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.

@tortoiseshell1985

Not baseless, there's a lot of disquiet about these two The truth will out

If you are going to libel by insinuation, you may as well go the whole hog and let the rest of know what the heck you are on about

Suggestions from my 9 and 11 year olds (6 o’clock news happened to be on at dinner time):

• they should put the vaccine in our advent calendar chocolates
• It should be an up the nose one like flu. In fact they should just add it to the flu vaccine. Why can’t they just do that, Mum?

Many thanks, small armchair scientists

Like previous posters I’m content that shedloads of good thinking has been done by the experts and that good pragmatic decisions will be made.

@DarkMintChocolate

I presume nobody here has been involved with giving injections to people with severe dementia, neurological disorders, learning disabilities and other conditions.

I’ve taken DD for 4 injections this year - no problems! The places she’s lived, the residents will be used to injections, canulas, x rays, MRIs, EEGs, video telemetry for days....possibly CT scans, PET scans, etc! She certainly is!

So because your DD is ok with vaccinations every care home resident is??? 😳 do you really believe that??? As someone who has worked in the care sector I can assure you that not all individuals will be cooperative or cope with having an injection without a significant amount of distress!

@DarkMintChocolate

I presume nobody here has been involved with giving injections to people with severe dementia, neurological disorders, learning disabilities and other conditions.

I’ve taken DD for 4 injections this year - no problems! The places she’s lived, the residents will be used to injections, canulas, x rays, MRIs, EEGs, video telemetry for days....possibly CT scans, PET scans, etc! She certainly is!

I’m presuming she’s not in an average care home where most of the residents have end stage dementia, BPSD and serious brain injury with very poor cognitive function/DoLs? Or with conditions like Parkinson’s which can cause extreme rigidity and involuntary movements? Giving an injection to someone who can’t stay still or simply is scared because they have no idea of what is going on is pretty difficult. If the residents can leave the care home for medical treatment it’s not a problem giving them a vaccine in hospital. Yes, I hope this can be accommodated as well as care home staff.

@notevenat20

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,?

I work for the NHS abs I'm involved in the planning process. Believe me, a huge amount of work and planning has gone into this operation. Delivering mass vaccinations is hugely complex, I'm pretty sure the experts have considered all the 'solutions' being offered by MN!

@Theotherrudolph my thoughts entirely. Why can't people a) just read b) trust that individuals whose job and qualifications enable them to plan this can do it properly.

@notevenat20

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,?

Page 4 of the third doc in this list.

www.gov.uk/government/publications/regulatory-approval-of-pfizer-biontech-vaccine-for-covid-19

The people whose job it is to move the vaccine and the people who are going to administer it, are logistics experts

NHS hasn’t really faced a challenge like this before, but the military (moving kit and things like blood which is time limited and temperature dependent) in and out of the conflict zones where they are deployed

It was heartening when they announced the military would be involved

But it seems that isn’t going to be the case after all

Vaccination and public health experts with years of experience: We are not going to be able to roll out this particular vaccine to these people for these reasons.

Mumsnetters: Ah, but I bet you haven't thought of doing it this way have you.....?

@notevenat20

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.

But these people need recruiting and managing/organising. How can thjs be set up by Monday ? Which I think is when we’re likely to have vaccines ready to give?

I’m sure they will do this if necessary but can’t sort it for next week. Things take ages. I’m an NMC registered professional and have signed up with NSHP to be a vaccinator. Apparently I have to have an interview. Wouldnt be surprised if I need a new dbs check! That takes weeks to do.

I can also see the reasoning behind nhs hospital staff first knowing the current staffing crisis in my local hospital due to staff having covid and/or isolating. 300 staff last week! Staffing levels are dangerous. Which obviously impacts on patients. Care home residents can be shielded as much as possible for a few more weeks. Nhs staff can’t.

I imagine the govt are hoping the Oxford vaccine will be ready before Xmas and then roll that out to care homes.

The question of splitting down batches, safely and appropriately, so they can be moved in smaller numbers to eg care homes is still under active review according to the two experts who have just done the BBC Breakfast Q&A (sorry, didn't catch their names, but one is that bloke who is on all the time, and the other was a woman scientist speaking from Oxford)

So I think some posters here are actually writing about the very things the NHS is currently doing (hopefully with expert logistic input eg from military)

@Passmeabottlemrjones it’s usually the same PP who are telling teachers what they should be doing during COVID times

If as it seems it is logistically difficult to vaccinate care home residents themselves then it makes perfect sense to vaccinate care home workers and medical staff. If nobody is taking infection into care homes, then that will protect unvaccinated residents.

Also, there is a lot of hospital transmission of covid. So again vaccinate those who come into contact with vulnerable groups and there will be huge benefits.

@Theotherrudolph

There’s doing some actual research into something you don’t understand, which is great. Then there’s coming across as knowing better than the hundreds of people whose actual job it is to work this stuff out and who have all the qualifications, data and experience and information you just don’t have.

I have absolutely no idea how my car engine works. I could watch some you tube videos or go on a mechanics course, while mostly just trusting my reputable garage to service my car correctly. Or I could start writing to Ferrari about their F1 car and why isn’t it faster and had they ever thought of putting a bigger engine it it and maybe chopping off the ugly bit at the back.

This ⬆️⬆️⬆️⬆️

Don't the MHRA have to approve any procedures like splitting the vaccine, also I guess the MHRA will be at some of the vaccination sites auditing that procedures are being properly followed.

@247SylviaPlath

Some people just love to be obtuse, like the OP. They’ll have an agenda and not want to listen or understand all the facts

Please don’t be disheartened. For every OP, there will be hundreds who have the capacity to understand the facts and are appreciative, thankful, for the work so many have been doing on this new terrible pandemic and these vaccines, distribution and vaccination plans. Thank you. Let your colleagues know too, remind yourselves when you come upon people like the OP, other naysayers, conspiracy theory believers, anti vaxxers etc - there are thousands upon thousands of people who are thankful to you all.

By the way, I stopped reading the thread shortly after Your post about what your colleagues were doing/hours working etc because it just so angered me you had to defend your position. Just wanted to give you some support.

• Page 4 of the third doc in this list. www.gov.uk/government/publications/regulatory-approval-of-pfizer-biontech-vaccine-for-covid-19*

That is the key information. Thank you!

Don't the MHRA have to approve any procedures like splitting the vaccine, also I guess the MHRA will be at some of the vaccination sites auditing that procedures are being properly followed.

Yes I believe that is correct.

@notevenat20

Don't the MHRA have to approve any procedures like splitting the vaccine, also I guess the MHRA will be at some of the vaccination sites auditing that procedures are being properly followed.

Yes I believe that is correct.

Do you have a link?

Genuine question, as I thought their role was in licensing, and that safe storage (appropriate for the drug in question) was a different body's responsibility. Very happy to be corrected, but would like to know the governance structures (and google hasn't yet shown a good answer, so I hope a well-informed MNetter can give a definitive link)

Thanks to @WiseUpJanetWeiss for the reference assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/940728/Conditions_of_Authorisation_for_Pfizer_BioNTech_COVID-19_vaccine.pdf .

I think all the answers to my question are on page 4 of that document.

The product as supplied in ultra low temperature conditions (ULT) has a stability of six months at a temperature of -70 +/- 10 degrees Centigrade.
 Distribution as part of the deployment can be controlled at either ULT (-70 +/- 10 degrees Centigrade) within four transitions below -15 degrees Centigrade, or in 2-8 degrees Centigrade within 120 hours of leaving ULT.
 Further packing down of lots to aid deployment can occur at 2-8 degrees Centigrade within the 120 hours shelf life of leaving ULT.
 Transit of the undiluted product at 2-8 degree Centigrade can occur either in two journeys each up to 6 hours or, where there are real deployment needs, for a maximum of 12 hours in one sitting. These times are to be taken within the 120 hour shelf life.
 The undiluted product can be held at room temperature below 25 degrees Centigrade for up to two hours prior to dilution.
 The product can be diluted at room temperature less than 25 degrees Centigrade using sterile unpreserved 0.9 percent sodium chloride and in line with the healthcare professional information supplied by the company
 The diluted product can be used within 6 hours of dilution and then must be discarded. Diluted product cannot be transported.

I see it also has to be diluted, is this usual for vaccines or are they normally supplied in ready to go vials?

Do you have a link?

I think it’s all in that MHRA document I just pasted.

Makes sense to vaccinate care home staff before residents are they are the initial cause of the spread. And fewer care staff off sick
Or self isolating means better care for the vulnerable residents

@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.

You’re missing

• the number of transport steps starts in the factory

• packing down involves defrosting, dividing the main container, assigning a new shelf life, labelling... all under refrigeration. The MHRA will only permit that if it’s done properly with no risk of mis-labelling or storage at the wrong temperature. You may think that’s an easy process to control, but you would be wrong.

• once defrosted, transport is time limited and it has to be at the correct low temperature. You can’t just stick them in a picnic cooler. You certainly can’t move a fridge...

Some people, some of them on this thread, have been working insanely long hours over the past several weeks to try to find a way to make this work for care homes, and they’ll keep trying, but it’s beyond tiresome when armchair experts assume otherwise. I understand the frustration, but if the vaccine does not reach the recipient in good condition it may not work. This cannot be fudged to meet a political deadline.

My mum lives in a care home and I desperately want her to get a vaccine... but only one that has been cared for properly.

@LightasaBreeze

I see it also has to be diluted, is this usual for vaccines or are they normally supplied in ready to go vials?

Not at all normal. Not unheard of.