a radical new approach is required. Team work and direction are needed. Regional centres need to be set up, minimum staffing levels must be determined, professionals must enrol to help, and systems need to be put into place to help patients to register and book appointments. Delivery of the vaccination should be done around the clock, with trained teams of vaccinators, nurses and doctors in place for the unlikely event of rescucitation, and support staff on hand to help organise patients. It takes just a minute or so, at most, to vaccinate someone and appointments should be fast even if, at present, each person is required to wait fifteen minutes before leaving. That doesn’t require each person to have a fifteen minute appointment slot. Whenever there is a non attendance, another slot should open up in real time. Patient information, including age, could be logged through an online booking site, as is currently run for PCR testing, and linked to vaccination status, so that this can be sent to the GP and kept on record. This will almost certainly be required in the future, possibly for travelling, going to the cinema…etc. This will be especially relevant if and when vaccines are shown to reduce viral transmission, which we would expect, at least in some measure in the future. By registering vaccination status in real time, at the outset, time and money will be saved in the longterm.
After a year of deprivation, isolation, and with many people’s lives and liberty lost, this is moment to tap into the willingness and the need, for all of us to make a contribution. Motivate the workforce, engage the volunteers, and empower the population to get this done. Now is the time for ministers to get it right first time.
Jane McGregor is a consultant dermatologist, formerly a senior lecturer and honorary consultant at Bartshealth.
Competing interests: none declared.