Plans to vaccinate children against Covid-19 and roll out booster jabs could be disrupted by shortages of vaccinators in parts of England, as well as by child safeguarding protocols and wider pressures caused by the upcoming flu vaccination programme.
All 12- to 15-year-olds are set to be offered a single vaccine dose from later this month, with preparations also being made for the administration of third doses to millions of elderly and clinically vulnerable adults.
These rollouts will run alongside the largest flu vaccination programme in NHS history, which will see more than 35 million people offered a jab or nasal spray vaccine as health officials seek to bolster the UK’s defences ahead of what is feared will be a “very difficult winter”.
But one member of the Joint Committee on Vaccination and Immunisation (JCVI) said the logistics “won’t be easy”, while other experts have warned of the challenges in delivering booster jabs, child Covid vaccinations and flu jabs all at the same time.
With the focus on Covid and flu, there are also concerns that the administration of vaccines against other infections, such as human papillomavirus virus (HPV), could be affected.
According to minutes from a JCVI meeting held in June, there has been a 20 per cent reduction in adolescent immunisations across the UK during the pandemic.
For now, there is uncertainty about how the booster and child Covid vaccination programmes will be delivered concurrently.
The JCVI member said that vaccinator shortages are a “real issue”, adding that “NHS winter pressures will only exacerbate this”.
In Brighton, emails were circulated among local GPs last Wednesday calling for more vaccinators at the city’s racecourse hub due to a lack of staff. “They are struggling,” one local doctor said.
More generally, invitations to take part in the booster programme have been sent out to practices across the country in recent weeks, after many wound down their vaccination services over the summer to refocus on caring for local patients.
“Primary care has done a great job in delivering these vaccines,” said Dr Bharat Pankhania, a senior clinical lecturer at the University of Exeter. “If the same model is used, it is easier and better. Provided GPs are adequately supported, they can do it.”
There is also the option of turning to the temporary vaccinators who initially signed up to administer Covid jabs and were later stood down, including retired health workers and St John Ambulance staff, said Dr Elaine Maxwell, a scientific adviser at the National Institute for Health Research (NIHR).
Experts are envisioning greater challenges in vaccinating children, after the UK’s four chief medical officers recommended that all 12- to 15-year-olds receive a single dose of the Pfizer vaccine.
Only vaccinators who are qualified to work with children will be able to administer jabs in schools, making it far harder to employ an army of suitable volunteers for the programme.
“It’s a tall order to suddenly produce lots of vaccinators, especially in sensitive places like schools,” said Dr Pankhania, who is a former Public Health England consultant on communicable disease control.
“We prefer them to have had security clearance. You can’t employ everybody. There are child safeguarding issues. That requires training, time and effort. There are hurdles.”
School pupils aged under 17 will also be offered the flu vaccine ahead of an expected resurgence in cases of the virus in the run-up to winter. This will likely have a knock-on effect on the delivery of childhood vaccines, the JCVI member said.
“The supply of vaccinators for under-18s is not the same as for the rest of the country. They are a very specific group of people, and their focus on Covid and flu will affect their ability to immunise people with other vaccines,” they said.
Dr Joe Pajak, public governor at West Suffolk NHS Foundation Trust and a former director of education for Leicester City Council, said he was “aware of issues relating to the shortage of school nurses” who typically “deliver both universal and targeted services” in education settings.
“Years of cutbacks, and underfunding of school budgets, have meant that only those schools with the financial resources would be able to invest in this vital service,” he said.
“There is also the increasingly difficult pressure on local NHS services, not least because of the pandemic, potentially meaning less staff available in our health and education services.
“The logistics are of course going to be complex.”
It is understood that some NHS trusts have already written to schools and colleges to ask for dates by which they expect to have vaccinated all their eligible children.
In respect of adult vaccinations, ministers are banking on the option of administering a third Covid vaccine dose and the flu vaccine at the same time to eligible groups.
A study known as ComFluCov has been examining whether it is safe and effective to give both jabs together, but it’s unclear when the findings of the research will be presented to government advisers.
If the data doesn’t support the policy, and people are therefore required to receive their booster and flu jabs at different times, and possibly at different sites, that is likely to add to the pressures facing vaccinators across the UK, said the JCVI member, adding that supplies of the flu vaccine could be another issue to consider.
These challenges come amid NHS warnings of a challenging winter that will strain health services once again.
Saffron Cordery, deputy chief executive of NHS Providers, said: “No one should be under any illusions about the scale of the task we face in the coming months as we head into what looks like being a very difficult winter.”
And on Monday, chief medical officer Professor Chris Whitty said there “will continue to be challenges and pressure on the NHS” in the months ahead. “Anybody who believes the big risk of Covid is all in the past … has not understood where we are going.”