The National Audit Office publishes a report in which it has examined the UK government’s progress in securing potential coronavirus vaccines and determining how they will be deployed to the public.

First published in December 2020.

  • Government has had to work at pace without any certainty that an effective vaccine would be found.
  • Decision was taken to purchase different types of vaccines from different pharmaceutical companies to create a diverse set of options.
  • Total cost to the taxpayer of purchasing and deploying the vaccines is uncertain.
  • Government signed contracts with five pharmaceutical companies.
  • Contracts contain some form of indemnity protection for companies in the event of liabilities or legal action.
  • Assumption is that up to 25 million people could be vaccinated against COVID-19 in England throughout 2021.

The National Audit Office (NAO), the UK’s independent public spending watchdog that scrutinises public spending for Parliament and is independent from government and civil service, published a report today on the UK preparations for potential COVID-19 vaccines and vaccination campaign.

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, the NAO writes.

Dealing with many potential vaccines

In its report, Investigation into preparations for potential COVID-19 vaccines, the NAO finds that the UK government has worked quickly to secure potential COVID-19 vaccines, successfully signing deals for five vaccines:

  • Astra Zeneca UK Limited and the University of Oxford for 100 million doses (signed in August 2020);
  • Valneva SE for 60 million doses (signed in September 2020);
  • Pfizer Inc and BioNTech SE for 40 million doses (signed in October 2020);
  • Novavax Inc for 60 million doses (signed in October 2020); and
  • Moderna Inc for 7 million doses (signed in November 2020).
National Audit Office.

The Department for Business, Energy and Industrial Strategy (BEIS) chose to purchase different types of vaccines from a range of pharmaceutical companies to create a diverse set of options, rightly recognising the uncertainty over which ones, if any, would eventually prove to be safe and effective.

The NAO found that the BEIS “originally intended to purchase up to 12 vaccines, later reducing the number to up to nine as its understanding of requirements and costs developed.”

Cost and contracts

The cost to the taxpayer of providing up to 267 million doses is expected to be £2.9 billion. (Those vaccines will be bought for the UK, Crown Dependencies and Overseas Territories. Scotland, Wales, Northern Ireland, Crown Dependencies and Overseas Territories are then each responsible for deploying the vaccine to their own populations.) BEIS agreed upfront payments of £914 million in the five contracts it signed, prior to any vaccine being approved by regulators – payments used to start manufacturing and to support clinical trials.

The total cost to the taxpayer of government’s efforts to purchase and deploy vaccines, however, remains 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.”

Only one of the five contracts BEIS has signed with the pharmaceutical companies “provides for the full upfront payment to be refunded should the vaccine fail to achieve regulatory approval. Two other contracts contain provisions for BEIS to recover some of the upfront payments if the contract is terminated, “but for the remaining two contracts the upfront payments are non-refundable.”

The NAO adds to its report that many of the pharmaceutical companies also “requested immunity in the event of liabilities or legal action relating to their vaccines,” which means that the taxpayer may eventually 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.”

As part of the Spending Review in November 2020, the Department for Business, Energy and Industrial Strategy calculated that it needed £519 million to provide UK-based manufacturing capacity for vaccines. By December 2020, it had already committed £302 million of this to a range of manufacturing projects.

Alok Sharma. | Flickr - Number 10
For two of the contracts signed by Alok Sharma’s Department with pharmaceutical companies the upfront payments are non-refundable.

Delivering the vaccines

Because information about the COVID-19 vaccines is constantly changing and because each potential vaccine requires different plans for rolling it out to the general public (each vaccine has different sets of characteristics, such as the temperature it should be stored at, its shelf-life once open, and how it should be prepared before being administrated, etc. – characteristics which are still subject to change as clinical trials continue for some vaccines), NHS England and NHS Improvement (NHSE&I) is planning a vaccination programme with high levels of uncertainty,” the NAO suggests.

In its report, the NAO explains that NHSE&I is planning on the assumption it could vaccinate up to 25 million people with two doses throughout 2021.

NHSE&I has also concluded that it is not possible to deliver both the COVID-19 and seasonal flu vaccination programmes solely through existing arrangements such as GP practices and community pharmacies. It has therefore developed three models including offering vaccinations at large sites such as sports stadiums; mobile sites similar to polling stations; and roving units to take the vaccine to particular locations such as care homes.

National Audit Office.

Who will receive the vaccine?

“The Department of Health and Social Care’s (DHSC) policy objective is to vaccinate the entire adult population of England against COVID-19,” the NAO explains.

The Joint Committee on Vaccination and Immunisation (JCVI), an independent group of clinical experts who make recommendations to the Secretary of State for Health and Social Care (Matt Hancock) about which groups should be eligible for a vaccine based on its review of scientific evidence, has therefore been tasked with planning which groups should receive the vaccine before others, including health and social care workers and older adults living in care homes.

National Audit Office.

The scale of the vaccinations needed will require a significant additional workforce at a time when shortages exist. There are also concerns about staff well-being due to their ongoing efforts responding to the pandemic.

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%it may therefore 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.

In August 2020, DHSC began a consultation around changes to human medicines regulations in order to support the administration of COVID-19 vaccines. Among the suggested changes were:

  • the introduction of a new national protocol to allow registered healthcare professionals who do not normally vaccinate, and people who are not registered healthcare professionals, to safely administer the vaccine; and
  • expanding who is allowed to administer a vaccine to include occupational health professionals.

Because legislative changes came into effect last October, it has allowed NHSE&I since November to look for the workforce required for the vaccination programme from NHS professionals, doctors and nurses that have left the profession and first aid charities.

Welcoming the overall findings of the report, Gareth Davies, head of the National Audit Office, explains that “developing and securing an effective vaccine is central to reducing the impact of COVID-19 on society and saving lives.

Government has worked quickly and effectively to secure access to potential vaccines, using the available information to make big decisions in an inherently uncertain environment.

“With one vaccine now approved for use and its roll out started, significant challenges remain. Efficient delivery to the UK population presents complex logistical challenges and requires excellent communication with the public.🔷

Further Reading:

J.N. PAQUET, Editor of PMP Magazine.


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🗳️ Alok Sharma

🗳️ Matt Hancock

[This piece was first published in PMP Magazine on 16 December 2020. | The author writes in a personal capacity.]

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(Cover: Flickr/Number 10. - Matt Hancock. / Licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.)