Corona Daily 240: 15 Minute Observation Rule

An astounding scientific breakthrough can be marred by poor understanding of logistics. The scientist couple who invented the novel technology used in Pfizer vaccines specializes in cancer research. Technology requiring -70C is tolerable for a niche population of cancer patients, but not for national and international rollout. UK is beginning to understand the logistical challenge with several family doctors/ General practitioners now withdrawing from the vaccination rollout.

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To cover its population of 68 million with two doses, UK must deliver 2 million shots every week, which is 400 jabs every minute. Even such a brilliant performance will vaccinate the nation only by the second quarter of 2022.

Vaccination began in 50 hospital hubs this week. Next week, GPs at 280 sites were expected to administer 273,000 doses. But several GPs in Sussex, Lincolnshire, Yorkshire, Thames valley and other places have pulled out. The problem is especially acute in Manchester.

NHS has negotiated a contract with the doctors’ trade union that obliges a GP who signs it to vaccinate 8 am to 8 pm all 7 days, all holidays, for nine months. NHS also has a contractual right to impose new conditions unilaterally.

Because of the freak conditions imposed by the cold chain, each GP site must deliver 975 doses in 3.5 days (or else the vaccine gets spoilt). Rather than pre-filled syringes, the vaccines are stored in boxes of 195 vials containing five doses each, which means they need to be diluted and split into individual jabs.

As if this was not enough, yesterday MHRA confirmed a 15-minute observation rule. This was prompted by the two allergy cases. To rule out anaphylaxis, the vaccinee must wait for a minimum of fifteen minutes under observation.

GP practices have heavy workloads and fewer staff. They know the importance of vaccination, but with their conversion into vaccine centres, they won’t be able to attend to patients. They are at a loss about what to do with the 15-minute wait. The waiting rooms and the car parks will be full, and the process will be slow.  

In an average year, GPs administer 15 million flu shots. But flu shots don’t require 70C storage, two doses, social distancing, and fifteen-minute observation. The second dose after precisely 21 days is another challenge. UK hasn’t rolled out IT systems to individual GPs or pharmacies. They are required to operate their own systems or carry out the process manually. The army has been asked to help, but it has no electronic patient records nor IT access. The GP switchboards are jammed, with people calling the whole day asking when they can get the vaccines.

Many GP practices must hire extra staff, install special super-freezers and reconfigure surgeries to manage the patient flow, at the same time observing social distancing.

There is little compensation for such hardship and loss of regular practice. The NHS and the GPs know the disastrous rollouts of testing and tracing services.  

Oxford/AstraZeneca vaccine is expected to have normal (2c-8c) cold chain conditions. Many GPs would rather wait for that vaccine to get approved, rather than bother about the Pfizer vaccine.

Already more than 100,000 residents must look for alternatives, as a result of their GPs withdrawing.

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The cold chain conditions mean people must go to vaccines, rather than vaccines coming to them. Vaccinations of those in the care homes has been postponed.

NHS doctors, nurses and other frontline staff were supposed to be the first to be vaccinated. In the first week of December, for unknown reasons, it was decided to vaccinate senior citizens (80+) instead. This is like denying a restaurant chef the food he prepares for others. That decision should be reversed. Hospitals with freezers are the best places for vaccinations. Rather than making a mess with GPs and pharmacies, UK should focus on using the Pfizer vaccines for the NHS staff first. If lucky, a logistically normal vaccine may arrive in time for the rollout.

Ravi