Measuring success in the great UK vaccine roll-out (but we are not finished yet)

It was a record achievement that seemed against all odds – “a rare win”, the New York Times begrudgingly called it. By mid-February, more than 15 million people in the UK had received their first dose of a COVID-19 vaccine, putting the nation firmly on track to meet its mass vaccination targets by the end of July.

Such impressive figures have captured the world’s attention and are worthy of praise indeed. But the road has not been smooth, and new variants in the virus suggest further challenges are yet to come. With that in mind, is it too soon to call the UK’s story a success?

For one thing, planning the vaccination roll-out has been a nightmare for project leaders. Frequent changes to experts’ understanding of the virus – and indeed the patterns of its spread – have led to last-minute changes in strategy. The unprecedented nature of the crisis also goes some way towards explaining some of the mixed messages given and missed targets set by the government early on in the pandemic.

Organising the cold chain

Back in May 2020, Alok Sharma (then the UK’s business secretary) said the Oxford AstraZeneca vaccine group was working to make 30 million doses available by September for UK use. Fast forward to September, however, and vaccinations were still waiting to begin.

In November, the UK government’s vaccine taskforce told a House of Commons committee they had “low millions” of doses ready – although admittedly not yet in the vials healthcare workers would need them in – and that a total of four million doses were anticipated to be ready by the end of the year. So where had the other 26 million doses gone, and what was the hold up?

To answer this, Tom Keith-Roach, president of AstraZeneca UK, explained to committee members in late January that the slow nature of distribution early on had been unavoidable to an extent. Drug substance manufacture is a “complex biological process” which takes 58 to 60 days and “cannot be sped up”, he said. Once the biological product is grown, manufacturers have to apply finishing and packaging, which means each batch release takes a further 28 days, adding up to a three to four-month process in total. “In between that, you have extensive quality testing of every batch, ensuring the vaccine carries the spike protein, and there’s nothing else in there that shouldn’t be.”

Another possible explanation for the misalignment between government expectations and reality is likely to do with cold chains: the logistics involved to get vaccines from manufacturer to the public while maintaining the low temperatures required to keep the ingredients effective.

Toby Peters, a University of Birmingham professor and expert in the cold economy, believes that government ministers overlooked the scale of the project required to organise a cold chain, resulting in the delays seen at the end of 2020. “The day we started designing the vaccine, we should have started to design the cold chains to deliver it, because it was obvious we would need one,” he says.

Frequently moving goalposts

Communication, it’s clear, is a key factor in distributing a vaccine successfully. Without access to information such as how long the vaccine ingredients take to grow, project leaders have a tough time managing expectations.

“From a modelling perspective, the needs changed quite a lot and that impacted our anticipated flow,” says Melanie Bagot, a head of Kaizen promotion office tasked with leading the vaccination roll-out for the Mid Yorkshire Hospitals NHS Trust. “We have also grappled with the frequently moving goalposts of when we were set to go live with public vaccines,” she adds.

Managing these changes was a case of “keeping our finger on the pulse”, she says, helped by daily staff meetings and a flexible attitude towards scheduling that meant project leaders were able to “tweak things along the way. Often we’ve had to clear out our diaries to enable us to do this – we've had to be quite reactive.”

Overall, she believes government communications have been very good, certainly from an NHS point of view: “Yes there are frustrations as with every project but, as a whole, the programme has exceeded our expectations. At times they were updating us hourly and we also had meetings focused around learning from other sites.”

The UK can offer a positive example to other countries therefore – both in terms of communicating changes at scale, but also in advertising the power of having a centrally run national health service. But no matter how successful the UK is in delivering vaccines to its own citizens, to view the roll-out as a national project would be a mistake, experts believe.

“For us to be really safe, we need most of the world to be vaccinated,” says Charlotte Summers, an intensive care physician and one of the clinical researchers responsible for advising the UK government on COVID-19.

“Alongside this, we need to continue our research into finding new therapies for both the acute illness of COVID-19, but also for ‘long Covid’ – no vaccine is 100 per cent effective at preventing illness,” she warns. “The UK’s vaccine programme continues to be a success, but we are not finished yet.”