Why we must start making plans now for Covid-19 vaccination

THERE is a tremendous global effort to develop a vaccine for Covid-19.

However, lockdown can only be fully relaxed when the vaccine has been fully deployed, and that means we have to plan for its distribution.

The nature of the pandemic has meant that countries were exposed to the virus at different times. Theoretically, those countries that have only recently become infected, have had more time to prepare.

In contrast, vaccination will take place simultaneously across the planet. Once developed and tested there will be an international stampede to deploy it. But deploying a vaccine requires more than the vaccine itself. You need to be able to store, distribute, and deliver it.

Most vaccines have to be kept at a temperature between 2 and 8C. This requires a robust cold chain which will need a number of links – warehouses with refrigeration; refrigerated vehicles for distribution; fridges for local storage; and ultimately syringes. All these resources are incremental to what we normally need, and that means we need to plan, not least because every other country will need to access the same resources at about the same time.

The pandemic response has thus far has been characterised by a lack of preparedness mitigated by a monumental effort in crisis management, and all those who have participated in that response must be congratulated. Furthermore, we shouldn’t be too hard on ourselves – after all, we didn’t even know that this virus existed four months ago. But now is the time to get back on the front foot, time to plan and organise for a vaccination programme.

Even in the phased exposure to the virus countries have found themselves competing for scarce resources such as PPE. We should avoid reliving the PPE saga and plan for the vaccination programme.

The population of Scotland is 5.4 million, and there are 940 primary care locations plus about 1,100 care homes. On average, each GP practice serves about 6,000 patients. This gives some scale to the challenge of distributing vaccines to everybody in the shortest period possible.

The first thing we should do is carry out an audit to establish what resources already exist and how easily they could be deployed.

We need to establish what the distribution strategy is. Fundamentally, do we adopt the centralised strategy that has been used for testing or do we leverage the existing primary care system and deliver the vaccine through GP practices? The former runs the risk of bottlenecks, but presents an easier distribution challenge. The latter is more resilient, relatively free of bottlenecks but presents a bigger distribution challenge. The World Health Organisation advocates a local distribution strategy for vaccination programmes and this is what we currently use for the flu vaccination programme.

The distribution strategy determines what resources will be required to make the programme work. Distributing the vaccine to GP locations in Scotland will mean that we will need a fleet of refrigerated vans, about 2,000 fridges, and six million syringes. This may not seem like a monumental task but if we leave it too long, we will have to compete with every other country in the world for what by then will be a very scarce resource.

Dr Phil Greening is deputy director for the Centre of Sustainable Road Freight and a professor at Heriot-Watt University.