Why is there a problem with vaccinating in care homes

[notevenat20]

I was reading www.bbc.co.uk/news/uk-55166292 where it explains that:

"Roll-out is also difficult. Through a combination of the need to keep the vaccine at ultra-cold storage and the fact that the jab comes in batches of 975 that cannot be split up at the moment, immunisation will only be offered from a network of 50 hospitals to start with."

But I don't understand. Why can't they be split? And why can't you take out 975 and then drive them, with a flashing blue light, to different care homes? I believe the vaccine can survive a few days at fridge temperature.

They are only licensed for use in complete batches of 975. Once you have opened one they all have to be used. It’s not a yoghurt as JVT said , once opened they all have to be used you cannot put them back. it’s a very fragile and unstable culture, this is why we really need the Oxford vaccine to get approval.

Once you open a pack of 975 and use one, you can't literally have to use all the others immediately. They must last for some time at fridge temperature otherwise the whole thing is useless.

Survivable in fridge for up to week apparently

But I don't understand. Why can't they be split? And why can't you take out 975 and then drive them, with a flashing blue light, to different care homes? I believe the vaccine can survive a few days at fridge temperature

You can. Once thawed it can be kept perfectly happily in a normal medical fridge.

The issue is in who would staff the 'flying squads' - but some recently retired HCPs with military drivers could provide a very good service

It's simply a case of whether you see problems or solutions

Ignore JVT

Vaccine once thawed keeps at 2-5 degrees. But only for 5 days When taken out fridge keeps 2 hours but 6 if reconstituted. Advice us it shouldn't be moved about much. Just been on zoom meeting with 600 GPs in Lothian (and nurses and health board organisers) Pfizer avy hopefully next Tuesday for us and from 21st the Oxford available...much easier to move around and less chance of waste. 2 vaccination s 28 days apart but still works if longer. Immunity best from 7 days after 2nd vaccine but us some after first lot.
Public will need to accept reduced GP services as we help give over 80s vaccine in practice but we are also being asked to help give at mass hubs. It's all very exciting but it's logistics that the Pfizer isn't being distributed outside big centres.

The firm I work for has just finished work on a new vaccination centre. It’s the quickest project from quote to starting to completion ever!

And you can't easily transport an entire care home's residents in one go to the hospital hub where they have a batch open. Twice.

The issue is in who would staff the 'flying squads' - but some recently retired HCPs with military drivers could provide a very good service

That sounds good to me. Delivering vaccine to enough care homes that there are 975 people to receive it within a short time period seems like a doable logistics challenge.

@notevenat20

I was reading www.bbc.co.uk/news/uk-55166292 where it explains that:

"Roll-out is also difficult. Through a combination of the need to keep the vaccine at ultra-cold storage and the fact that the jab comes in batches of 975 that cannot be split up at the moment, immunisation will only be offered from a network of 50 hospitals to start with."

But I don't understand. Why can't they be split? And why can't you take out 975 and then drive them, with a flashing blue light, to different care homes? I believe the vaccine can survive a few days at fridge temperature.

The issue is that this particular vaccine won’t survive and function correctly if it’s split with 50 for this care homes residents, and 925 then moved on the 875 moved on etc

It also needs a follow up, so either 50 more have to be kept at the same temperature for 3 weeks or another batch sent out, split and passed on

If the logistics and storage are there with a suitable number of recipients around then it’s viable, otherwise the Oxford vaccine is more suitable

And you can't easily transport an entire care home's residents in one go to the hospital hub where they have a batch open. Twice.

Right. I was assuming the vaccine would go to the care homes not the other way round.

It lso needs a follow up, so either 50 more have to be kept at the same temperature for 3 weeks or another batch sent out, split and passed on

Doesn't it make sense to use another batch for the second dose as it happens quite a bit later.

Radio 4 were also stating the vaccine can only be moved 4 times as well

The issue is that this particular vaccine won’t survive and function correctly if it’s split with 50 for this care homes residents, and 925 then moved on the 875 moved on etc

Sorry - am I missing something, but this doesn't make sense

"It also needs a follow up, so either 50 more have to be kept at the same temperature for 3 weeks or another batch sent out, split and passed on*

No, none will be kept thawed for 3 weeks as it only stays effective/safe for 5 days. Your second jab will not be the same as first jab

If the logistics and storage are there with a suitable number of recipients around then it’s viable, otherwise the Oxford vaccine is more suitable

Oddxf s likely to be easier, as you don't have a 5 day window between thawing and administration.

But really, it isn't difficult tomcinfirm the number of recipients on the 'flying squad's' round that day, and take the correct amount with you (with rest left for use at a high traffic hub)

Work in nhs and part of this work. It is so far from simple it’s untrue. But yes as a pp said, the first vaccine is too unstable to be moved once it is delivered. When the second vaccine is ready that will be what primary care use to vaccinate care homes and the housebound as well as their other patients in fixed sites they will have as part of their primary care networks.

Everyone working on this is working insane hours with ridiculous pressure to make it happen. And no, as I said above none of it is simple. And if you think people haven’t been looking for solutions not problems, you just haven’t been involved in it. Everything looks easy until you have the details.

Sorry if I sound a bit arsey but so many of us in supporting functions have worked our arses off all year to keep clinicians working, and it’s never enough!

Radio 4 were also stating the vaccine can only be moved 4 times as well

I must be missing something but I was thinking it could go like this. First, batch taken out of freezer, split into 10 sets (say) and put into 10 separate fridges. Each fridge is taken by a different group to a different care home. So each vaccine is only ever moved once.

Seems bonkers to risk movement going wrong and ending up wasting large numbers, when you can just as easily use these on NHS workers and wait a few weeks longer for the Oxford vaccine.
In any case if it’s only licensed by the MHRA to be used in batches it doesn’t matter how brilliant your logistics specialists are, you have to follow the rules.

@notevenat20

It lso needs a follow up, so either 50 more have to be kept at the same temperature for 3 weeks or another batch sent out, split and passed on

Doesn't it make sense to use another batch for the second dose as it happens quite a bit later.

Yes. It makes more sense for a new batch on the follow up. I was meaning to refer to it being a way of dealing with the 975 doses - you either need to distribute to 975 recipients and repeat, or about 480 and make sure you store properly in the meantime (either storing at a cold enough temperature in the multiple locations or redistributing)

Do you not think if it was that simple that it would be done already? And even if you can use flying squads, split cases or whatever, that takes more manpower, more resources, more time,more logistics, probably more wastage... is it worth all that to ensure that group 1 gets vaccinated absolutely first, as opposed to getting on with vaccinating some group 2 and waiting a few weeks for a simpler and easier solution (Oxford) for group 1? Is it that absolutely vital to go in the precise order from the JCVI?

Seems bonkers to risk movement going wrong and ending up wasting large numbers, when you can just as easily use these on NHS workers and wait a few weeks longer for the Oxford vaccine.

That's a tricky calculation as all unvaccinated people in care homes are at some risk of catching a fatal disease. Also the Oxford vaccine does not seem quite as good, at least according to the press releases.

In any case if it’s only licensed by the MHRA to be used in batches it doesn’t matter how brilliant your logistics specialists are, you have to follow the rules.

This may be the key point.

R4 guy said it can only be moved 4 times once manufactured. So once from "factory"/ lab, once from transport to storage in this country, then to a hosp - and I may have missed out another stage as I know nothing about medicine logistics, so that's your four!

Is it that absolutely vital to go in the precise order from the JCVI?

This depends on an estimate of how many extra people in care homes will die for each week their vaccination is delayed. I don't have that figure.

The Pfizer vaccine is complex and can't be moved too many times. The journey it makes to the hospital site must be the last one - it can't be moved again.

The Pfizer vaccine is complex and can't be moved too many times. The journey it makes to the hospital site must be the last one - it can't be moved again.

Do you have a reference for this fact,?

@notevenat20

Radio 4 were also stating the vaccine can only be moved 4 times as well

I must be missing something but I was thinking it could go like this. First, batch taken out of freezer, split into 10 sets (say) and put into 10 separate fridges. Each fridge is taken by a different group to a different care home. So each vaccine is only ever moved once.

I don't know the details but common sense says you must be missing something unless you know something that all of the many hugely qualified people who've been working on this non stop for months have failed to notice. I'm sure there must be a way to contact them with your solution just in case.