The NHS may be taking the lead in the COVID-19 mass vaccination rollout – but it is now clear that local government and the public health system will also have a crucial role to play.
The bulk of the UK rollout will come in the new year, according to health secretary Matt Hancock – and Prime Minister Boris Johnston said the majority of those most in need of a vaccination could have one by Easter.
So with the race to immunise now on, what do local government and public health insiders believe the main challenges will be, how will they add value to the deployment, and are they confident their particular capabilities will be used to the maximum?
As a member of the newly-formed National Vaccine Deployment Steering Group (see below) city director at Stoke-on Trent City Council Jon Rouse is well placed to have an overview. Mr Rouse told The MJ: ‘I think to start with, the focus was on the estates and facilitating where the programme was going to be rolled out. So we've been doing a lot of work on where you might place mass vaccination sites and where you might place community facilities.'
Mr Rouse is clear that ‘more recently there has been strong acknowledgement of the fact that this [deployment] needs to be delivered in partnership between the NHS and local government – so we've now got a proper national engagement group'.
He added: ‘There's obviously a huge amount of work to do in very short order, but there's a genuine desire on the part of the NHS to work with local government on this. I think there's a real recognition of the value that we can bring, which is great.'
A letter from the NHS and copied to local authority chiefs, seen by The MJ, lays out the three deployment models; NHS trusts, large-scale vaccination sites and community/primary care led locations. Fifty-four NHS trusts are listed in the letter as ‘vaccine hubs'.
According to media reports, there will be at least 42 large scale vaccination sites based in places such as conference centres, with at least one mass vaccination centre in cities and larger towns in each of the NHS's 42 sustainability and partnership areas. The letter says successful rollout depends on vaccinating population groups at highest risk, through delivery channels that can ensure patient safety and integrity, while minimising wasted doses. It also depends on ‘operationally feasible deployment methods that can be used within the set timeframe'.
The letter continues: ‘Given what is known about the first expected vaccine, the imperative is that NHS Trusts are ready to start vaccinating from the beginning of December'. And ‘where NHS trusts are the lead providers for large scale vaccination sites, these will also need to be ready'.
Mr Rouse believes local government will be particularly good at helping to make the community rollout happen. ‘We're already proving that in terms of the logistics of which sites will and won't work, working very closely with NHS colleagues around the map of where vaccination will take place. More locally, we will give support to Clinical Commissioning Groups, GPs and primary care networks around their role and what they need in terms of logistics and facilitation.'
He identified ‘a massive workforce challenge which we're going to have to solve collectively, particularly given the other demands we've got upon us in terms of testing, track and trace and all the other elements of dealing with the pandemic.'
His concerns were also touched on last week by Solace spokesperson for health and social care Paul Najsarek. He highlighted that rolling out mass testing was resource-intensive, and could hit already-stretched teams trying to both plan for the implementation of a potential vaccination programme and sustain other testing activities.
Public trust, communication and engagement are key in large scale vaccination exercises, according to vice president of the Association of Directors of Public Health and member of the steering group Jim McManus. He told The MJ there would be ‘several massive challenges' concerning people who are hesitant to take up vaccination.
He highlighted the need to manage expectations about the time it would take for transmission to reduce and how quickly the numbers of people being diagnosed with ‘long COVID' would fall. And every single incident of vaccine failure ‘will be seized on in the ideological battle against vaccination', he added.
But while he underlined that ‘if we are not absolutely on the front foot on that it will stop people taking up the vaccine', he is confident there is a ‘massive local authority capability and there is a very strong director of public health capability that complement what the NHS has to bring to bear on this programme'.
Professor Susan Michie, a member of the Government's scientific advisors group SAGE, has already urged district councils to encourage communities to take up vaccines – and to focus on the ‘vaccine hesitants' rather than those who were anti-vaxxers and unlikely to change their views.
The Local Government Association (LGA) has said millions more people could ‘safely and swiftly be protected against coronavirus if councils are able to act shoulder-to-shoulder with the NHS in the distribution of a vaccine'.
Is chair of the LGA's Community Wellbeing Board Cllr Ian Hudspeth confident that sufficient small local vaccination sites will be found that are accessible to those who would struggle to reach drive-in large scale locations? ‘I think the key thing is that everybody is working as quickly as possible and it's a very fast-moving situation. I think that in local areas the joint approach of the NHS and local government is to identify those areas and then to make sure the facilities are available.'
Will the system work well enough across the country to avoid the risk of postcode lotteries developing? He believes that with Integrated Care Systems due to be in place by April 2021 ‘with everyone working together there will be the input from local government to make sure it is delivered in the most appropriate way.'
Chair of the District Councils' Network Cllr John Fuller told The MJ that rolling out a mass vaccine would be ‘an extraordinarily complex national logistical task, but one thing that COVID has shown us is that for success you need to bake in local knowledge'.
Does he believe central government will fully use the strengths and capacity of local government – including district councils – during the rollout? ‘Whatever is in the Government's mind we are never going to deliver the final mile without the active participation of local councils. By now government should have learned that trying to deliver national objectives without local input is not the way to achieve the best outcome at the lowest cost.'
The National Vaccine Deployment Steering Group
The steering group, which has met three times (before 3 Dec) and will meet weekly, draws together local authority chief executives and/or senior health leaders from each of the nine regions, local resilience forums from each region, the Association of Directors of Public Health and senior officials from NHS England, the Department of Health and Social Care, the Ministry of Housing, Communities and Local Government (MHCLG), and the Local Government Association. The Secretariat is provided by the MHCLG
