Five things the government needs to get right on the vaccine rollout

The emergence of a new and potentially more transmissible Covid-19 variant has put even greater focus on vaccinations as the only route out of repeated lockdowns. As Tom Whipple put it in The Times, “it is now injections, or infections”. ^[1]

The UK starts from a good position: it was the first country to approve successful vaccine candidates and has already started vaccinating the most vulnerable (500,000 had received jabs as of Monday). More importantly, it has signed contracts for 267m doses from several approved and potential candidates. ^[2]

But the rollout – which means vaccinating as many as 25m people next year – will be an enormous logistical and communications task, fraught with difficulties. The government will only succeed if it learns from the problems that have been a feature of its response to the pandemic. Here are five things it needs to get right.

1. Make responsibility for decision making clear

The government’s handling of the crisis so far has been hampered by confused, at times chaotic, decision making. Ministers’ objectives have been unclear, to their own scientific advisers as well as the wider public; decision making has been fragmented; accountability between different organisations has been muddled, including for key tasks such as raising testing capacity.

Mass vaccination will require the government to decide which vaccines to purchase, how to deliver them and who to deliver them to. The rollout itself is the responsibility of the health department, working with NHS England, NHS Improvement and Public Health England. Purchasing vaccines and R&D falls under the business department and the Vaccine Task Force. The two areas need to be closely aligned.

Last month, the prime minister appointed Nadhim Zahawi as minister for Covid-19 Vaccinations, handing the responsibility of running a complex and uncertain delivery programme to a junior minister. Ultimately, however, the success of the rollout will be a test of whether changes at the centre of government brings some of the discipline that has been missing from decision making.

2. Fix problems with local delivery

Vaccinating 25m people next year means delivering up to 50m doses (many vaccines require two) on top of the existing winter flu vaccination programme. That will require a mix of GP surgeries and pharmacies, roving units and dozens of mass vaccination centres including in stadiums. The latter need to be accredited and the NHS needs to hire and train 40,000 staff to work in them. ^[3] There are distribution and storage issues – some vaccines will need to be kept at very low temperatures – and plans will need to be regularly adapted as supply becomes clearer. 

The government’s response to the virus so far has been undermined by delivery problems. It promised a “world beating” contact tracing service, but NHS Test and Trace failed to ever reach proper functionality – before being overwhelmed by rising case numbers – with many criticising its decision to initially ignore local government expertise and outsource much of the operation to large contractors. Tom Riordan, chief executive of Leeds City Council, was brought in as an adviser on test and trace, and he spoke recently on the IfG podcast about the need to take those lessons into the vaccine rollout. He said it will require local NHS, social care, government and other organisations to manage major complexities, including how to deliver the vaccine in care homes, city centres and rural areas.

To reach all these people will also a huge test for the NHS’s IT. Doctors and nurses will be calling, emailing, phoning and sending letters, and they have already been reporting problems accessing personal data and information about who has been vaccinated because of IT systems “failing constantly”. ^[4]

3. Ensure messaging is strong and consistent

Communications are critical in a public health crisis – the public needs to understand what it is supposed to do and why. But the government’s approach has been inconsistent and confusing, with Christmas guidance only the latest example. Public trust in the government took a serious dent after Dominic Cummings’ castle-based rule breach went unpunished. ^[5]

Better communication is needed to build the trust required for mass vaccination. There is already evidence of widespread misinformation, spread particularly via WhatsApp groups (and promoted by anti-vaxxers). ^[6] Vaccinating the oldest and most vulnerable creates an inevitable risk that health problems will be conflated with adverse reactions: the sheer number being vaccinated means, statistically, thousands will suffer heart attacks, strokes and other conditions. ^[7] 

The government will need to reassure patients’ concerns and be ready with answers to questions about how vaccines were produced so quickly, how safe they are and what side-effects patients might suffer. It should be saying loudly that there are no major reasons to think new variants will stop vaccines working. A recent NAO report was lukewarm about the health department’s progress with a communications strategy. ^[8] Germany is already planning a large “sleeves up” campaign to foster a sense of national effort. ^[9]

Ministers will need to encourage vaccination while continuing to emphasise the risks of the virus and the need for continued adherence. Some have questioned whether the recent rise in transmission has at least partly been caused by lower adherence as people start to think that, with a vaccine coming to the rescue, the crisis is nearly over. As the threat of “killing granny” recedes, this balance will only get trickier.

4. Plan for how to reach different groups

The government has estimated that it needs to vaccinate two-thirds of the population to achieve ‘herd immunity’ – although debates about lifting restrictions are likely to grow early next year once the most vulnerable are protected.

Polling and the government’s operating assumptions suggest around 70-75% of people are happy to be vaccinated. ^[10] But those most likely to suffer from the virus – particularly in deprived and ethnic minority communities – are least likely to say they will get jabs. ^[11] These are places, battered by coronavirus, in which trust in government is lowest. The Kings Fund have reported that some are concerned that vaccines have not been tested on people from their communities. ^[12]

The government will need to think about the messages it needs to reach and persuade different groups, and who those messages need to come from. The role of local government, charities, community and faith leaders – who know and have relationships with people – will be critical. As will that of other role models, such as footballer and food poverty campaigner Marcus Rashford. ^[13] Another centralised, top-down process – like the initial approach to contact tracing – won’t work.

5. Think through the ethical implications

The crisis so far has relied on the sense that the rules apply to everyone equally (hence the outrage over Barnard Castle). But what freedoms should be given to those who have been vaccinated? How should restrictions apply to them, and friends and family who wish to see them? How should those inoculated from the disease be expected to prove it (the government has sounded cautious about the idea, floated by some, of vaccine passports)? Given the economy is likely to be operating under tight restrictions for months, should the government find ways to make doses available more quickly to those unable to work? ^[14] As it answers these questions, the government will need to avoid any hint of favouritism that could undermine trust, and ensure its messages cut through.

While the approval of effective vaccines less than a year after the Covid-19 genome was sequenced is an incredible feat for science, our return to normality depends on those vaccines reaching millions of people. This will rely on the government leading, communicating and delivering a major national programme. The country cannot afford for it to repeat the mistakes it has made so far.