Recommendations & Conclusions
32 items
2
Recommendation
Eleventh Report - The rollout of the CO…
Accepted
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. …
Government response. NHS England, supported by UKHSA, will evaluate approaches to vaccine delivery and work with local systems to continue evaluating different approaches to vaccine delivery, especially for communities where uptake and confidence may be lower. NHS England intends to continue offering …
HM Treasury
3
Recommendation
Eleventh Report - The rollout of the CO…
Accepted
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 …
Government response. The government agrees with the Committee’s recommendation and states that NHSE wrote to the Committee on 31 October 2022 to provide an update on the outcome of assurance of local plans.
HM Treasury
4
Recommendation
Eleventh Report - The rollout of the CO…
Accepted
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 …
Government response. The government agreed to identify successes and lessons from the COVID-19 vaccine programme and communicate to the Committee the main improvements it will make as a result in other health programmes and wider government.
HM Treasury
5
Recommendation
Eleventh Report - The rollout of the CO…
Rejected
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 …
Government response. The government disagrees with the recommendation to review the future procurement strategy for COVID-19 vaccines, stating that the current strategy is kept under constant review with expert advice. They cite agreements with developers that give access to updated vaccines and …
HM Treasury
6
Conclusion
Eleventh Report - The rollout of the CO…
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 …
Government response. 6.1 The government agrees with the Committee’s recommendation. Recommendation implemented 6.2 The government has numerous safeguards and procedures in place to reduce the risk of dose wastage. 6.3 UKHSA manages the central storage and distribution of COVID-19 vaccines for the …
HM Treasury
7
Recommendation
Eleventh Report - The rollout of the CO…
Accepted
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 …
Government response. The government agrees with the recommendation and has set aside a minimum of around £2 billion of funding in the 2022-23 financial year for vaccine procurement and deployment against COVID-19. They plan to deliver a spring booster, roll out vaccinations …
HM Treasury
1
Conclusion
Eleventh Report - The rollout of the CO…
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 …
HM Treasury
8
Conclusion
Eleventh Report - The rollout of the CO…
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 …
Government response. 4: PAC conclusion: 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. 4: PAC recommendation: The Department should carry out …
HM Treasury
9
Conclusion
Eleventh Report - The rollout of the CO…
Accepted
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 …
Government response. The government agrees that there are lessons to be learned from the COVID-19 vaccine roll-out, and NHSE is leading development of an integrated immunisations strategy, and the department will write to the Committee setting out the main improvements being made …
HM Treasury
10
Recommendation
Eleventh Report - The rollout of the CO…
Rejected
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 …
Government response. The government disagrees with the recommendation to set a challenge to reduce the number of unvaccinated adults to 2.5 million and achieve 80% booster uptake, arguing it is moving away from target-based approaches.
HM Treasury
11
Conclusion
Eleventh Report - The rollout of the CO…
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 …
Government response. 1. PAC conclusion: Nearly 3 million adults in England remain unvaccinated and are therefore at greater risk of becoming hospitalised or dying because of COVID-19 than if they were vaccinated. 2 1: PAC recommendation: Both NHS England and its local …
HM Treasury
12
Conclusion
Eleventh Report - The rollout of the CO…
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. …
Government response. 1. PAC conclusion: Nearly 3 million adults in England remain unvaccinated and are therefore at greater risk of becoming hospitalised or dying because of COVID-19 than if they were vaccinated. 2 1: PAC recommendation: Both NHS England and its local …
HM Treasury
13
Conclusion
Eleventh Report - The rollout of the CO…
Not Addressed
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 …
Government response. The government disagreed with the committee's recommendation to reduce the overall number of unvaccinated adults to 2.5 million and achieve an 80% uptake for first boosters among adults within four months. They stated they continue to focus on reaching out …
HM Treasury
14
Recommendation
Eleventh Report - The rollout of the CO…
Accepted
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 …
Government response. The government agreed to evaluate approaches for increasing vaccine uptake in vulnerable groups and support local areas in deploying the most effective approaches, including fresh approaches to tackle low uptake in some ethnic groups.
HM Treasury
15
Conclusion
Eleventh Report - The rollout of the CO…
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 …
Government response. 2: PAC conclusion: Comparatively low vaccination uptake persists in many vulnerable groups and, after the first booster campaign, has even dropped further for some. 2. PAC recommendation: Recognising that reasons for lower uptake will vary, NHS England and UKHSA should …
HM Treasury
16
Conclusion
Eleventh Report - The rollout of the CO…
Not Addressed
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
Government response. The government agrees with the Committee’s recommendation that NHS England and UKHSA should urgently evaluate which approaches are most effective for increasing vaccine uptake, communicate again with local areas about what works, and provide support to them to deploy the …
HM Treasury
17
Conclusion
Eleventh Report - The rollout of the CO…
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 …
Government response. 2: PAC conclusion: Comparatively low vaccination uptake persists in many vulnerable groups and, after the first booster campaign, has even dropped further for some. 2. PAC recommendation: Recognising that reasons for lower uptake will vary, NHS England and UKHSA should …
HM Treasury
18
Conclusion
Eleventh Report - The rollout of the CO…
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 …
HM Treasury
19
Recommendation
Eleventh Report - The rollout of the CO…
Rejected
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 …
Government response. The government disagrees with the recommendation to review the future procurement strategy for COVID-19 vaccines, stating that the current strategy is kept under constant review with expert advice. They cite agreements with developers that give access to updated vaccines and …
HM Treasury
20
Conclusion
Eleventh Report - The rollout of the CO…
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 …
Government response. 5: PAC conclusion: 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. 5: …
HM Treasury
21
Recommendation
Eleventh Report - The rollout of the CO…
Rejected
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 …
Government response. The government disagrees with the recommendation to review the future procurement strategy for COVID-19 vaccines, arguing that the current portfolio approach is constantly reviewed with clinical and commercial expertise.
HM Treasury
22
Conclusion
Eleventh Report - The rollout of the CO…
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 …
HM Treasury
23
Conclusion
Eleventh Report - The rollout of the CO…
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 …
Government response. 3: PAC conclusion: 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 …
HM Treasury
24
Conclusion
Eleventh Report - The rollout of the CO…
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 …
HM Treasury
25
Conclusion
Eleventh Report - The rollout of the CO…
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 …
HM Treasury
26
Conclusion
Eleventh Report - The rollout of the CO…
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 …
HM Treasury
27
Conclusion
Eleventh Report - The rollout of the CO…
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 …
HM Treasury
28
Conclusion
Eleventh Report - The rollout of the CO…
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 …
HM Treasury
29
Conclusion
Eleventh Report - The rollout of the CO…
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 …
HM Treasury
30
Conclusion
Eleventh Report - The rollout of the CO…
Accepted
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 …
Government response. The government agrees with the Committee’s recommendation and has currently set aside a minimum of around £2 billion of funding in the 2022-23 financial year for vaccine procurement and deployment against COVID-19.
HM Treasury
31
Conclusion
Eleventh Report - The rollout of the CO…
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 …
HM Treasury
32
Conclusion
Eleventh Report - The rollout of the CO…
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 …
HM Treasury