Vial and syringe.

Challenges in COVID-19 Vaccine Rollout: Lessons from the UK

By Sravya Chary

Just over a week after the United Kingdom became the first Western country to authorize the COVID-19 vaccine developed by Pfizer and BioNTech for emergency use, the U.S. Food and Drug Administration (FDA) followed suit on December 11, 2020.

This lag may prove beneficial. The United States can and should cautiously assess the United Kingdom’s vaccination strategy to avoid challenges that may impede its ability to control the virus.

The U.K. authorized the emergency use of the vaccine on December 2, 2020, and less than a week later, on Tuesday, December 8 individuals began receiving the vaccine across the country. These recipients largely consist of the elderly and nursing home caregivers.

The FDA convened to discuss the issuance of an Emergency Use Authorization (EUA) for the Pfizer and BioNTech vaccine candidate on December 10 and then proceeded to issue the EUA on December 11. The Food and Drug Administration (FDA) had previously confirmed both the safety and efficacy of Pfizer’s vaccine after finding it was 95% effective at preventing COVID-19 after both doses of the vaccine are administered roughly three weeks apart.

The U.S. has now started its vaccination campaign, prioritizing health care workers and the elderly. As this campaign commences, we should prepare for challenges that have presented already in the U.K, including COVID-19 vaccine skepticism, as well as supply chain and administration issues.

Vaccine Skepticism

COVID-19 vaccine skepticism can impede efforts to establish herd immunity and eradicate the virus.

According to a survey conducted by The Associated Press-NORC Center for Public Affairs Research (AP-NORC), roughly 25% of U.S. adults weren’t sure if they would get vaccinated against COVID-19, while another 25% admitted they do not want to get vaccinated.

The survey found that men, older adults, and white Americans are more likely to say they plan on getting vaccinated, whereas Black Americans and adults under 45 are less likely to say they will get vaccinated.

Meanwhile a separate poll conducted between December 3 and 7, 2020 found that only 28% of Americans felt extremely confident that COVID-19 vaccines would be “[properly] tested for safety and effectiveness.”

Further, while COVID-19 has disproportionately affected Black, Hispanic, and Native Americans, these groups have reported to be less likely to get vaccinated than white Americans. Roughly 25% of Black and 37% of Hispanic respondents, respectively, have reported that they would get the vaccine whenever it is available. These findings, might seem shocking given the current circumstances, but are not surprising given historical racism in science and human subjects research.

And it is worth bearing in mind that vaccine aversion rates in the U.K. are lower than those in the U.S. An Ipsos poll in October showed that while 79% of people in the U.K. said they would take a COVID-19 vaccine when available, only 64% of people in the U.S. said the same.

To combat vaccine skepticism, a recent Washington Post article emphasizes the value in physicians focusing on empathy rather than authority when talking to patients about vaccines. Public health officials continue to stress the value in rewording vaccine-related communications to convince “vaccine fence-sitters.” Similarly, the Navajo Nation recommends rephrasing vaccine rhetoric to resonate better with Native Americans. In a Wall Street Journal opinion, Jason L. Riley even suggests monetary rewards as incentives for individuals to get vaccinated, though some have argued such incentives may backfire.

Supply Chain Challenges

The vaccine requires an unbroken cold chain to maintain its integrity, which poses distribution challenges.

It is particularly imperative that the vaccine is stored at roughly -94 degrees Fahrenheit throughout the transportation process. At the Pfizer plant in Belgium, workers loaded vaccine vials stored at -100 degrees Fahrenheit with dry ice in thermally protected containers.

According to The Wall Street Journal, Michael Breen, a director of infectious diseases and ophthalmology at a data analytics company, stated that “[the] U.K. is an ideal test for the roll out: a developed country not far from the production site with a good health service and a dense population.” However, even so, the supply chain restrictions have cost the U.K. 10 million doses compared to the government’s November forecast.

Although the United States falls under the same umbrella, as a developed country that houses vaccine manufacturing sites, continuous monitoring of the cold chain system in the U.K. can provide insights as to the most effective means of efficiently distributing the vaccine without compromising integrity or number of doses.

Difficulties of Vaccine Administration

Finally, the aforementioned stringent temperature requirements pose difficulties for individuals administering the vaccine.

The COVID-19 vaccine is much more difficult to administer than the flu vaccine. The vaccine vials need to be retrieved from a freezer, monitored by a pharmacist, and checked to confirm they are at the proper temperature, according to Lynne Cronine, a nurse at a vaccine center in Cardiff, Wales.

To combat a potential shortage in the number of vaccinators, the U.K. government modified the law to allow student doctors, dental workers, and physiotherapists to administer the COVID-19 vaccine. Further, the National Health Service (NHS) appealed for retired physicians, nurses, and volunteers to train and provide support as well.

As an added difficulty, following two severe allergic reactions that occurred on December 8, 2020, physicians in the U.K. are now required to monitor patients for at least 15 minutes after each injection. This added time has decreased the number of individuals that can be accommodated at certain vaccination sites due to social distancing requirements, thus slowing down the U.K.’s vaccine administration plan.

The COVID-19 statistics in the U.S. are much more dire than in the U.K. — the number of total cases in the U.S. is nearly 9 times that of the U.K. and the number of deaths is almost 4.7 times higher. Thus, the U.S. has all the more reason to be proactive and work to prevent the challenges the U.K. has experienced early in its vaccination campaign. Simultaneously, we must remain vigilant of potential U.S.-specific challenges now that the Pfizer and BioNTech vaccine is being administered here under an emergency use authorization.


The above opinions are wholly my own and in no way represent the opinions of my associated institutions.

Sravya Chary

Sravya Chary is a manager in the pharmaceutical industry, a Master of Bioethics (MBE) candidate at Harvard Medical School, and a Petrie-Flom student fellow for the 2020-2021 academic year.

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