Select committee inquiry
Roll out of the COVID:19 vaccine programme
Closed
What the inquiry looked at
“This inquiry follows on from our February 2021 report on the development and rollout of the first vaccines in the UK The Committee will question senior officials at DHSC, NHS England and the UK Health Security Agency on how well placed the government is to meet its full objectives for the COVID-19 vaccine programme , including: progress with the COVID-19 vaccines programme since the NAO last reported in December 2020; the drivers of success in the first phases of the mass roll-out: the rollout of first and second doses to all priority groups and all adults, and the rollout of first doses to 12-17 year olds the future aims and challenges for the vaccines programme as the first phases of roll-out come to an end; and the risks to sustainability and delivering value for money in future, including in phases yet to be evaluated such as the rollout of boosters, second doses for 12-17 year olds, and vaccines for younger children If you have evidence on these issues please submit it here by Monday 21 March 2022.”
The committee's words, from the inquiry page on parliament.uk ↗.
What it found
In the committee's words, from the summary of Eleventh Report - The rollout of the COVID-19 vaccine programme in England ↗
The highly successful COVID-19 vaccine programme in England was delivered thanks to the actions of many bodies, including the Vaccine Taskforce, NHS England, and thousands of local GPs, pharmacists, NHS staff and volunteers. By the end of May 2022, 90% of the adult population had been vaccinated with two doses, well above the planning assumption of 75%. By the end of October 2021, the vaccine programme had spent £5.6 billion to purchase and deploy COVID-19 vaccines. Two features particularly contributed to the programme achieving its initial objectives. First, the Taskforce secured early access to the vaccines the UK needed, by signing contracts before regulatory approval. Second, NHS England ensured a range of different routes for people to get vaccinated, while clearly prioritising those most at risk.
This success should be welcomed, and all involved congratulated. However, the nature of the pandemic and the health response to it are changing, and the programme must not allow these first stage achievements to cloud the need to review and adapt its approaches. In December 2021, in response to the omicron variant, the government rapidly accelerated the rollout of first boosters to people aged 12 and over. Since then, the daily number of first boosters administered has slowed markedly. The programme also started rolling out second boosters to selected groups in spring 2022 and providing vaccinations to newly-eligible 5- to 11-year-olds. The need for, and nature of, future booster campaigns is unknown and much else remains uncertain, including about how the virus will mutate, the vaccine market and vaccine efficacy. The vaccine programme is still necessary and every effort must be made to ensure vaccines reach the people who have been missed as well as ensuring new boosters are provided.
While overall uptake has been high, some important groups have had much lower uptake, including pregnant women and some minority ethnic groups. At the end of May 2022, nearly 3 million people were still completely unvaccinated. Overall demand for vaccination during the rest of 2022 may be lower, raising the risk of increased wastage.
NHS England and local health bodies also now face the difficult task of formulating staffing and delivery plans for COVID-19 vaccination for the rest of 2022–23, plans that will need to fit in with other demands on a hard-pressed and often exhausted healthcare workforce. The portfolio of UK vaccines has narrowed over the course of the programme and, for 2022 and 2023, the UK is primarily reliant on two vaccines from seven original candidates.
What the government said
The government responded on 8 November 2022. The deadline was 13 September 2022.
Summary written by Accountability Index from the government's response.
The government agrees with most of the Committee's recommendations, including on evaluating uptake approaches and learning lessons, but disagrees with the recommendations to set an unvaccinated-adults and booster uptake challenge and to review vaccine procurement strategy.
- On uptake, it disagrees with setting a challenge, saying it has moved "away from uptake targets" to "making a credible offer to the population". It reports 2.9 million adults unvaccinated and 82.2% of eligible adults boosted.
- It agrees that approaches to raising uptake in lower-uptake groups should be evaluated, with a target implementation date of Spring 2023. For the 2022 autumn/winter campaign NHS England will work with local systems to continue evaluating delivery approaches.
- It disagrees with the call to review procurement strategy, saying the portfolio approach was "the right strategy in the early stages" and that the strategy "is kept under constant review". A UKHSA advisory group including clinical and commercial experts is being set up.
- It agrees to write to the Committee on main improvements arising from lessons learned (target Spring 2023). On wastage, it says it will share future supply details "in confidence" because they are "commercially sensitive".
Read the government's response ↗ Read the report ↗ Report an error
How the inquiry ran
Each dot is a dated item listed on this page, from the inquiry's opening on 26 January 2022 to its close on 8 November 2022. The dashed mark is the deadline Parliament records for the government's response.
- Oral evidence 28 Mar 2022
- Report 13 Jul 2022
- Government response 8 Nov 2022
- Correspondence 2 letters
What it recommended 23 recommendations · 9 conclusions
2Comparatively low vaccination uptake persists in many vulnerable groups and, after the first booster campaign,...
Recommended (the committee's words)
Comparatively low vaccination uptake persists in many vulnerable groups and, after the first booster campaign, has even dropped further for some. Overall uptake of COVID-vaccination has been high, reaching 90% of adults by the end of May 2022 (based on 2 doses). But some groups have seen much lower uptake. For example, by the same point, only 55% of young people aged 16 and 17 had received 2 doses, and only 38% of 12- to 15-year-olds. There has been particularly low uptake among pregnant women: as of February 2022, only 58% had received 2 doses. Some gaps widen when acceptance of booster doses is taken into account: for example, compared to people of White British origin, people of Black, Black British and Pakistani origins were less than half as likely to have had their boosters. Local and national bodies have taken a variety of approaches to encourage uptake, but it is not clear which of these has really been most effective, and for which groups. There are particular challenges when it comes to vaccinating people with learning disabilities, including identifying who is eligible, making communications accessible, and tackling needle phobia: these have not always been consistently or adequately addressed. Recommendation: Recognising that reasons for lower uptake will vary, NHS England and UKHSA should urgently evaluate which approaches are most effective for increasing uptake, communicate again with local areas about what works, and provide support to them to deploy the most effective approaches. This should include fresh approaches to tackling the persistent low uptake observed in some ethnic groups.
3NHS England has started planning for a reduction in vaccine sites and staffing for the...
Recommended (the committee's words)
NHS England has started planning for a reduction in vaccine sites and staffing for the rest of 2022 in anticipation of lower overall demand, but it is not yet clear how its strategy will strike the right balance between maintaining high 6 The rollout of the COVID-19 vaccine programme in England levels of vaccination uptake and ensuring that demands on healthcare staff are sustainable. In February 2022, NHS England set out requirements for local area planning for the vaccine programme through to March 2023. NHS England says it is encouraging each area to think about the best approach locally both in terms of the right mix of vaccination sites and the right staffing. Overall, it expects a reduction in the number of sites from the 2,900 active at that time. The NAO, the Royal College of Nursing and pharmacy representatives have all highlighted that future staffing is a major risk due to staff burnout and the lack of surplus capacity in the healthcare system more generally. Our own work looking at NHS backlogs and waiting times has highlighted the particular strains on GPs, who delivered around half of all COVID-19 vaccinations up to the end of May 2022. We note that NHS England has already taken some central action to support staff, including the maintenance of national contracts for volunteer responders. Recommendation: By the end of October 2022, NHS England should write to the Committee with the results of its assurance of local plans – particularly with regard to whether these provide an efficient and effective basis for the programme to achieve its aims, while safeguarding staff welfare and aligning with other demands on the NHS. It should also set out any further central actions it will take to address areas of deficiency in the plans. During 2022–23, NHS England working with others should develop clear, costed options for how the programme will ensure both value for money and accessibility in its future approach to COVID-19 vaccination, including who it expects
4There is considerable learning from the COVID-19 vaccine programme that might apply elsewhere, both in...
Recommended (the committee's words)
There is considerable learning from the COVID-19 vaccine programme that might apply elsewhere, both in the health sector, such as screening programmes and routine vaccinations, and across wider government. In our March 2022 report on government preparedness for the pandemic, we noted the importance of learning lessons from the COVID-19 response. The NAO identified several factors behind the significant success of the vaccine programme, including how it acted decisively at an early stage, how it clearly set out competing risks, and its effective use of data. These are areas where we have found some other parts of the government’s COVID-19 response lacking. While recognising that the COVID-19 vaccine programme was an emergency response, we also see potential for learning for business-as-usual activities. Recommendation: The Department should carry out a systematic exercise to identify successes and other lessons from the programme and, within six months of this report, communicate to the Committee the main improvements it will make as a result in other health programmes, as well as any wider applications to emergency response planning or other government programmes.
5After starting with a portfolio of seven candidates, the UK’s vaccine supply for 2022 and...
Recommended (the committee's words)
After starting with a portfolio of seven candidates, the UK’s vaccine supply for 2022 and 2023 now relies primarily on just two, yet many of the risks that the ‘portfolio’ approach was intended to mitigate remain. The UK’s portfolio strategy aimed to optimise the chances of success in securing access to vaccines at a time of huge uncertainty. Out of the original portfolio of seven candidates, six have been approved for use in the UK to date, with three—AstraZeneca, Pfizer and Moderna— actually deployed. However, the only new contracts the UK signed in 2021 were The rollout of the COVID-19 vaccine programme in England 7 with Pfizer and Moderna, both manufacturers of mRNA vaccines. The Vaccine Taskforce is confident that these remain the most effective choice for boosters and will provide the UK with access to reformulations against emerging variant viruses, if required. However uncertainty remains, which the original portfolio strategy was designed to mitigate. While the UK will be likely to continue to need 6- or 12-month COVID-19 booster campaigns for at-risk groups, there is much uncertainty about, for example, the emergence of new variants and what kind of vaccines might be needed in future. The COVID-19 vaccine market is also still very much a developing market and consequently volatile. Recommendation: The Department and the Vaccine Taskforce should urgently review the future procurement strategy for COVID-19 vaccines, seeking all necessary clinical and commercial expertise, to ensure that future contracts are not let to too narrow a set of providers. It should report the results of the work in detail to the Committee.
6While vaccine wastage was well below assumptions in 2021, NHS England believes the level could...
Recommended (the committee's words)
While vaccine wastage was well below assumptions in 2021, NHS England believes the level could increase in 2022, which would be regrettable. Up to the end of October 2021, the NAO estimated COVID-19 vaccine wastage levels for England of under 5%, a remarkable figure—especially considering the Pfizer vaccine’s transport and storage ultra-low temperature requirements—well below the programme’s initial assumptions, and, according to NHS England, low by historical standards. NHS England was expecting wastage levels to increase in 2022, in anticipation of a fall in overall demand and resulting difficulties in using up supplies. The programme has already seen how reduced demand can impact on wastage: in 2021, it had to write off around 1.9 million AstraZeneca doses as demand fell following changes to clinical advice on how AstraZeneca should be used. It seems very likely that the programme will have an excess of supply over the next year: the Taskforce is finding it difficult to predict demand for 2022 but it has consciously taken a conservative approach to procurement, on the basis that too much is better than too little. Nevertheless, there are opportunities to minimise wastage at all stages of the supply process, including careful handling and stock management by local sites; and early action by the Taskforce to tee up international donations and swaps, and to reschedule deliveries. Recommendation: As part of the Treasury Minute response, the Taskforce, NHS England and UKHSA should update the Committee on levels of wastage across the programme, the number of doses donated internationally, and the number of doses still to be supplied by the end of 2022.
7We were concerned that, in the week before the start of the new financial year,...
Recommended (the committee's words)
We were concerned that, in the week before the start of the new financial year, the Department had not finalised the allocation of its £9.6 billion Spending Review settlement for COVID-19 response activities, creating uncertainty for the vaccine programme. In the 2021 Spending Review, the Department received £9.6 billion for all its key COVID-19 programmes throughout the three-year spending review period. But when we took evidence on 28 March, the Department still could not tell us how it would distribute funding among different programmes for 2022–23, including the vaccine programme. It also had not finalised the 2022–23 budget for UKHSA, which has key roles in COVID-19 vaccine storage and distribution, and monitors and analyses vaccine coverage and effectiveness. There are many 8 The rollout of the COVID-19 vaccine programme in England other parts of the vaccine programme, including GPs and pharmacies, external contractors, volunteer schemes, local authorities and temporary staff, that are central to successful delivery and also need timely confirmation of funding. Meanwhile, the Department for Business, Energy and Industrial Strategy was expected to continue funding efforts to boost domestic vaccine manufacturing capacity. Recommendation: Departments should always set out annual budgets and funding for their key bodies and programmes in good time, only using supplementary estimates to manage uncertainties as they arise later in the financial year. For the vaccine programme, the Department of Health and Social Care and the Department for Business, Energy and Industrial Strategy should, as part of the Treasury Minute response to this report, confirm the agreed funding for the main elements of the vaccine programme for 2022–23 and any subsequent financial years, alongside a clear statement of the aims and targets the programme needs to achieve with this funding. The rollout of the COVID-19 vaccine programme in England 9 1 Learning lessons and maximising uptake
1On the basis of a report by the Comptroller and Auditor General, we took evidence...
Concluded (the committee's words)
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (the Department), the Department for Business, Energy and Industrial Strategy (BEIS), NHS England and NHS Improvement (NHS England), the UK Health and Security Agency (UKHSA) and the Vaccine Taskforce (the Taskforce), on the rollout of the COVID-19 vaccination programme in England.1 The evidence session took place on the 28 March and our report is based on both the session and other evidence supplied to us at the time.
8We asked the Department how learning would be applied to future emergency response planning.
Recommended (the committee's words)
We asked the Department how learning would be applied to future emergency response planning. The Taskforce noted that a success factor had been the closer working relationships with vaccine manufacturers, which were critical to the speedy supply and deployment of vaccines. It indicated that this could be important for future ways of working.19 Following a Global Pandemic Preparedness Summit in early March 2022, the government committed along with the Coalition for Epidemic Preparedness and a number of other bodies to the ‘100 Days Mission’, to lay the groundwork for developing novel vaccines against future emerging pathogens within 100 days.20
9Overall the evidence session indicated that officials were keen to learn lessons and saw clear...
Concluded (the committee's words)
Overall the evidence session indicated that officials were keen to learn lessons and saw clear potential benefits from doing so. However, it seemed likely to us that different organisations could be left to learn their own lessons and then to reach their own decisions about whether and to whom to disseminate them.21 If this were to be the case, it would create a clear risk of important learning not being identified or not being drawn to the attention of other government bodies and programmes that could benefit from it.22 Increasing vaccine uptake
10The vaccine programme still has some issues to address.
Recommended (the committee's words)
The vaccine programme still has some issues to address. In England, 2.98 million adults were still unvaccinated at the end of May 2022. Analysis by UKHSA has confirmed that full and booster vaccination reduces the risk of someone falling seriously ill, needing to go to hospital, or dying because of COVID-19.23 Consequently these people are at 14 RCP0006 Note dated March 2022 from Royal College of Nursing point 3.2 15 Committee of Public Accounts, Government preparedness for the COVID-19 pandemic: lessons for government on risk, Forty-Sixth Report of Session 2021–22, HC 952, 23 March 2022, page 1, 7 16 Qq 29, 30 17 Qq 29, 48 18 RCP0006 Note dated March 2022 from Royal College of Nursing point 3.3 19 Q 41 20 DHSC, Joint statement from the UK government, CEPI, IFPMA, ABPI, BIA, BIO and DCVMN on delivering the 100 day mission, 8 March 2022. 21 Qq 49–52 22 Q 39, 48 23 UKHSA’s report, COVID-19 vaccine surveillance report: week 14, 7 April 2022 12 The rollout of the COVID-19 vaccine programme in England greater risk of coming to harm than if they had been vaccinated. Additionally, a further 1.5 million people had only had one dose of a COVID-19 vaccine, while uptake of first boosters, for which all adults are eligible, stood at 73% (32.6 million people).24
11We asked officials about their strategy with regard to the unvaccinated.
Recommended (the committee's words)
We asked officials about their strategy with regard to the unvaccinated. UKHSA and NHS England told us that the basic public health message remained clear—that everyone was encouraged to get vaccinated—and that they continued to work with local government, local public health experts and community leaders to target the unvaccinated population.25 Written evidence from the Royal College of Nursing supported these goals but also suggested that there was a need for more work to ensure that all population groups had ready access to and felt trust in the vaccine.26
12NHS England said it had built on approaches recommended by the Scientific Advisory Group for...
Recommended (the committee's words)
NHS England said it had built on approaches recommended by the Scientific Advisory Group for Emergencies and the World Health Organisation to achieve the excellent uptake to date.27 But it acknowledged that the country was no longer in a state of emergency and that many restrictions had now been lifted. Consequently, it agreed that vaccination may have become a lower priority for many people.28 UKHSA noted that, although the basic message remained unchanged, individuals now found themselves with a wide range of different vaccination statuses (from no doses to one, two, three or even four doses). This could make it more complex to frame and target appropriate media campaigns to improve uptake.29
13However, effective targeting is now essential because those who are not fully vaccinated are concentrated...
Concluded (the committee's words)
However, effective targeting is now essential because those who are not fully vaccinated are concentrated in particular social groups. According to NHS England, many unvaccinated people are young city-dwellers, with just five cities accounting for a quarter of the total number of unvaccinated people.30 Data confirm that young people are indeed less likely to be vaccinated, including school children. Overall uptake of COVID vaccination had reached 90% of adults by the end of May 2022 (based on 2 doses). But by the same point, only 55% of young people aged 16 and 17 had received 2 doses, and only 38% of 12- to 15-year-olds.31 Even allowing for the later starting point of these campaigns, this is a significant difference.
14We are most concerned about the comparatively low vaccination uptake that persists in many vulnerable...
Recommended (the committee's words)
We are most concerned about the comparatively low vaccination uptake that persists in many vulnerable groups and, after the first booster campaign, has actually widened in some. For example, compared to people of White British origin, people of Black, Black British and Pakistani origins were less than half as likely to have had their boosters at the end of May 2022.32 The Association of Directors of Public Health and others confirmed to the Committee that inequalities in vaccine uptake persisted and more needed to be done.33 24 NAO analysis updated using NHS report, Statistics – Monthly COVID-19 Vaccinations statistics, data published 16 June 2022 25 Q 54 26 RCP0006 Note dated March 2022 from Royal College of Nursing point 4.9 27 Q 46 28 Q 53 29 Q 54 30 Qq 46, 54 31 C&AG’s report, para 3.5; NAO analysis updated using NHS report, Statistics – Monthly COVID-19 Vaccinations statistics, data published 16 June 2022 32 Updated analysis to end of May 33 RCP0010 Note dated March 2022 from The Association of Directors of Public Health, RCP0002 Note dated March 2022 from the International Longevity Centre UK (ILC), page 1 and RCP0008 Note dated March 2022 from Company Chemists’ Association, page 5. The rollout of the COVID-19 vaccine programme in England 13
15There has also been particularly low uptake of the vaccine among pregnant women.
Recommended (the committee's words)
There has also been particularly low uptake of the vaccine among pregnant women. As of February 2022, analysis by UKHSA showed that only 58% had received 2 doses.34 The Royal College of Nursing told us that lessons needed to be learnt from the mixed messaging and confusion around the vaccination of pregnant women early in 2021. It noted that many of the most critically ill patients in recent waves of infection had been pregnant unvaccinated women.35 NHS England told us about particular initiatives it considered had improved uptake in this challenging cohort, while efforts had also been made to encourage vaccination before pregnancy.36 In UKSHA’s most recent vaccine surveillance report, the committee noted that women of black ethnicity and women living in the most deprived areas continued to be least likely to have been vaccinated before they gave birth.37
16Additionally, Mencap raised concerns with us about specific difficulties in identifying and prioritising people with...
Concluded (the committee's words)
Additionally, Mencap raised concerns with us about specific difficulties in identifying and prioritising people with severe and profound learning disabilities.38 It said there was a need for more accessible communications for this group and to tackle needle phobia, which had not always been consistently or effectively addressed to date.39
17We asked the Department if communication campaigns had positively impacted vaccine hesitancy among any of...
Recommended (the committee's words)
We asked the Department if communication campaigns had positively impacted vaccine hesitancy among any of these groups. The Department told us that there had been a positive shift in general but conceded that there remained more to do.40 NHS England described a range of targeted approaches that local and national bodies had used to encourage uptake within specific groups. However, it was still not really clear to us that officials knew which approaches had been most successful, nor that they had a clear plan to address pockets of low uptake in future.41 34 UKHSA’s report, COVID-19 vaccine surveillance report: week 24, 16 June 2022, pp 20–21 35 RCP0006 Note dated March 2022 from Royal College of Nursing, point 4.11 36 Q 47 37 UKHSA’s report, COVID-19 vaccine surveillance report: week 24, 16 June 2022, pp 22–24 38 RCP0009 Note dated March 2022 from Royal Mencap, page 2 39 RCP0009 Note dated March 2022 from Royal Mencap, summary and pp 2–4 40 Q 46 41 Qq 46–47 14 The rollout of the COVID-19 vaccine programme in England 2 Future planning for the programme Future vaccine procurement
18As part of an earlier inquiry in January 2021, the Taskforce told us how its...
Concluded (the committee's words)
As part of an earlier inquiry in January 2021, the Taskforce told us how its portfolio strategy aimed to “optimise the chances of success” in securing access to vaccines at a time of huge uncertainty about whether effective vaccines were even feasible.42 The strategy worked well, giving the UK access to the earliest vaccines to complete clinical trials and come to market.43
19Since then, out of the original portfolio of seven candidates, six have been approved for...
Recommended (the committee's words)
Since then, out of the original portfolio of seven candidates, six have been approved for use in the UK to date.44 But with six vaccines to choose from, it is noteworthy that only three—AstraZeneca, Pfizer and Moderna—have actually been deployed in the UK and also that the only new contracts signed in 2021 were with Pfizer and Moderna.45 The UK’s vaccine supply for 2022 and 2023 now relies primarily on just these two companies, both manufacturers of mRNA vaccines.46
20In our assessment, many of the risks that the portfolio approach was intended to mitigate...
Recommended (the committee's words)
In our assessment, many of the risks that the portfolio approach was intended to mitigate remain. Most notable among these is the risk that future variants of the virus may respond better to one vaccine than another, perhaps a vaccine the UK has not procured. We asked the Taskforce what it was doing to protect the UK against such risks. It agreed that it had indeed ended up with a narrow set of suppliers. But it considered that, in spite of continuing uncertainties, it had adequate provisions to access timely variant vaccines for the UK at fixed prices, thereby protecting taxpayers against rising global prices.47
21The Taskforce also told us that the COVID-19 vaccine market was still developing and that...
Recommended (the committee's words)
The Taskforce also told us that the COVID-19 vaccine market was still developing and that it considered many different factors when deciding which vaccines to procure, including the evolution of the virus and improved learning about different types of vaccines and how they work.48 The Taskforce was confident that the Pfizer and Moderna vaccines remained the most effective choice for boosters and that they would provide access to reformulations against emerging variant viruses if and when required.49 We note that the approval of the Valneva vaccine happened after the UK government cancelled its contract with Valneva.50 The Taskforce had previously told us it had procured this vaccine specifically because it used a different technology to provide a “broader range of immune response”.51 Deployment and workforce planning
22The next stage for the rollout of the COVID-19 vaccination programme is to vaccinate 5-...
Concluded (the committee's words)
The next stage for the rollout of the COVID-19 vaccination programme is to vaccinate 5- to 11-year-olds. NHS England told us it recognised that this would probably be a slower and more challenging rollout given the adaptations necessary to accommodate 42 Public Accounts Committee, Oral evidence: Covid-19: Planning for a vaccine, HC 930, 11 January 2021, Qq 28, 66 43 C&AG’s Report, paras 1.10, 2.3 44 Since the session a sixth vaccine, the Valneva COVID-19 vaccine, received approval by MHRA on 14 April 2022 45 C&AG’s Report, paras 4, 2.7, Figure 7 46 Qq 60–61 47 Qq 59–64 48 Qq 26, 59 49 Qq 60, 62 50 Valneva COVID-19 vaccine approved by MHRA on 14 April 2022 51 Public Accounts Committee, Oral evidence: Covid-19: Planning for a vaccine, HC 930, 11 January 2021, Qq 28, 32 The rollout of the COVID-19 vaccine programme in England 15 small children and their parents at vaccination sites. Demand for vaccines would depend on parents making decisions on behalf of children. Sites would need to be prepared to vaccinate uncertain numbers throughout the spring.52 Looking ahead to later in the year, we heard from UKHSA that, while the UK would likely continue to need 6- or 12-month COVID-19 booster campaigns for at-risk groups, there was still much uncertainty.53 Officials did not seem to think that further whole-population booster campaigns were likely in the immediate future.54
23It is in this context that NHS England has started to plan for a reduction...
Recommended (the committee's words)
It is in this context that NHS England has started to plan for a reduction in vaccine sites and staffing in 2022. Its strategy responds to the likely drop in the overall scale of the vaccination effort, but it is not yet clear how it will strike the right balance between maintaining high levels of vaccination uptake, increasing efficiency, and ensuring that demands on healthcare staff are sustainable. In February 2022, NHS England set out next steps for local areas as they planned their contribution to the programme up to March
24We also heard from NHS England that it was moving to a position where the...
Recommended (the committee's words)
We also heard from NHS England that it was moving to a position where the NHS and wider public sector estate should be used for vaccination sites wherever possible, in preference to renting private sector sites. Nevertheless, officials confirmed that established private sector sites with good uptake rates in particular communities would be considered for continued funding.58 This decision does not affect the involvement of community pharmacies in the vaccine programme. However, the Company Chemists Association told us that that sector needed greater certainty about its contribution to allow it to engage in medium- and long-term planning.59
25The NAO report highlighted that future staffing was a major risk for the programme as...
Recommended (the committee's words)
The NAO report highlighted that future staffing was a major risk for the programme as a whole, due to staff burnout and the lack of surplus capacity in the healthcare system more generally.60 This was echoed by evidence provided to the Committee by the Royal College of Nursing and pharmacy representatives.61 Our own recent report looking at NHS backlogs and waiting times highlighted the particular strains on the GP workforce, who have delivered around half of all COVID-19 vaccinations to date.62 It will be a considerable challenge to maintain convenience and accessibility to COVID-19 52 Q 55 53 Qq 67–69 54 Q 69 55 Letter from NHS England to all Integrated Care System (ICS) Leads, Next steps for the NHS COVID-19 vaccination programme planning and delivery, 23 February 2022 NHS England COVID-19 planning statement, Planning parameters for 2022/23, 23 February 2022 56 Qq 36–37 57 Qq 36–37 58 Q37 59 RCP0008 Note dated March 2022 from the Company Chemists’ Association, page 6 60 C&AG’s Report, para 17 61 RCP0006 Note dated March 2022 from Royal College of Nursing point 1.4, RCP0004 Note dated March 2022 from Boots UK, page 2, RCP0008 Note dated March 2022 from the Company Chemists’Association, pages 3–4, 6 62 Committee of Public Accounts’ Report, NHS Backlogs and waiting times, Forty-Fourth Report of Session 2021–22, HC 747, 16 March 2022, recommendation 4; C&AG’s Report, The rollout of the COVID-19 vaccination programme in England, Session 2021–22, HC 1106, 25 February 2022, para 3.10 and Figure 17 16 The rollout of the COVID-19 vaccine programme in England vaccinations while giving staff the chance to recharge and return to their normal, equally important, roles. We know that NHS England has already taken some central action, including the maintenance of national contracts for volunteer responders.63 At the session, NHS England told us that in the longer term it wanted to retain the staffing capacity it had built for future vaccination and similar public health programm
26COVID-19 vaccine wastage was considerably below assumptions in 2021.
Concluded (the committee's words)
COVID-19 vaccine wastage was considerably below assumptions in 2021. We heard from NHS England and the Taskforce that this was due to system-wide efforts throughout the vaccination supply, distribution and deployment chain to ensure as much vaccine as possible was used.65 Vaccine was treated by all who came into contact with it like a precious commodity. Up to the end of October 2021, the NAO estimated COVID-19 vaccine wastage levels for England had been under 5%, well below the programme’s initial assumption of 15–20% and, according to NHS England, low by historical standards.66
27At our evidence session NHS England told us it was expecting wastage levels to increase...
Recommended (the committee's words)
At our evidence session NHS England told us it was expecting wastage levels to increase in 2022, because of the anticipated fall in overall demand.67 This is because, as demand reduces, it becomes harder to guarantee that all doses in a given pack will be used up within the designated time period. The programme has already seen how reduced demand can adversely impact wastage: in 2021, it had to write off around 1.9 million AstraZeneca doses as demand fell following changes to clinical advice on how AstraZeneca should be used.68 We asked officials about their learning from the AstraZeneca situation. We heard from NHS England that joint working between it, the Taskforce and UKHSA would be critical to minimising wastage in future.69
28Opportunities to reduce wastage should also be part of NHS considerations about which vaccination sites...
Recommended (the committee's words)
Opportunities to reduce wastage should also be part of NHS considerations about which vaccination sites will remain open in future. A nationwide pharmacy chain, Boots UK, told us that it would support a future model in which particular vaccination sites might be temporarily suspended to prevent ‘low demand, unacceptable wastage of vaccine or where a site does not represent value for money’.70
29The Taskforce told us that predicting demand for 2022 remained difficult.
Recommended (the committee's words)
The Taskforce told us that predicting demand for 2022 remained difficult. It said it had consciously taken a cautious approach to procurement, based on the presumption that having too much vaccine would be better than having too little.71 There were opportunities to minimise wastage at all stages of the supply process, including careful handling and stock management by local sites; and action by the Taskforce to set up international donations and swaps, and reschedule deliveries with vaccine manufacturers.72 However, 63 Letter from NHS England to all Integrated Care System (ICS) Leads, Next steps for the NHS COVID-19 vaccination programme planning and delivery, 23 February 2022 and NHS England COVID-19 planning statement, Planning parameters for 2022/23, 23 February 2022 64 Q 57 65 Qq 34, 65 66 C&AG’s Report, para 15; Q65 67 Q 65 68 C&AG’s Report, para 15 69 Qq 65, 66 70 RCP0004 Note dated March 2022 from Boots UK, page 2 71 Q 34 72 Q 65; C&AG’s Report, paras 2.10, 2.17–2.19 The rollout of the COVID-19 vaccine programme in England 17 the officials noted that handling restrictions mean that, once vaccines had left UKHSA’s possession for onward supply to local sites, any unused doses could not then be donated abroad.73 We accept that a lot of work has been done to monitor and minimise wastage in the programme to date. The challenge for the future will be to build new and innovative solutions to keep wastage down. Funding certainty for COVID-19 response activities
30The week before the start of the new financial year, the Department had still not...
Concluded (the committee's words)
The week before the start of the new financial year, the Department had still not finalised the allocation of its £9.6 billion Spending Review settlement for COVID-19 response activities, creating uncertainty for the vaccine programme. In the 2021 Spending Review, the Department received £9.6 billion for all its key COVID-19 programmes over the three years from 2022–23 to 2024–25.74 When we took evidence on 28 March, the Department still could not tell us how it would distribute this funding among its various programmes for 2022–23. This included the vaccine programme.75 It also had not finalised the 2022–23 budget for UKHSA, which has a key role in COVID-19 vaccine storage and distribution, and additionally supports the programme through its monitoring and analysis of vaccine coverage and effectiveness.76
31There are many other parts of the vaccine programme, including GPs and pharmacies, external contractors,...
Recommended (the committee's words)
There are many other parts of the vaccine programme, including GPs and pharmacies, external contractors, volunteer schemes, local authorities and temporary staff, that are central to the delivery of the programme and that need timely confirmation about what funding will be available.77 The Directors of Public Health told us the commissioning process for vaccination had been unnecessarily complex, top-down and inflexible, and that the lack of confirmed and recurrent funding had hampered their ability to plan for the long term and led to missed opportunities.78 It is self-evident that, where organisations do not know if funding will be available in the near future, they may take suboptimal decisions, for example to cancel activities that are beneficial and should continue. Specifically for the Taskforce, an added complexity is that it receives funding from both the Department of Health and Social Care and the Department of Business, Energy and Industrial Strategy, the latter to boost domestic manufacturing capacity.79
32Finally, we note that in setting up the vaccine programme the Department provided indemnities to...
Concluded (the committee's words)
Finally, we note that in setting up the vaccine programme the Department provided indemnities to vaccine manufacturers, which gave cover for future claims against producers for any adverse effects of their vaccines. These indemnities may add to the costs of the programme in the long term.80 We heard from one individual whose relative had suffered side-effects as a result of vaccination. Their evidence underlined the importance of having clear, prompt and adequate compensation. arrangements for people in need. The Department told us it had a substantial number of contingent liabilities related to 73 Q66; C&AG’s Report, paras 15 and 2.19 74 C&AG’s Report, para 1.9, Figure 1 75 Qq 71–73 76 Qq 1–4; RCP0008 Note dated March 2022 from the Company Chemists’ Association, page 6, and RCP0010 Note dated March 2022 from The Association of Directors of Public Health page 7–8 77 C&AG’s Report, paras 2, 1.16, Figure 1 78 RCP0010 Note dated March 2022 from The Association of Directors of Public Health, page 7 79 Qq 74–75 80 C&AG’s Report, para 1.8 18 The rollout of the COVID-19 vaccine programme in England these indemnities and that it was seeking to reduce their value.81 The Committee will potentially want to know more about the Department’s arrangements and plans in this regard in due course.82 81 Qq 25–26 82 Q 27 The rollout of the COVID-19 vaccine programme in England 19
Evidence
Oral evidence sessions 1
- 28 Mar 2022Roll out of the COVID:19 vaccine programme5 witnesses, listed belowparliament.uk ↗
Who gave evidence 5 witnesses
- Amanda PritchardChief Executive Officer, NHS England
- Dame Dr Emily LawsonNational Director Vaccine Deployment, NHS England and NHS Improvement
- Dr Jenny Harries OBEChief Executive, UK Health Security Agency
- Madelaine McTernanDirector General Vaccines Taskforce, Department for Business, Energy and Industrial Strategy
- Shona DunnSecond Permanent Secretary, Home Office
Correspondence 2 letters
- 8 Nov 2022Correspondence from Amanda Pritchard, Chief Executive, NHS England, re House of Commons Committee of Public Accounts Eleventh Report of Sessions 2022- 2023: The rollout of the COVID-19 vaccine programme in England, dated 31 October 2022
- 12 May 2022Correspondence from Amanda Pritchard, Chief Executive, NHS, re Follow up to the Public Accounts Committee oral evidence session on COVID-19 vaccines – 28 March 2022, dated 22 April 2022