Select committee inquiry
COVID-19: Planning for the vaccine (part 1)
Closed
What the inquiry looked at
“Since the first cases of COVID-19 in the UK in January 2020, the impact on society and the economy has been significant. Government’s overall objective since May has been “to return to life as close to normal as possible, for as many people as possible, as fast and fairly as possible”. A vaccination programme plays a central role in achieving this objective. Extremely high global demand, coupled with the scarcity of vaccine resources, has put added pressure on government to make fast-paced decisions to secure access to potential vaccines, and to quickly build the capacity to manufacture and deploy them. On 2 December 2020, the first vaccine for use in the UK was approved by the regulator and deployment began on 8 December. This first inquiry on the development and roll out of a Covid-19 vaccine covers the period from April to 8 December 2020 and examines government’s approach and progress in securing potential vaccines and determining how they will be deployed to the public. The UK government has worked quickly to secure potential COVID-19 vaccines, successfully signing deals for five vaccines providing up to 267 million doses at an expected cost of £2.9 billion. The total cost to the taxpayer of government’s efforts to purchase and deploy vaccines is uncertain. The current estimate is up to £11.7 billion which includes the costs of purchasing and manufacturing vaccines for the UK, deploying them in England and investing in global efforts to purchase vaccines. Many pharmaceutical companies requested immunity in the event of liabilities or legal action relating to their vaccines, meaning the taxpayer may have to pay the costs of claims against them. In four out of the five contracts agreed so far, no cap has been applied to the amount that government could pay in the event of a successful claim against the pharmaceutical companies. NHSE&I is planning a vaccination programme with high levels of uncertainty because information about the COVID-19 vaccines is constantly changing. Each potential vaccine requires different plans for rolling it out to the public because each has different characteristics. These include the temperature it should be stored at, its shelf-life once open, and how it should be prepared before it is administered. In September 2020 NHSE&I calculated that if every adult in England needed to be vaccinated with two doses of a COVID-19 vaccine, its vaccination workload would increase by 740%. NHSE&I calculated that it may need up to 46,000 staff consisting of 26,000 vaccinators and 20,000 administrative staff to deliver the COVID-19 vaccination programme based on a 75% take-up rate. As at 8 December 2020, NHSE&I’s planning assumption is that it could vaccinate up to 25 million people with two doses throughout 2021. The Committee will question senior officials at the Department for Business, the Department for Health and Social Care, the NHS including the Vaccine Taskforce, and Public Health England. If you have evidence on this first stage of the UK’s vaccination programme – sourcing and preparing the first Covid19 vaccine - please submit it here by 6pm on Tuesday 5 January 2021”
The committee's words, from the inquiry page on parliament.uk ↗.
What it found
In the committee's words, from the summary of Forty-Third Report - COVID-19: Planning for a vaccine Part 1 ↗
Government acted quickly to put in place a vaccine programme in response to the COVID-19 pandemic, including supporting the development of potential vaccines, striking deals with pharmaceutical companies and starting to vaccinate some of the most at-risk members of society. We commend the work of the Vaccines Taskforce in identifying the vaccines to back and supporting scale-up of manufacturing; the Department for Business, Energy & Industrial Strategy for purchasing vaccines, and the Department for Health & Social Care, NHS England and NHS Improvement and Public England for launching the largest vaccination programme in the UK’s history.
At the point of our evidence session, 2.5 million of the most vulnerable people across the UK had received at least one dose of a vaccine against COVID-19 and as of 10 February 2021 more than 13 million doses had been delivered.
Despite this significant achievement, there is still much to be done to meet the Government’s target to offer a vaccine to 17.7 million in priority groups by the end of April 2021, with supply a key factor. We are concerned by Departments’ lack of planning for the next phase of the programme and in learning the lessons from what has already been done that will be so vital to the programme’s success. While the Department for Business, Energy & Industrial Strategy, through its Vaccine Taskforce, has needed to work at pace, it has not quite struck the right balance between making decisions quickly and maintaining transparency over how those decisions are made and there remains some uncertainty over key issues.
Government has at times struggled to communicate clearly to the public about what they can expect from the vaccine programme, otherwise it risks confusion about who will be able to access the vaccine, how and when. With misinformation about vaccines being circulated on various digital platforms, clear communication from government is particularly important to maintain public confidence and take up. High global demand for those vaccines that have been approved means it is vital government builds on the momentum to date if the vaccine programme is to be a success and have offered a vaccine to all those who want one by autumn 2021.
What the government said
The government responded on 3 September 2021. The deadline was 12 April 2021.
Summary written by Accountability Index from the government's response.
The government states that it "agrees with the Committee's recommendation" on all six recommendations, and in most cases describes them as already implemented.
- On future developments, it says a new expert advisory group will look at current and potential future virus variants, and that it is planning for a potential revaccination campaign later in the year, with final decisions to be made "in due course in light of expert advice".
- On the supply chain, it says it wrote to the Committee on 26 February 2021 with its assessment of key risks and mitigations, and that it does not expect vaccines beyond Oxford/AstraZeneca and Pfizer/BioNTech to be affected by the temporary EU export measures.
- On BEIS decision-making, it intends to continue the process improvements for Taskforce approvals, "will consider" whether they should be replicated elsewhere in the department, and will write again to the Committee by the end of April 2021 on lessons learned.
- On public reporting, it says it publishes consistent and comparable daily vaccination data for the UK and each of the four countries, and that NHSE/I publishes weekly data for England covering characteristics including age, region, ethnicity and cohort.
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 17 December 2020 to 3 September 2021. The dashed mark is the deadline Parliament records for the government's response.
- Oral evidence 11 Jan 2021
- Report 12 Feb 2021
- Government response 3 Sep 2021
- Correspondence 9 letters
What it recommended 7 recommendations · 24 conclusions
2Despite BEIS’s confidence, concerns remain over the vaccine supply chain.
Recommended (the committee's words)
Despite BEIS’s confidence, concerns remain over the vaccine supply chain. Under the Government’s ambitious plans, everyone who wants a vaccination should be able to have one by Autumn 2021. This will depend on continuing vaccine supply. Whilst BEIS asserts that the UK has access to more doses than it likely needs if they all work, NHSE&I is less certain when the doses will arrive. BEIS holds detailed supply schedules up to the end of February 2021 but until recently NHSE&I was only able to provide vaccination sites with supply schedules one week in advance. There have been conflicting statements about vaccine supply. BEIS is unequivocal that supply will not be a constraint in meeting the Government’s 15 February target and on current numbers this appears to be on track. The Department is confident that, through its investment of £302 million, of a potential £519 million, in the UK’s manufacturing capacity, the UK could manufacture all the vaccine doses that it might need should this contingency be required. Yet on the same day we took evidence the Secretary of State for Health and Social Care stated that supply of the vaccine is the ‘rate limiting factor’ for deployment plans. 1 Latest figures can be found at: https://coronavirus.data.gov.uk/details/vaccinations 6 COVID-19: Planning for a vaccine Part 1 Recommendation: BEIS should, by the end of February 2021, write to the Committee with its assessment of the risks within the vaccine supply chain and a plan to proactively address these to ensure sufficient doses of vaccine are available through to Autumn 2021.
3BEIS has worked quickly to secure access to vaccines but could have been more transparent...
Recommended (the committee's words)
BEIS has worked quickly to secure access to vaccines but could have been more transparent about how decisions have been made. Transparency is essential to maintain public confidence and ensure taxpayers’ money is being well spent. BEIS has managed significant uncertainty and worked at pace to purchase vaccines, but it could have been more transparent about how key decisions were made. The Chair of the Taskforce was appointed directly by the Prime Minister. While we recognise that a full competition was not an option at the height of the pandemic our witnesses could not explain why she was chosen or the reasoning behind the appointment which appears to be a personal decision by the Prime Minister. Transparency and openness about such key appointments is important and helps hold decision makers to account.) Almost a fifth of the 200 individuals on the Taskforce have recorded at least one conflict of interest although most are minor. To ensure the UK could access vaccines once they were approved, BEIS has made £914 million worth of upfront payments to enable pharmaceutical companies to start manufacturing vaccines at scale, but this could be lost if the vaccines are not approved. It has also agreed to provide each pharmaceutical company with broad ranging indemnity cover against adverse effects arising from their vaccine. In evidence witnesses were clear that had the indemnities not been provided this would have put the UK behind other countries in securing vaccines. Recommendation: BEIS should, by the end of March 2021, review its decisions about how to invest taxpayers’ money and its appointments processes to identify what it would repeat and what it will change in future. As part of this, BEIS should examine its experience of using the Taskforce model to inform its own and government’s future skills requirements and to ensure accountability arrangements are robust. BEIS should, by the end of April 2021, lay out its learning so the rest of government can improve the
4DHSC, NHSE&I and PHE will continue to face significant challenges in making sure they can...
Recommended (the committee's words)
DHSC, NHSE&I and PHE will continue to face significant challenges in making sure they can get the vaccine to the right people at the right time. Each vaccine will require different plans for deploying because each has different characteristics. Getting the vaccine to the right place to allow it to be administered is challenging. For example, the Pfizer Inc and BioNTech SE vaccine must be stored at -70°c, whereas the vaccine developed by the Astra-Zeneca Ltd—University of Oxford partnership can be stored at between 2°c and minus 8°c. BEIS considered the logistics of deployment as part of deciding which vaccines to purchase but prioritised whether the vaccine itself would work. Despite these challenges, 97.3% of vaccine deliveries so far have been made on-time and in full. The Former Chair of the Taskforce explained that the MHRA had compressed parts of the process while ensuring the efficacy and safety of the programme. NHSE&I is working to ensure any surplus vaccines are redistributed to those areas most in need and is using large vaccination sites and community pharmacies to help smooth distribution at a local level. NHSE&I is COVID-19: Planning for a vaccine Part 1 7 confident that it has in place the workforce it needs to meet its 15 February target, with around 80,000 people trained and ready to administer vaccines. Convenience and location of vaccine centres will be important in encouraging people to take up the offer of a vaccine, particularly in hard to reach groups. We were informed that 21 mobile army units of 101 Logistics Brigade were deployed. Local GPs and community leaders will play a crucial role in making sure people are willing and able to take up the offer of a vaccine and PHE has committed to working with local government to ensure that no community gets left behind. Recommendation: By the end of February 2021 DHSC, NHSE&I and PHE should write to us with their assessment of the main challenges and risks to the ongoing deployment of the vaccine pro
5There is a risk that NHSE&I and DHSC’s plans for the vaccine programme will not...
Recommended (the committee's words)
There is a risk that NHSE&I and DHSC’s plans for the vaccine programme will not meet public expectations. NHSE&I recognises that its goal to vaccinate the first four priority groups by 15 February is a huge task which it appears to be on track to deliver. As no-one can be forced to have the vaccination, NHSE&I will determine the programme’s success based on the number of people offered a vaccine rather than the number of people who are vaccinated. The daily vaccination totals published by government, however, are based on the number of vaccines administered, not offers made. We are concerned that using these could create confusion among the public about progress with the vaccine programme. NHSE&I has lengthened the time between individuals’ first and second doses of the vaccine from 3 to 12 weeks. It asserts that this delay is not linked to the introduction of new lockdown measures, but “basic maths” that it is better to have more people with single dose protection than a smaller number with double dose protection. NHSE&I currently expects around 25% of people will not take-up the offer of a vaccination but is hopeful that actual take-up rates will be higher. We are nonetheless concerned about how vaccines will be deployed across parts of the country with different age demographics, local need and people with vulnerabilities. NHSE&I recognises that there is a trade-off between equity of access and the speed of deployment and that it cannot allow one part of the country to race ahead of another. Recommendation: NHSE&I and DHSC need to immediately set out in detail what they are planning to achieve so the public has a better understanding of what the daily progress reports mean in practice. It should clearly set out: the definition of ‘vaccinated’ and ‘offered a vaccination’; and expected take up rates across both doses and across different cohorts, for example by age and ethnicity. Progress should also be reported at local, regional, devolved and UK levels in a consi
6Public confidence in the vaccine programme is crucial to its success yet some members of...
Recommended (the committee's words)
Public confidence in the vaccine programme is crucial to its success yet some members of the public and health professionals were confused by the messaging about when and how people can access a vaccine. The number of people who choose to have the vaccine will ultimately be determined by public trust in the vaccines. Clear communication is essential to enable the public, Parliament and health professionals understand what is going on within the vaccination programme, but is challenging because the situation is evolving so rapidly. We have previously found that a lack of information during the pandemic, or repeatedly changing and 8 COVID-19: Planning for a vaccine Part 1 updating guidance, can be confusing and frightening for those affected. NHSE&I had not yet developed a Frequently Asked Questions section for its website at the time of our evidence session nor has it put in place a rebuttal unit to deal with negative publicity or fake reporting about the vaccines. NHSE&I acknowledges it needs to be vigilant about the potential for fraudsters to take advantage of the more vulnerable in society in offering fake vaccines. Recommendation: NHSE&I and DHSC need to immediately develop clear and straightforward communication, including comprehensive FAQs, to help the public navigate the constantly changing situation. This should be publicised to the public and those who can help inform the public such as GPs, Clinical Commissioning Groups and MPs, as well as setting up a unit to quickly rebut false claims about the vaccines. COVID-19: Planning for a vaccine Part 1 9 1 Part 1 – Securing the UK’s access to potential vaccines
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 for Business, Energy and Industrial Strategy (BEIS), the Department of Health and Social Care (the Department), NHS England and NHS Improvement (NHSE&I), Public Health England (PHE) and the former Chair of the Vaccine Taskforce, on the government’s preparations for potential COVID-19 vaccines.2 The evidence session took place on the 11 January, our report is based on the evidence that we took at the time.
7BEIS created a Vaccines Taskforce (the Taskforce) in April 2020 to support the research and...
Concluded (the committee's words)
BEIS created a Vaccines Taskforce (the Taskforce) in April 2020 to support the research and development of potential vaccines, select which vaccines to purchase, secure the UK’s 7 Committee of Public Accounts, CPVID-19: Supply of Ventilators, HC 685, 25 November 2020 8 Q 33, C&AG’s Report, para 20–21, 3.8–3.10 9 Q 33, C&AG’s Report, para 10, 1.6 10 C&AG’s Report, para 16, 2.5 11 Qq 42–43 12 Q 43 13 Qq 47–49, C&AG’s Report para 17, 2.8–2.9 COVID-19: Planning for a vaccine Part 1 11 access to sufficient quantities of vaccines, and develop manufacturing capacity to ensure supply.14 It explained that creating the Taskforce allowed it to very quickly give a potential vaccine the senior focus, governance and skills needed to respond to the pandemic.15 The Taskforce consists of pharmaceutical industry experts, academics and civil servants from across government. At December 2020, the Taskforce had 201.7 full-time equivalent staff, including 79.9 full-time equivalent staff recruited from outside the civil service. We asked how BEIS was ensuring that it was able to keep hold of, or ensure access to, the skills and expertise it needed. It responded that to date it had not encountered any problems with this as the best way to motivate and retain people was to give them something that really mattered to work on and the issues the Taskforce was dealing with was the “absolute No.1 national priority”.16
8The Chair of the Taskforce took up the unpaid post in May 2020.
Concluded (the committee's words)
The Chair of the Taskforce took up the unpaid post in May 2020. The Chair was appointed by, and reported directly to, the Prime Minister until the term expired at the end of 2020.17 We asked the former Chair about criticisms of their appointment and their potential political connection. The former Chair told us that they had been clear at the outset that they were not a vaccines expert and that their experience was in “taking novel science and turning those into therapeutics”.18 They explained that, in essence, this meant demonstrating that treatments were effective and safe, ensuring they could be manufactured, and in getting the regulatory approvals needed so that they could be administered . They noted that there were other vaccine experts available, and others may have been better qualified, but that their “venture capital skillset and biotech mindset” had been what was needed for the Taskforce.19 We noted that in a pandemic it was not necessarily possible to undertake a full-recruitment process, but asked whether there should have been more discussion about, or others should have been involved in, the appointment of the Chair. The former Chair told us that they were not privy to what process took place. BEIS similarly told us that it was not privy to the process for this specific appointment and that, in non-emergency circumstances, it would still expect to undertake a normal recruitment process.20
9Our report on Government’s procurement and supply of personal protective equipment during the pandemic found...
Recommended (the committee's words)
Our report on Government’s procurement and supply of personal protective equipment during the pandemic found that a failure to be transparent had opened up Government to accusations of poor value for money, conflicts of interest and preferential treatment of some suppliers, and risked undermining public trust in government procurement and the use of taxpayers’ money.21 BEIS recognised that the involvement of a range of different people being brought in to support government’s decisions created the potential for conflicts of interest. BEIS and the Taskforce share a register of conflicts of interest between their HR Department and Programme Management Office each week. By December 2020, 38 individuals within the Taskforce had registered at least one conflict of interest.22 We asked the Departments how they were ensuring that conflicts of interest were properly managed. Both the Department and BEIS explained that their approach 14 Qq 99, 112, C&AG’s Report, para 2, 1.1, 3.1–3.2 15 Qq 99–100, 116–117 16 Qq 101–102, C&AG’s Report para 3.1–3.5 17 Qq 109–110, C&AG’s Report, para 3.11 18 Qq 110–114, 118–121 19 Q 109 20 Qq 110–111, 117 21 Committee of Public Accounts, COVID-19: Government procurement and supply of personal protective equipment, HC 928, 10 February 2021 22 Q 106, C&AG’s Report, para 3.7 12 COVID-19: Planning for a vaccine Part 1 was the same as for any other area of their work and that they had standard procedures in place to deal with conflicts of interest.23 BEIS told us that the majority of the conflicts of interests within the Taskforce were attributable to members of staff who had been brought in from the private sector, but that in most cases the potential conflicts of interest were small. It explained that it had needed to scale up its business-as-usual conflicts of interest system to deal with the quantity of people coming in, but that this was “not particularly because they have been more conflicted that usual, but because there have been more of the
10We asked what premium the UK had paid for its access to the vaccines and...
Concluded (the committee's words)
We asked what premium the UK had paid for its access to the vaccines and their development at speed. BEIS asserted that the UK had not paid any premiums for access to the vaccines, as at the time the contracts were signed it was not possible to know what the final costs would be, but that it had secured access to the vaccines by negotiating “quickly and early”.26 On the issue of the price of vaccines in future, it expected that its negotiating position would improve over time as more vaccines were approved and available.27 Of those signed by December 2020, the UK’s contracts with pharmaceutical companies included: Astra Zeneca UK Limited and the University of Oxford for 100 million doses, signed in August 2020; Pfizer Inc and BioNTech SE for 40 million doses, signed in October 2020; and Moderna Inc for 7 million doses, signed in November 2020.28 BEIS told us that, since the NAO report, it had signed contracts to provide access to a further 10 million doses to the vaccine produced by Moderna Inc.29 We asked how Departments and the Taskforce had determined the doses they would need for each vaccine and why the UK had ordered such different quantities of the different vaccines. The former Chair of the Taskforce told us that this had been based on advice from the Joint Committee on Vaccination & Immunisation that it should look to vaccinate 30 million people in the high priority groups one to nine, equivalent to needing to secure access to 60 million doses if two doses were needed. They explained that the differences in the quantities ordered from manufacturers was a combination of the number of doses available and when those doses were expected.30 DHSC policy is to vaccinate the entire population of the UK against Covid-19.
11In response to our questions about whether the UK now had access to enough doses...
Concluded (the committee's words)
In response to our questions about whether the UK now had access to enough doses of vaccine or would need to go back to buy more from other suppliers, the former Chair of the Taskforce told us that the “we have more doses than we are likely to need, if they all work”.31 BEIS confirmed that was “absolutely confident” that supply would not be a constraint in achieving the mid-February target, even if take-up rates were higher than 23 Qq 103, 105–6 24 Q 106 25 Q 107 26 Q 29 27 Q 34 28 C&AG’s Report, para 2.2 29 Qq 32, 73 30 Q 30 31 Q 31 COVID-19: Planning for a vaccine Part 1 13 expected.32 BEIS explained that it was too early to say what would happen to any surplus doses as it depended on whether all those it had access to were approved for use, and what happened during the roll-out of the vaccines. It confirmed that it had, however, tried to ensure as much flexibility as possible in its contracts with pharmaceutical companies to allow it not to take-up vaccines or to consider alternative options.33
12On 11 January 2021, the Secretary of State of Health and Social Care stated that...
Concluded (the committee's words)
On 11 January 2021, the Secretary of State of Health and Social Care stated that “the supply of the vaccine is currently the rate limiting step”.34 NHSE&I recognised that ensuring everyone who wants a vaccination can have one by Autumn 2021 will depend on continuing vaccine supply.35 Given this, we asked why Government did not yet have a timetable for when vaccines would be delivered. The former Chair of the Taskforce told us that, as part of procuring the vaccines, it had agreed a timetable for the expected supply of vaccines, but that this had taken place before the manufacturing of the vaccines had been fully scaled-up. BEIS confirmed that it was working daily with suppliers and had detailed schedules for the supply of vaccines until the end of February, and was “increasingly confident” about the schedules for March.36
13Manufacturing the vaccines is the responsibility of pharmaceutical companies.
Concluded (the committee's words)
Manufacturing the vaccines is the responsibility of pharmaceutical companies. In order to ensure that vaccines can be provided quickly to the UK and reduce the risks to its supply of the vaccine, BEIS calculated that it needed to invest £519 million to provide manufacturing capacity for producing the vaccines within the UK. By 8 December 2020, it had committed £302 million to manufacturing projects, including: £127 million to the Cell and Gene Therapy Catapult Manufacturing Centre; £93 million to the Vaccine Manufacturing and innovation Centre; and £42 million to fill and finish facilities. BEIS told us it was confident that, if it needed to, the UK now had sufficient capacity, and a full contingency, to manufacture all the vaccine doses that it might need.37 32 Qq 71–72 33 Q 32 34 Health and Social Care Secretary’s statement on coronavirus (COVID-19), 11 January 2021 35 Qq 5, 22 36 Qq 70–71 37 Qq 45–46, C&AG’s Report, para 18, 2.14–2.15 14 COVID-19: Planning for a vaccine Part 1 2 Part Two – Deploying the vaccines
14Government plans to have offered a first vaccine dose to everyone in the top four...
Concluded (the committee's words)
Government plans to have offered a first vaccine dose to everyone in the top four priority groups identified by the Joint Committee on Vaccination and Immunisation by 15 February. This includes: all residents in a care home for older adults and their carers; all those 80 years of age and over and frontline health and social care workers; all those 75 years of age and over; and all those 70 years of age and over and clinically extremely vulnerable individuals; and is equivalent to around 12.2 million people.38 In January 2021, the Government announced that it would likely take until spring to offer the first dose of the vaccine to the remaining priority groups, equivalent to around 27 million people in England. It planned to offer a vaccine to the remaining adult population by the autumn.39
15We asked NHSE&I whether the timetable for the roll-out of the vaccine was realistic, and...
Concluded (the committee's words)
We asked NHSE&I whether the timetable for the roll-out of the vaccine was realistic, and how fast it could reach those groups on the priority list. NHSE&I told us that over the first three weeks of the programme, it had administered around 1.1 million doses across the country. and that the speed of vaccinations had tripled over the last week, with 1.2 million vaccinations, meaning that 2.3 million vaccinations had now been administrated in England and 2.5 million across the UK.40 As of [date] over [10] million had been delivered. We commended the progress that had been made to date, but noted that there was still a huge amount of work to do to meet the government’s target. NHSE&I expected the number of vaccinations to further accelerate in the coming weeks as supply of the vaccines increased and confirmed it was on course to have offered a vaccine to everyone in the first four priority groups by 15 February as planned.41
16NHSE&I is planning its deployment of vaccines in the face of high levels of uncertainty...
Concluded (the committee's words)
NHSE&I is planning its deployment of vaccines in the face of high levels of uncertainty because information about the COVID-19 vaccines is still changing. It needs to keep its plans under review to ensure it can respond to the latest information about which vaccines have been approved, which groups in society need to be vaccinated, how many doses will be available, and when and how those vaccines will need to be deployed. The NAO found that it remained uncertain whether the vaccination programme would need to take place more regularly, for example becoming an annual programme.42 We asked Departments whether they now thought than an annual vaccination programme would be needed. BEIS confirmed that it was considering this, but that it was not an urgent or critical question at present as it had “plenty of doses to be getting on with, not only for this year, but likely for next year as well”.43 It explained that while it had needed to work at speed for the current programme, it expected to be able to take time to “survey the field” and plan for any future annual vaccination programme.44 In response to our questions about when these decision would need to be made, BEIS told us “not for a while”.45 The Department explained that plans for the vaccination programme in future will also depend on how the virus develops and any new variants, and it would respond as information became available.46 38 Q 17–18, Department of Health and Social Care, UK COVID-19 vaccines delivery plan, 13 January 2021 39 Qq 5, 19, Department of Health and Social Care, UK COVID-19 vaccines delivery plan, 13 January 2021 40 Qq 3, 8, 18 41 Qq 3–4, 6, 16, 22 42 Q 37, C&AG’s Report, para 5, 28, 4.13–14 43 Q 33 44 Qq 33, 36 45 Qq 35–36 46 Qq 37–38 COVID-19: Planning for a vaccine Part 1 15
17Decisions about who will be vaccinated were taken by the Secretary of State for Health...
Concluded (the committee's words)
Decisions about who will be vaccinated were taken by the Secretary of State for Health and Social Care, as is the case with all vaccination programmes, based on advice from the Joint Committee on Vaccination and Immunisation.47 The Joint Committee identified nine priority groups for the first phase of vaccinations to maximise the effectiveness of the programme and prevent further deaths from COVID-19. These groups were predominantly based on age in light of evidence that this was the single greatest risk of mortality from COVID-19. When the groups were announced, the Joint Committee recommended that the second phase of the vaccination programme should focus on preventing further hospitalisation and acknowledged that vaccinating those at increased risk of exposure due to their occupation could also be a priority.48 In its written evidence to us, the Nuffield Council on Bioethics told us that it would be important that Governments were transparent about their prioritisation strategies for delivering vaccines and good communication about the values, evidence and criteria behind those decisions would be key.49 We also received written evidence from JKS Bioscience Limited, which told us that, as well as older people, the vaccine programme should prioritise: medical staff and care staff; school teachers and staff; University students, staff and researchers; and workers and consumers.50
18We asked what progress had been made in identifying who would be prioritised in the...
Concluded (the committee's words)
We asked what progress had been made in identifying who would be prioritised in the next phase of the vaccine programme and whether those in key services, for example education, transport and those working in supermarkets, would be given priority. NHSE&I told us that, while these were decisions for Ministers and the Joint Committee, it thought that there was a strong case for asking the Joint Committee to consider specific groups, particularly teacher and other key workers, once the first priority groups had been vaccinated.51 The Department explained that, to support those decisions, it would be important to know more about the extent to which the vaccines stop the transmission of the virus, as well as the extent they stop people getting sick and how long protection from the vaccines lasts.52 Getting the vaccines to the right people at the right time
19Each potential vaccine will require different plans for deploying it to the public because each...
Concluded (the committee's words)
Each potential vaccine will require different plans for deploying it to the public because each vaccine has different characteristics. This includes the temperature vaccines need to be stored at, their shelf-life once open, and any preparatory work needed before they are administered.53 The Pfizer Inc and BioNTech SE vaccine, for example, must be stored at minus 70°c. In comparison, the vaccine developed by the Astra-Zeneca Ltd—University of Oxford partnership can be stored at between 2°c and minus 8°c. The former Chair of the Taskforce confirmed that the Taskforce considered the logistics needed to administer a vaccine as part of determining which vaccines to buy, but that its overriding concern had been whether the vaccine itself would work.54 PHE acknowledged that delivering the Pfizer vaccine was “the most tricky” but was confident that its previous experience 47 C&AG’s Report, para 1. 48 Department of Health and Social Care, Joint Committee on Vaccination and Immunisation: Advice on priority groups for COVID-19 vaccination, 30 December 2020, updated 6 January 2021 49 PFV0004 – Written Evidence submitted by Ms Richella Logan on behalf of Hugh Whittall, Director of Nuffield Council on Bioethics, 50 PFV0001 – Written Evidence submitted by Karl Simpson, Director JKS Bioscience Limited 51 Q 7 52 Qq 9–10 53 C&AG’s Report para 2.2, 4.4–4.7 54 Q 65 16 COVID-19: Planning for a vaccine Part 1 of delivering vaccinations programmes meant it had the skills and expertise it needed to deal with each vaccine.55 We asked about anecdotal reports of teething problems with the roll-out of the vaccines, including double vaccines appearing at GP practices, or people expecting one type of vaccine and receiving another. NHSE&I told us that it investigated any mistakes to work out what had happened and how to ensure they were not repeated. It emphasised, however, that 97.3% of the vaccine deliveries, and 98.15% of all deliveries related to the vaccine programme, had been on time and in
20In September 2020, NHSE&I estimated that it could need up to 46,000 additional staff to...
Concluded (the committee's words)
In September 2020, NHSE&I estimated that it could need up to 46,000 additional staff to deliver the COVID-19 vaccination programme, including 26,000 vaccinators and 20,000 administrative staff. It planned to fill these posts through a combination of existing primary care staff and targeted local recruitment campaigns.57 At the time of our evidence session, the Department had recruited 80,000 people to deploy the vaccines.58 NHSE&I told us that while the workforce needed for the programme had been “of real concern”, the response to its call for volunteers and clinical staff had been “incredibly successful – more so than we could ever have imagined”. Over 200,000 people expressed an interest in supporting the vaccine programme. Not all of those who volunteered will be deployed immediately, but NHSE&I told us that it was confident it had the staff it needed to scale-up the programme as planned.59 Local distribution
21The NHSE&I concluded that it was not possible to deliver both the COVID-19 and seasonal...
Concluded (the committee's words)
The NHSE&I concluded that it was not possible to deliver both the COVID-19 and seasonal flu vaccinations solely through existing arrangements such as GP practices and community pharmacies. In response, it developed three new delivery models to take account of different groups and different regional needs. Each region must choose the delivery models that best suit local conditions.60 We asked NHSE&I what oversight it had of local decision making about the programme and how it was taking into account the different proportions of priority groups in local areas.61 NHSE&I recognised that it would be unfair for one part of the country to run significantly ahead of others and that it was conscious of the trade-off between ensuring complete equity in the supply and availability of vaccines and in ensuring as many people were vaccinated as quickly as possible. It explained it was working to ensure that all Primary Care Networks (PCNs) were able to vaccinate those over 80 and care home residents. Where PCNs had been able to successfully vaccinate all those over 80 in their area, it had so far redistributed vaccines to those PCNs who had a larger group of people over 80 to vaccination and who still needed doses. It confirmed, however, that “as soon as we are at reasonable coverage”, it expected to be able to talk to the Chief Medical Officers about pushing out as many vaccines as possible.62
22We were concerned that this approach risked creating a ‘stop-start’ system where the logistics for...
Concluded (the committee's words)
We were concerned that this approach risked creating a ‘stop-start’ system where the logistics for vaccinations people were in place, but would be difficult to get up and running again if the roll-out was paused while other areas caught up. NHSE&I confirmed 55 Qq 63–65 56 Q 67 57 C&AG’s Report, para 4.13 58 Q 77–78, Department of Health and Social Care, UK COVID-19 vaccines delivery plan, 13 January 2021 59 Qq 77–78, Department of Health and Social Care, UK COVID-19 vaccines delivery plan, 13 January 2021 60 C&AG’s Report, para 26, 4.8–4.11 61 Qq 68, 81 62 Q 81 COVID-19: Planning for a vaccine Part 1 17 that it was bearing in mind the importance of having a smooth distribution in addition to vaccinating priority groups as soon as possible. It noted that the mix of delivery models, including mass vaccination centres and community pharmacies, would be essential in helping smooth the distribution of vaccines in local areas and meet the needs of the population in each area.63 NHSE&I changed how it communicated with PCNs about what and how many vaccines would be delivered each week, including communicating directly with vaccine sites to ensure information was not delayed. It told us that, as of the end of the day, it would also have shared information with PCNs on the supply of vaccines available over the next two weeks rather than only the next week, so that PCNs could better plan ahead. It explained that it would contact individual PCNs if additional supply became available and would focus any additional supplies on PCNs with the largest populations of the priority groups being vaccinated to ensure that they had enough to vaccination patients in “roughly the right order” without holding up overall deployment.64
23In its written evidence to us, the Nuffield Council on Bioethics noted that COVID-19 had...
Concluded (the committee's words)
In its written evidence to us, the Nuffield Council on Bioethics noted that COVID-19 had a disproportionate impact on groups who already had unmet health needs, such as poorer and BAME communities, those living in care and those with learning disabilities. It explained that it was important that plans for the allocation and distribution of the vaccine carefully considered these groups in order to avoid exacerbating existing inequalities.65 We asked PHE how it was ensuring that communities, vulnerable groups, or those with specific needs such as people with learning disabilities, were not being left behind by the vaccine programme. PHE recognised that COVID-19 risked amplifying the impact of inequalities, particularly those with learning disabilities, and committed to writing to us about what specifically it was doing to support those affected.66 63 Q 82 64 Qq 67–68 65 PFV0004 – Written Evidence submitted by Ms Richella Logan on behalf of Hugh Whittall, Director of Nuffield Council on Bioethics, 66 Q 89 18 COVID-19: Planning for a vaccine Part 1 3 Part Three – Public confidence and communication Expectations for the vaccines programme
24NHSE&I recognised that its goal of vaccinating the top four priority groups by mid- February...
Concluded (the committee's words)
NHSE&I recognised that its goal of vaccinating the top four priority groups by mid- February was a huge task.67 We noted that it would be essential for Departments to be clear in the language they used to describe progress with the vaccine programme to avoid over-promising and under-delivering. We asked what counted as a vaccine having been offered and how it was monitoring and reporting progress. NHSE&I explained that it could not force people to take the vaccine, so was monitoring progress on the basis of how many people had been offered a vaccine.68 It planned the roll-out of the vaccine on the assumption that 75% of people who are offered the vaccine will take it.69 We were concerned by the potential for confusion between expected take-up and figures currently in the public domain about the number of people who will be vaccinated. If, for example, 25% of each cohort choose not to take-up the offer of a vaccine, then the programme would not be able to meet the expected number of people being vaccinated.70 NHSE&I told us that national data on the roll-out of the vaccine had been published each week and would now be published on a daily basis. It confirmed that it expected to publish localised data by region, and by local authority if possible, within the next 7–10 days.71 However, while government aims to have offered a vaccine to 12.2 million people by 15-February, its daily and weekly progress reports only include statistics on the number of “announced vaccinations” i.e. vaccinations that have been administered rather than how many have been offered.72
25When it was first rolled-out, the vaccine programme included a three-week break between people receiving...
Concluded (the committee's words)
When it was first rolled-out, the vaccine programme included a three-week break between people receiving their first and second doses. In December 2020, the Government announced that the second dose of the vaccine would be administered 12 weeks after the first dose.73 We asked why this decision had been made and whether it would be reviewed in light of the current, or future, lockdowns. The Department explained that the decision was based on the advice of the Joint Committee on Vaccination and Immunisation and the Chief Medical Officers and “basic maths” that it was better to get a first dose to as many vulnerable people as possible and delay the second dose, than to give second doses to the same people. It emphasised that the second dose was still very important to vaccinating people against the virus, but the more the virus spread, the more important it was to maximise the number of people who had the first dose. It confirmed that its decision was not explicitly linked to the lockdown, and it would “keep all those things under constant review as the evidence develops”.74 67 As of 10 February, in the UK, 12,646,486 people had received a first dose and 516,392 people had received a second dose, indicating that the government is on track to achieve this target. https://coronavirus.data.gov.uk/ details/vaccinations 68 Q 6 69 Q 6, C&AG’s Report, para 4.2 70 Q 74 71 Qq 3, 20–23 72 NHS England – Data on CVID-19 Vaccinations 73 Statement from the UK Chief Medical Officers on the prioritisation of the first does of COVID-19 vaccines, 30 December 2020 74 Qq 51–52 COVID-19: Planning for a vaccine Part 1 19 Expected take-up of the vaccine
26In 2019–20 the long-established seasonal flu vaccination programme had a take-up rate of 72% among...
Concluded (the committee's words)
In 2019–20 the long-established seasonal flu vaccination programme had a take-up rate of 72% among those aged 65 years and older, and up to 45% for those aged 64 years or younger. NHSE&I explained that it was using the flu vaccine as an indicator for expected take-up of the COVID-19 vaccine programme as both targeted the same age group. In addition, the COVID-19 vaccine programme was being rolled-out at a time of increased concerns about the virus in the older population. NHSE&I recognised that, while a useful indicator, take-up rates of the flu vaccine would not determine take-up of the COVID-19 vaccines, but asserted that early signs of take-up among those aged 80 and above were very strong. It confirmed that its plans for the supply of vaccines meant the enough would be available should take-up rates be higher than expected.75
27PHE recognised that people trust their local GP, local faith groups and community groups so...
Concluded (the committee's words)
PHE recognised that people trust their local GP, local faith groups and community groups so public health organisations and local government will have an important role to play to encourage people to take-up the vaccine. Flu vaccination programmes have also shown the importance of convenience and location to the take-up of vaccines, particularly within harder to reach communities.76 We therefore asked about reports that people had received letters sending them to mass vaccinations which were not close to where they lived. The Department confirmed that while people had been invited to larger-scale vaccination centres, this was “simply an additional option that some people may choose to avail themselves of” and that those individuals would also receive an invitations from their local GP service to have the vaccine at a more convenient location if they would prefer.77 Communication about the vaccine programme
28The number of people who choose to have the vaccine will ultimately be determined by...
Concluded (the committee's words)
The number of people who choose to have the vaccine will ultimately be determined by public trust in the vaccines.78 Our previous reports have shown the importance of clear and consistent communication and that a lack of information during the pandemic, or repeatedly changing and updating guidance, can be confusing and frightening for those affected.79 The Department of Health & Social Care is responsible for developing a communications plan and communicating with the public about the vaccination programme. It established a cross-Government communications team, including representatives from the Vaccine Taskforce and the Cabinet Office, to consider communication about the vaccine. The Department of Health & Social Care explained that communication about the COVID-19 vaccine programme was more difficult than with other vaccine programmes because the situation was evolving so rapidly. In June 2020, Public Health England emphasised the need for attitudinal research to inform the communications strategy, but this research was not complete in time for the first vaccinations. PHE confirmed that it still planned to undertake a range of attitudinal surveys, and was working with Newcastle University and the London School of Hygiene & Tropical Medicine as part of this as well as undertaking weekly polling through YouGov.80 75 Qq 72, 92, C&AG’s Report para 24 76 Q 88 77 Q 12 78 C&AG’s Report, para 24, 4.3 79 Committee of Public Accounts, COVID-19: Government procurement and supply of personal protective equipment, HC 928, 10 February 2021 80 Qq 88, 124, C&AG’s Report, para 24, 4.3 20 COVID-19: Planning for a vaccine Part 1
29Research commissioned by PHE showed that about two-thirds of the population were very likely to...
Concluded (the committee's words)
Research commissioned by PHE showed that about two-thirds of the population were very likely to take-up the vaccine, around 10% were unlikely, and the rest were uncertain. For those who were uncertain or unlikely to have the vaccine, efficacy and safety were the key issues. We asked witnesses what were the key risks to public confidence in the COVID-19 vaccines. NHSE&I that these were very similar to other vaccine programmes that the NHS ran successfully each year, but that the scale of the programme and the newness of the supply chain were different. The Department of Health & Social Care recognised the need for clear messaging to enable the public to understand progress with the vaccine programme and be assured that the vaccines were being deployed safely and properly.81
30We were concerned by reports of confusion among health professionals and the public about what...
Recommended (the committee's words)
We were concerned by reports of confusion among health professionals and the public about what to expect from the vaccine programme and when. We asked NHSE&I how it was ensuring clear lines of communication so that people had access to accurate information quickly and easily.82 NHSE&I explained that its messaging was first and foremost “you will be contacted”, in contrast to seasonal flu vaccinations where people could present themselves to their local pharmacist. We similarly asked NHSE&I whether it had a rebuttal unit to dispel any myths about the vaccine programme, or a Frequently Asked Questions section on its website to answer queries from the public. NHSE&I agreed that including FAQs about the vaccine programme on its website would be sensible and committed to introducing this immediately.83
31NHSE&I explained that it would give people “more than one channel and more than one...
Concluded (the committee's words)
NHSE&I explained that it would give people “more than one channel and more than one chance” to come forward for a vaccine. It expected to have to go back to people who did not come forward after being contacted to understand why they had not responded and give them another opportunity to take-up the vaccine.84 It similarly planned to use different ways to try to make sure that those who were vaccinated returned for their second dose, including pre-empting any issues by booking both appointments at the same time and putting in place procedures to identify and contact anyone who didn’t come to their second appointment.85 We were alarmed by reports of an individual calling on a house, charging money and administering a fake vaccination and how NHSE&I would ensure that such instances were not repeated. NHSE&I recognised the need for “great vigilance” on this, but that it was ultimately a matter for the police and the Home Office.86 81 Qq 87–88 82 Qq 81–86 83 Qq 79–80 84 Q 89 85 Q 59 86 Qq 11, 89 COVID-19: Planning for a vaccine Part 1 21
Evidence
Oral evidence sessions 1
- 11 Jan 2021COVID-19: Planning for a vaccine (part 1)7 witnesses, listed belowparliament.uk ↗
Who gave evidence 7 witnesses
- Emily LawsonChief Commercial Officer, NHS England and NHS Improvement
- Kate BinghamChair, UK Vaccine Taskforce
- Michael BrodieChief Executive, NHS Business Service Authority
- Nick ElliottFormer Director General and SRO, Vaccine Taskforce, Department for Business, Energy and Industrial Strategy
- Sarah MunbyPermanent Secretary, Department for Business, Energy and Industrial Strategy
- Sir Chris WormaldPermanent Secretary, Department of Health and Social Care
- Sir Simon StevensChief Executive, NHS England and NHS Improvement
Correspondence 9 letters
- 14 May 2021Correspondence from Sarah Munby, Permanent Secretary, Department for Business, Energy and Industrial Strategy, re Response to the Committee re: Planning for a vaccine Part 1 PAC Report, dated 30 April 2021
- 20 Apr 2021Correspondence from Sir Chris Wormald KCB, Permanent Secretary, Department of Health and Social Care, re The panning for a Vaccine (Part 1) PAC hearing, dated 12 April 2021
- 16 Apr 2021Correspondence from Sarah Munby, Permanent Secretary, Department for Business, Energy and Industrial Strategy, re Response to the Committee re: Planning for a vaccine Part 1 PAC Report, dated 31 March 2021
- 16 Apr 2021Correspondence from letter from Sir Chris Wormald KCB, Permanent Secretary, Department for Health and Social Care, and Sarah Munby, Permanent Secretary, Department for Business, Energy and Industrial Strategy, re Panning for a Vaccine Part 1 PAC hearing, dated 7 April 2021To committee
- 16 Mar 2021Correspondence from NHS Chief Executive, Sir Simon Stevens, re Follow up to the Public Accounts Committee Oral Evidence Session on Covid- 19 Vaccines, dated 11 February 2021
- 8 Mar 2021Correspondence from Sarah Munby, Permanent Secretary Department for Business, Energy and Industrial Strategy, re Planning for a vaccine Part 1 PAC Report, dated 26 February 2021
- 25 Feb 2021Correspondence from Sir Chris Wormald KCB, Permanent Secretary, Department of Health and Social Care, re 11 Jan hearing on Covid 19 vaccine planning, dated 18 February 2021
- 1 Feb 2021Correspondence from Michael Brodie, Interim Chief Executive, Public Health England, re COVID-19: Planning for a vaccine (part 1), dated 25 January 2021
- 13 Jan 2021Correspondence from Sarah Munby, Permanent Secretary, Department for Business, Energy and Industrial Strategy and Sir Chris Wormald, Permanent Secretary, Department of Health and Social Care, re COVID-19 Indemnities, dated 31 December 2020