The full list of hospitals where Pfizer jabs will be given to the first British recipients were revealed last night as the UK military carried out dry-run drills for the country's biggest-ever mass vaccination.
Fifty trusts are poised to roll out Pfizer's coronavirus vaccine when the first of 40 million doses are administered from next week, with 13 in the Midlands, eight are in the North West, South East and South West, seven are in the East of England and London, and only one in each of Yorkshire and the North East regions.
The Army held a trial run at one of the first mass vaccination sites where tens of thousands of patients will be immunised after NHS chief executive Sir Simon Stevens told a Downing street press conference yesterday that the logistics of getting the vaccine out to people will be 'complicated'.
Care homes were told they will have to wait because the stock can't be broken down into batches smaller than 975 at a time. The vaccine, which must be kept at -70°C (-94°F) until shortly before it is used, means storage must meticulously controlled for the entire distribution and storage process.
Such stringent requirements mean hospitals equipped with ultra-cold freezers have been called upon to act as 'hubs' where the first people will receive jabs.
The drill, code-named Exercise Panacea, took place at Ashton Gate football and rugby stadium in Bristol. Approximately seven regional hubs will be used to vaccinate the wider population as GP surgeries target at-risk patients and hospitals are used to immunise NHS and care home staff, as well as some patients.
The Government and NHS will have to get extra permission from the MHRA to break the vaccine supplies down into smaller batches that could then be handed out to care homes to give to their residents. It is not yet clear how long this might take, but Sir Simon said most of the vaccinations would be given out in 2021, not this year.
In yesterday's exercise 30 staff and volunteers were looped through the building pretending to be different types of patients, from one suffering an adverse reaction to one with symptoms or one who won't get the jab.
It is planned that vaccinations will be given at the stadium 12 hours a day, seven days a week. Other venues being prepared to be used as regional hubs include the Nightingale Hospital at London's ExCeL Centre, Leicester Racecourse and Manchester Tennis and Football Centre.
The NHS is expecting to immunise between 75,000 and 110,000 people a week at the stadium and other local facilities in Bristol and neighbouring North Somerset and South Gloucestershire between now and April.
The drill yesterday follows an earlier 'live play field exercise' code-named Exercise Asclepius that took place at Epsom Downs Racecourse in October to 'gauge the capabilities' of mass vaccination centres.
Initial batches of the Pfizer jab are already heading to Britain after a clinical trial suggested it was 95 per cent effective. It will be distributed at hospitals first, then GP surgeries and cities via stadiums and conference centres.
Doses - which have to be packed in dry ice - are coming from Belgium to a central warehouse in the UK, from which they will be sent to NHS hospitals around the country.
But there is growing confusion about which groups will get the first doses. The Joint Committee on Vaccination and Immunisation (JCVI) published its Covid-19 priority list yesterday, advising that care home residents and the staff who treat them should be the first in line to be inoculated.
However, officials warned they couldn't promise care homes would get the vaccine before anyone else, admitting 'whether or not that is actually doable depends on deployment and implementation'.
Sir Simon said in yesterday's briefing: 'The vaccine that has been approved for the NHS to deploy today, the Pfizer/BioNTech vaccine, has been independently shown to be medically safe, but it is logistically complicated.
'We have to move it around the country in a carefully controlled way initially at minus 70 degrees centigrade, or thereabouts, and there are a limited number of further movements that we are allowed by the regulator to make.
The 50 NHS hospitals that will start rolling out the vaccine
- Blackpool Teaching Hospitals
- Brighton and Sussex University Hospitals
- Cambridge University Hospitals
- Chesterfield Royal Hospital
- Countess of Chester Hospital
- Croydon University Hospital
- Dartford and Gravesham Hospitals
- Dorset County Hospitals
- East and North Hertfordshire Hospitals
- East Kent Hospitals
- East Suffolk and North Essex Hospitals
- Frimley Health NHS Foundation Trust
- Gloucestershire Hospitals
- Great Western Hospitals
- Guys & St Thomas NHS Trust
- James Paget University Hospitals
- Kings College Hospital
- Princess Royal University Hospital, Kings
- Lancashire Teaching Hospital
- Leeds Teaching Hospital
- Leicester Partnership NHS Trust
- Liverpool University Hospitals
- Medway NHS Foundation Trust
- Mid and South Essex Hospitals
- Milton Keynes University Hospital
- Norfolk and Norwich University Hospital
- Northampton General Hospital
- North Bristol NHS Foundation Trust
- North West Anglia Foundation Trust
- Nottingham University Hospitals
- Oxford Health NHS Foundation Trust
- Portsmouth Hospital University
- Royal Cornwall Hospitals
- Royal Free London NHS Foundation Trust
- Salford Royal NHS Foundation Trust
- Sheffield Teaching Hospitals
- Sherwood Forest Hospitals
- Shrewsbury and Telford NHS Trust
- Stockport NHS Foundation Trust
- St George's University Hospitals
- The Newcastle Upon Type Hospitals
- University College Hospitals
- University Hospitals Birmingham
- University Hospitals Coventry and Warwickshire
- University Hospitals Derby Burton
- University Hospitals of North Midlands
- University Hospitals Plymouth
- United Lincolnshire Hospitals
- Walsall Healthcare
- West Hertfordshire Hospitals
- Wirral University Teaching Hospital
- Worcestershire Acute Hospitals
- Yeovil District Hospital
'It also comes in packs of 975 people's doses so you can't at this point just distribute it to every individual GP surgery or pharmacy as we normally would for many of the other vaccines available on the NHS.
'So the phasing of delivery, the way we will do it, is that next week around 50 hospital hubs across England will start offering the vaccine to the over-80s and to care home staff and others identified by the JCVI typically they may be people who were already down to come into hospital next week for an outpatient appointment.
'So if you are going to be one of those people next week or in the weeks that follow the hospital will get in touch with you, you don't need to do anything about it yourself.'
He added: 'If the MHRA, the independent regulator, as we expect they will, give approval for a safe way of splitting these packs of 975 doses then the good news is we will be able to start distributing those to care homes.
'And then as even more vaccine becomes available finally we will be able to switch on large vaccination centres across the country and indeed invite local community pharmacists probably at the beginning of January to begin to offer vaccination as well.'
This is how the vaccine roll-out could look:
Next week: 50 hospitals around the UK will be set up as the first vaccination hubs and are expected to start work next week, the week beginning December 7. Patients over the age of 80 and health and care workers are expected to be the first people to be invited for vaccinations at hospitals.
Following weeks: The NHS's chief executive, Sir Simon Stevens, said he expected that doctors surgeries would be able to start offering vaccines to vulnerable people in the 'subsequent weeks'.
This month: The Government and NHS will have to get extra permission from the drugs regulator, the MHRA, to break down the vaccines into batches smaller than 975 doses at a time. Officials must wait for this approval before they can take the jabs out into care homes, because transporting them in any way that is less than perfect could make the vaccine unstable and stop it working once it is injected.
January 2021: Sir Simon said that 'as even more vaccine becomes available' at the start of 2021, the NHS would be able to start opening more vaccination centres outside of hospitals and also make them available in local pharmacies. This is expected to be the last phase of the programme and will coincide with jabs being offered to younger and healthier groups of people.
To keep doses of the jab at this ultra-low temperature, they need to be packaged with dry ice and placed in a special transport box the size of a suitcase which hold 5,000 doses.
These containers can prevent the vaccines from spoiling for 10 days if they remain unopened. Once the batches arrive at vaccination hubs, they can be stored in standard medical fridges at between 2°C and 8°C for up to five days. Or they can be kept in their shipping boxes for up to 30 days if the containers are topped up with dry ice at least once a week.
Fifty NHS hospitals in England are already equipped with super-cold freezers that can keep the vaccine at -70°C, meaning healthcare staff could be inoculated first. However, the sticking point for care homes may be that BioNTech says that the vaccine can only be kept at between 2°C and 8°C for six hours in transit without going off.
Because the Pfizer suitcases hold 5,000 vaccine doses, smaller quantities would have to be removed from the dry ice suitcases for transport to care homes.
But once they are in transit the doses could perish after six hours. Welsh Health Minister Vaughan Gething said the logistical issues meant 'in practical terms at this stage that we cannot deliver this vaccine to care homes'.
Matt Hancock hailed the jab's approval, claiming an end to the pandemic was now 'in sight', while Boris Johnson declared it would 'allow us to reclaim our lives and get the economy moving again'.
Some 800,000 doses of the Pfizer's vaccine - which requires people getting two doses 21 days apart - will be made available 'from next week'. The UK has ordered 40million doses in total, with 10m due by the end of 2020 and the rest next year.
Mr Hancock declared the vaccine drive 'one of the biggest civilian logistical efforts that we've faced as a nation'. 'It will be difficult,' he said. 'There will be challenges and complications, but I know that the NHS is equal to the task.'
He added: 'We will deliver according to clinical prioritisation and operational necessity because of the need to hold the vaccine at minus 70 - it makes this vaccine particularly challenging to deploy.'
Mr Hancock outlined how vaccines will be rolled out across the country, including using 'conference centres and sports venues'. He said: 'While we begin vaccination next week the bulk of the vaccinations will be in the New Year, but I would urge anyone called forward for vaccination by the NHS to respond quickly to protect themselves, their loved ones and their community.
'Over the next few months, we will see vaccines delivered in three different ways. First, we will begin vaccinations in hospital hubs. Second, we'll deploy through local community services including GPs and, in due course, pharmacies too.'
Once the vaccine arrives in the UK from Pfizer's plant in Belgium, batches will be checked at a central warehouse to ensure their quality. The vaccine will then be unloaded and moved to storage freezers where it will undergo an additional temperature check.
Public Health England (PHE) will process orders placed by the NHS for next day delivery to hospital hubs around the UK. At this point, the first stage of the rollout process can begin.
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