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.

@LightasaBreeze

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

I can't speak for all vaccines but for the flu vaccine at least it comes in a pre filled syringe ready to use and when my toddler had his baby jabs the vaccines i believe were in ready to go vials or again in a pre filled syringe. I am surprised actually that they will have to be prepared first before administration or atleast that sounds like from what the OP pasted.

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

Their role is much wider than you think

www.gov.uk/government/organisations/medicines-and-healthcare-products-regulatory-agency/about

don't know why they don't just hold on a few weeks for the full approval of the Oxford vaccine, which is roughly 4x cheaper and can be fridge stored the whole time - or at least make sure to incorporate using the Oxford instead soon as it's fully approved

@lubeybooby I'd say price isn't relevant now- we've already paid. Pre ordering allowed the development to happen, an investment if you will. Not using it won't save any money, and may cost lives.

don't know why they don't just hold on a few weeks for the full approval of the Oxford vaccine, which is roughly 4x cheaper and can be fridge stored the whole time

I guess some people will catch covid and die in those weeks who could have been saved by the Pfizer vaccine. Also, the Oxford vaccine doesn’t seem quite as effective.

[quote picklemewalnuts]@lubeybooby I'd say price isn't relevant now- we've already paid. Pre ordering allowed the development to happen, an investment if you will. Not using it won't save any money, and may cost lives.[/quote]
@picklemewalnuts I see yes that makes sense then, thank you

@notevenat20 the Oxford vaccine is still an insane way over the effectiveness they hope for when developing a vaccine though. I do hope it is utilised at some point

There are huge medical ethics issues regarding the vaccination programme - particularly around going into care homes.

First of all - the suitcases hold 950 doses - that's a specific amount, why not 1,000 doses?

It's obviously built that way as that's the right size and shape to keep the vials at the right temperature.

So if you take out 200 doses, I assume that alters the efficiency of the suitcase, so once you break open the suitcase, you have to use all of the doses.

Again an assumption but I assume the reason it isn't diluted until its thawed is because its harder to transport when diluted, maybe it doesn't hold the temperature, maybe it becomes unstable.

With care homes - there are issues in the vials. Each vial holds 5 doses. So you need to be vaccinating in batches of 5, as a minimum.

So if a care home has 7 residents, you have two choices, you use one vial - and vaccinate 5 out of the 7 people; or you open two vials, and waste three doses. Which as the vaccine is like gold dust, wastage won't be acceptable.

So you choose to vaccinate 5 out of 7 residents. Who do you choose? Who has more need, whose medical conditions are a priority?

Then what happens if Frieda, who didn't have the vaccine, gets Covid and dies. How do you explain to the family why George got the vaccine but Frieda didn't?

Who is responsible for making those choices? The care homes? The government? the NHS?

Because if you choose not to vaccinate Frieda, the family might be able to bring a claim for negligence. Who do they sue - the care home, the NHS or the Government?

I would assume that the care home staff can get vaccinated at the hospitals along with NHS staff. That should also be the same for any resident who is well enough to be conveyed to hospital.

That is a logistical challenge. You need ambulances to transport the residents to the hospitals, so you are limited on how many you can do per day.

I think there needs to be overlap in the tiers of priority, to keep the vaccination programme going.

There is no point waiting until you have vaccinated all the care home residents, before starting on NHS staff, if you have enough vaccine to get on with it.

Same with the over 80's. You are better to vaccinate 4 people who are over 80 and 1 person over 75, than vaccinate 4 people over 80 and waste the fifth dose because you don't have another person over 80 to take the last dose.

There are 800,000 doses arriving by Monday - so 400,000 people can be vaccinated. I don't think there are 400,000 people in care homes and staff, but I might be wrong.

Regardless, you can't get to and vaccinate everyone in a care home and their staff in a week. It's not logistically possible.

There's more vaccine coming, so you need to get on with vaccinating as many people as possible asap.

@Christmas1935

I appreciate the complications but your description does sound a little like saying it is better to vaccinate no one in a care home than 5 out of 7, which can't be right.

@notevenat20

don't know why they don't just hold on a few weeks for the full approval of the Oxford vaccine, which is roughly 4x cheaper and can be fridge stored the whole time

I guess some people will catch covid and die in those weeks who could have been saved by the Pfizer vaccine. Also, the Oxford vaccine doesn’t seem quite as effective.

Hopefully not as all staff will be offered the vaccine, care home staff can be vaccinated very quickly at a mass vaccination site. The efficacy is very high so it is unlikely that vaccinated staff will bring covid in to their workplace, once they have both doses. Please lets not be doom and gloom. It is no ones fault this vaccine cannot be transported to each site - it is still wonderful news that it is here. There are many more vaccines coming, lets be patient. Lets look at how many lives this vaccine will save, no point trying to twist it round. THIS IS GOOD NEWS OP!

The NI Chief Medical Officer said this morning that each pack contains 975 vials, each of which contains 5 doses. So actually each pack contains nearly 5000 doses. Or is he wrong? Just curious as that is not what is being said on this thread.

The efficacy is very high so it is unlikely that vaccinated staff will bring covid in to their workplace,

Do we know that the vaccination stops you being contagious? I thought that wasn't part of the study.

THIS IS GOOD NEWS OP

Definitely good news!

The packs contain 195 vials. Each vial contains 5 doses. So each pack contains 975 doses. It’s all in the links on the MHRA’s web pages that I posted earlier.

@WiseUpJanetWeiss

The packs contain 195 vials. Each vial contains 5 doses. So each pack contains 975 doses. It’s all in the links on the MHRA’s web pages that I posted earlier.

Ah maybe I miss heard! Apologies, but I don't have time to trawl through links, I thought a quick question was ok.

@notevenat20

The efficacy is very high so it is unlikely that vaccinated staff will bring covid in to their workplace,

Do we know that the vaccination stops you being contagious? I thought that wasn't part of the study.

We will just have to wait and see I guess, but I can't see it not reducing the risk of residents? Better than nothing. The NI Chief Medical Officer seemed confident it would work, I am happy to believe that since there is no other option at present.

Ultimately the oxford one is the world saver due to its stability.

I really do not envy trying to get dementia care home residents to have the vaccine. It’s going to be truly heartbreaking.

If it’s batches of 975, then I’m guessing a lot of elderly people who can’t use public transport will incur huge taxi costs to get to the centres? And have to queue in the cold?

@247SylviaPlath

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!

Yes fair post

@AcornAutumn

If it’s batches of 975, then I’m guessing a lot of elderly people who can’t use public transport will incur huge taxi costs to get to the centres? And have to queue in the cold?

Perhaps, if living rurally and they have no one to take them to the site. But it will be their choice whether to do that or wait for another vaccine, which is likely to not be too far away.

Urban area will have a solution, it is likely GP practices in towns and cities will find a way to make this work by sharing resources.

Many people are working hard behind the scenes to overcome as many barriers as possible but of course it won't be possible to make it easy for everyone with this vaccine. That is why there are others coming in the near future.

Thanks Private

Mum isn’t rural but with these batch sizes, I think it’s going to be an issue.

I wonder how long the other one will take.

Ultimately the oxford one is the world saver due to its stability.

Yes, and price!

Apologies, but I don't have time to trawl through links, I thought a quick question was ok.

Yes of course - I was just providing the source info to prove I wasn’t making it up.

It’s the fact sheets for patients and HCPs and the MHRA’s conditions so well worth a read when you get the time.

Then why supply them in batches of 975??
Why not say 50?

[quote notevenat20]@Christmas1935

I appreciate the complications but your description does sound a little like saying it is better to vaccinate no one in a care home than 5 out of 7, which can't be right.[/quote]
@notevenat20

No I'm definitely not saying don't vaccinate in care homes, just the logistics will take more time.

Each care home needs to be individually assessed to see who cannot get to a hub, and then they need to work out how best to vaccinate from there.

They will work it out but it's simpler to just start vaccinating NHS and care hone staff while they get it sorted x

@Susanwouldntlikeit

Then why supply them in batches of 975?? Why not say 50?

And how much time would be lost packing 20 cases instead of one large one.

If you want to buy 30 tins of beans from Sainsbury's do you put them
Into your trolley one at a time, or do you look for packs of six and put five packs in. Far quicker and safer to do the latter. Especially with a very unstable product where speed of delivery is of the essence.