The original objective for rolling out the vaccine was to reduce the severity, and ultimately the mortality, of Covid-19. Stemming from this, the logical strategy has been to prioritise the most vulnerable who are more susceptible to severe illness. This group, primarily those aged over 70 and with underlying conditions, are accountable for the vast majority of deaths.
An additional objective should now be adopted. The vaccine strategy should reduce the spread of the virus among those most at risk of catching and therefore most likely to transmit Covid-19. Recent data from Israel and early AstraZeneca trial data indicate that vaccines are effective at reducing disease occurrence and transmissibility of the virus. The data from Israel’s highly effective vaccine rollout suggest transmissibility is reduced,[_] and phase III data on the AstraZeneca vaccine (which is easier to store and administer than the Pfizer vaccine) indicated that the “vaccine could reduce virus transmission from an observed reduction in symptomatic infections”.[_] The evidence is continuing to build positively in both instances.
This information, particularly that emerging from Israel, requires a fresh look at who is prioritised for vaccination.
Based on the emerging information on reduced transmissibility after vaccination, we suggest accelerating and broadening the scope of the “key worker” phase of the strategy. In the grand scheme of things, this group is small in number but likely to be responsible for spreading more of the disease. We know that Covid-19 is likely to have a low k number – the so-called super-spreader phenomenon. Vaccinating a bigger key worker group earlier on could have a disproportionately positive impact on case numbers and expedite the reopening of the economy.
It is vital our health and care workers are vaccinated, and they rightly sit at the apex of the “key worker” group. The government has indicated Phase 1 of the vaccine strategy will prioritise those over 50, with key workers then looked at in Phase 2.
Existing supply of vaccines should remain solely for those initially prioritised in the existing Phase 1 framework, but any additional supply should be directed towards an expanded group of key workers, set out below. The government must commit to a 'zero wastage' approach that means any open vials aren't thrown away at the end of the day but instead given to an on-demand waiting list, made up of key workers who live nearby and can arrive at a GP surgery, vaccine centre or vaccination station at short notice. Currently, the predicted wastage of vaccines is 5 per cent which could mean 10,000 a day based on current numbers.
Alongside the very vulnerable, the following groups of people should be included in an expanded Phase 1:
PRIORITY KEY WORKERS
First Responders (Fire Services, Ambulance & Police): 211,000.
Food & necessary goods workers: circa 1.5 million people work in food retail[_]
Pharmacy staff: circa 40,000.
Vaccine pipeline: all workers involved in the production and distribution of the vaccine, including manufacture of vaccines for variants. Circa 3,000 (AstraZeneca/ Oxford staff, manufacturing staff, regulatory staff and clinical trial nurses).
TOTAL: circa 1.75 million people.
During the second phase of the vaccine programme we then suggest the following key workers are prioritised:
ADDITIONAL KEY WORKERS
All teachers: circa 500,000.[_]
Key travel workers: there are circa 600,000 key transport workers in the UK.[_]
Key retail staff: there are overall around 2.9 million retail workers in the UK. Only a proportion of these are frontline public-facing roles and many of these fall within the food and necessary goods category. There are 287,000 retail outlets in the UK.[_]
Key hospitality workers: around 3 million people work in hospitality and tourism. Again, only a proportion of this number work in frontline roles.
TOTAL: Government to work with industry and unions to identify precise number of frontline staff in these sectors. Those most in contact with the public should be prioritised. We believe a number of 3 million is a helpful start (based on vaccinating all teachers, key transport workers, at least two people in each retail outlet, as well as half of all hospitality workers).
Those on the frontline during lockdown, particularly those working tirelessly in our supermarkets, are not simply at risk in terms of the health but critically also in transmitting the virus. Vaccinating them will help us bring the spread of the virus under control.
This is especially true in regard to our schools. It is critical this period of school closure is not simply “dead time” but is used to vaccinate all our teachers in preparation for the return of in-person classes as soon as possible.
Preventing serious illness or death is rightly our central mission. As the facts change, however, so should our strategy. We are not suggesting a deviation away from protecting the vulnerable, but rather expanding eligibility for Phase 1 vaccines to include priority key workers. This would direct any additional supply and enable these key workers to join an “on demand” waiting list. When those most at risk have been vaccinated, all remaining key workers should then be eligible for vaccines.
In practice this would mean that existing supply to vaccinate the top four priority groups by mid-February is kept for that purpose. Where additional supply is available, either through avoiding wastage or access to further amounts of the vaccine, it should be used to begin covering the priority key workers we identify. After the government has vaccinated the top four priority groups we then advocate a separate, parallel stream be established to work through vaccinating key workers, in the priority order set out, alongside the process for vaccinating priority groups 5-9.
This new posture can ensure, by the spring, that not only those most at risk are protected, but we can begin to reopen our economy with confidence.