The United Kingdom’s vaccination programme is faltering and unless vaccination numbers increase quickly, too many people will be at risk from covid-19 when restrictions in England end on 19 July
The United Kingdom’s vaccination programme was launched with great fanfare in December 2020, and hailed as “world-beating” by our politicians. The Joint Committee on Vaccination and Immunisation (JCVI) decided on the sequence in which people would be prioritised for vaccination and the government set an ambitious target of offering all adults in the United Kingdom (UK) a first dose of a covid-19 vaccine by the end of July 2021. Now that vaccination appointments have been opened up to everyone aged 18 years and over, the government could argue it has met that target. However, the vaccination programme is slowing down, threatening public health in the UK.
Towards the end of May, an average of around 595,000 covid-19 vaccinations were being given in the UK each day. By 4 July, the daily average had fallen to around 270,000, less than half that seen in the later part of May. The slowdown in vaccinations has left a large part of the UK’s population either entirely unprotected or just partially protected with one dose of vaccine. By 8 July 2021, 45.6 million people had received one dose of a covid-19 vaccine; of whom 34.2 million had received two doses. This leaves around 7.2 million adults who are currently unvaccinated (nearly 1 in 7 of all adults in the UK) and who remain at very high risk of infection; along with 11.4 million adults who have had one dose of vaccine and hence have reduced protection from infection from the delta variant that is now the predominant strain of SARS-CoV-2 in the UK.
Some of these unvaccinated and partially vaccinated people will receive their first or second doses of vaccine by the time “Freedom Day” arrives in England on 19 July. However, because of the slowdown in the daily vaccination numbers, many millions of people across the UK will not have maximum protection from infection by this date, when most covid-19 restrictions in England will end. The unvaccinated and partially vaccinated groups include some older people, ethnic minority groups with high levels of vaccine hesitancy, and people living in deprived, urban areas such as parts of London. These groups have all been shown to be at higher risk of infection; as well as being at higher risk of serious illness, hospitalisation and death. The lower vaccine uptake in these groups will further exacerbate the health inequalities we have seen in the UK during the pandemic. Concerningly, many health and care workers (particularly in London) remain unvaccinated and this is a threat to their own health and also to the patients they care for.
One of the main reasons for the slowdown in vaccination numbers is that we are now trying to reach vaccine hesitant people who often lack confidence in vaccines. At the start of the vaccine programme, many GP-led sites were in charge of sending out invitations for vaccinations and uptake was very high. Patients were usually given a time slot and expected to attend—whereas we are now relying on people to book a slot themselves. GPs and their teams could also have discussions with people from vulnerable groups to encourage them to take up the offer of a vaccination.
Because of the increased workload pressures on primary care, negative portrayals in the media, and because many general practices have felt very unsupported by NHS England, practices have begun to withdraw from the vaccination programme. The switch away from using local GP sites to administer vaccines to using larger, central sites may hinder addressing vaccine hesitancy and improving vaccine confidence in unvaccinated people. Larger sites will be less able to deal with queries from vaccine hesitant individuals than locally-based GP and pharmacy sites where the patients are known to the staff and vaccination can be discussed opportunistically when patients present to their health professionals for other reasons. Vaccination can also be discussed as part of a programme of holistic, person-centred care in local settings; something which is not always possible in larger and more distant vaccine sites.
With most covid-19 restrictions ending in England on 19 July, there is a significant risk of large outbreaks among unvaccinated and partially vaccinated groups. We have already seen large covid-19 outbreaks among students and young people. As society starts to open up and indoor mixing increases, these outbreaks could then spill over into more vulnerable groups such as the elderly and those with significant medical problems. Although vaccination will protect these groups, no vaccine will be 100% effective and a proportion will develop a more serious illness, threatening their health and placing additional burdens on an already over-stretched NHS.
What can be done to improve vaccine uptake in the UK? A first step is for the government to be more transparent about vaccine supply. The government has treated information on the supply of vaccines as though it was a matter of state security. The lack of information about vaccine supplies and vaccine delivery dates has made it very difficult for local sites to plan vaccination clinics and invite patients in a timely manner. Secondly, the emphasis on vaccine administration has to switch from using large central sites to using a much larger number of smaller sites based in general practices and pharmacies. Thirdly, opportunistic vaccination needs to be made available so that people can be offered a vaccine when they attend their general practice or pharmacy for another reason. Fourthly, stronger incentives to encourage vaccination are needed. The USA has, for example been very creative in this area. The recent announcement that holidaymakers from England travelling to amber list countries will not have to quarantine on return if they are fully vaccinated may also help improve vaccine uptake in currently unvaccinated groups.
Improving vaccine uptake and speeding up the delivery of vaccines requires funding, staff and time; all of which are in short supply in primary care in England. However, a failure to urgently address the issues of vaccine hesitancy and vaccine uptake threatens public health in the UK and risks overwhelming the NHS. It will also make the booster covid-19 vaccination programme planned for the UK later this year less able to deliver high vaccine uptake. Finally, we are continually told that “we are in a race against the virus.” Large outbreaks of covid-19 may encourage the development of new variants of SARS-CoV-2 with the possibility that strains may emerge that are more resistant to vaccines than the current and previous strains circulating in the UK, making it more difficult for us to “win the race.”
Urgent action is needed to revitalise the UK’s covid-19 vaccine programme. As we discussed in a previous article, it is essential that the programme is fully embedded in primary care and that general practices, pharmacies and other local health services are well supported to deliver the programme; both the current programme during the summer and also the booster programme that will start later in the year. Large vaccine sites provide good photo-opportunities for politicians and senior NHS managers. But ultimately, it will be a primary-care based infrastructure that is needed to address vaccine hesitancy, improve vaccine confidence and ensure the UK has the high uptake of vaccination need to bring the covid-19 pandemic under control.
Azeem Majeed, Professor of Primary Care and Public Health, Imperial College London, London, UK, Twitter @Azeem_Majeed, Email firstname.lastname@example.org
Simon Hodes, GP Partner, Watford, UK, Twitter @DrSimonHodes
Sian Stanley, GP and Clinical Director, Stort Valley and Villages Primary Care Network, Twitter @SianStanley1
Competing Interests: We have read and understood the BMJ policy on declaration of interests. We are all GPs and have supported the NHS covid-19 vaccination programme. We have no other competing interests.
Acknowledgements: AM is supported by the NIHR Applied Research Collaboration NW London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.