Exclusive: NHS planning to start covid vaccination of under 50s by end of January

Under the plan, everyone who wants to would have been vaccinated by early April.

NHS England’s draft covid-19 vaccine deployment programme, seen by HSJ,  reveals when each cohort is likely to begin receiving it, based on its plans to create huge capacity across GP-run facilities, “large scale mass vaccination sites”, NHS trusts, and “roving models” for those who cannot travel.

It relies on a range of assumptions including that there will be 75 per cent takeup, outside of residential settings like care homes and prisons, where 100 per cent is expected.

The plan also relies on supplies, including more than 7 million doses being available in December. It is not clear what impact a delay to this would have on the rollout. With most doses due to be administered between early January and  mid March — at a rate of 4-5 million every week — a small delay may not make a huge impact to the overall schedule.

The document is dated 13 November and was shared among some senior NHS regional leaders yesterday.

The document sets out, under this main planning scenario, when each population group would begin to receive the vaccine. Cohorts would run concurrently — one does not need to be completed before another starts.

It starts with care home residents, social care workers and healthcare workers at the beginning of December. It states that there is uncertainty about whether government will decide if unpaid carers are included in the care worker cohort — if so, it would add more than 5 million people to this priority group.

The plan would see vaccination of all priority cohorts completed by the end of February, with everyone who wants it in the English over-18s population vaccinated by April.

The dates pencilled in for beginning each group are:

• Care home residents and staff, healthcare workers - from beginning of December;
• Ages 80 plus - from mid-December;
• Everyone aged 70-80 - from late December;
• Everyone aged 65-70 - from early January;
• All high and moderate risk under 65s - from early January;
• Everyone aged 50-65 - from mid January; and
• Everyone aged 18-50 - from late January; but with the bulk of this group vaccinated during March.

The plan would see 88.5 million vaccination doses delivered across England, with two doses per person over the age of 18, by the end of April. The doses must be given 28 days apart, for both the Pfizer/BioNTech vaccine (known in the planning documents by the codename Courageous) and the Oxford/AstraZeneca vaccine (known by the name Talent), according to the document.

The document stresses the plan is based on current supply intelligence, subject to data from trials and licensing by regulators, to some unknowns about logistics of delivery, and government decisions about priority groups.

Huge capacity

The document outlines the huge capacity to administer doses. The biggest total — 33.9 million — are due to be done at “community mass vaccination sites”, of which GPs have been asked to establish about one in each primary care network (around 1,000 nationally). However, only 6 million fewer — 27.7 million — are pencilled in for “large scale mass vaccination centres”, of which there are expected to be around 40-50 across England in conference centres, stadiums and similar venues.

On top of this, nearly 2 million would be delivered by NHS trusts to their staff (between December and mid January), and roving teams would deliver 3.5 million to care homes, people who are housebound, and detainees.

Vaccination large scale and community centres (including those operated by primary care) will be operational seven days a week, 12 hours per day.

The plan also states that: “Eligible individuals will be able to book a vaccine at any available vaccination site of their choice irrespective of distance from their home address.”

Modelling suggests there is expected to be 15-20 per cent of vaccine wasted, but the service is being asked to keep waste to an “absolute minimum”, according to the plan.

The document includes little detail on the logistical challenges of getting the vaccines — which rely on strict cold-chains — to the right sites at the right time.

An NHSE spokeswoman said:  ”These earlier draft slides are no longer up to date relative to the latest information from companies on likely supply schedules, and as there is of course as yet no authorised vaccine in the world the NHS is having to plan for many different scenarios.” NHSE provided no further updated information.

The Department of Health and Social Care declined to comment on whether unpaid carers would be included in the priority cohort, but said: “The NHS has vast experience delivering widespread vaccination programmes and an enormous amount of planning has taken place to ensure our health service stands ready to roll out a covid-19 vaccine.”

Updated at 6pm on 20 November after NHSE provided a comment.