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Explainer: essential information for nurses about the Covid vaccines

Explainer: essential information for nurses about the Covid vaccines

Article updated 25 January.

After nine months of the coronavirus crisis, the first vaccine was finally administered to a 90-year-old woman from Coventry on 8 December. It marked the start of the biggest vaccine campaign in NHS history, of which nurses will be at the forefront. Here, we answer frequently asked questions about the programme.  

What vaccines are there?  

On 2 December, Britain was the first country in the world to approve the coronavirus vaccine from German company BionTech and American company Pfizer.  A clinical trial showed the Pfizer/BioNTech vaccine has an efficacy rate of almost 95% in preventing Covid-19. It uses genetic material called messenger RNA – or mRNA – that contains instructions for building the spike protein that Covid-19 uses to enter human cells. In response to these proteins, the body’s immune response is activated, although it is not yet clear how long this immune memory lasts nor whether the vaccine prevents virus transmission. 

The University of Oxford/AstraZeneca vaccine was also approved for use in the UK on 30 December. The evidence shows that the initial dose of vaccine offers as much as 70% protection against the effects of the virus. The vaccine works by using a weakened version of the common virus that causes cold in chimpanzees. Like the Pfizer vaccine, it carries genetic instructions for building the spike protein – but stores this on double-stranded DNA rather than mRNA.

The Mordena vaccine was approved on 7 January. Clinical trials have found it is 94% efective. Like the Pfizer vaccine, it is an mRNA vaccine.

How many doses of each vaccine are needed per person?

Each person needs two doses of the Pfizer and Oxford vaccine. But on 30 December, the four UK chief medical officers announced second doses should be given between three and 12 weeks for the Pfizer vaccine, and between four and 12 weeks for the Oxford vaccine. This is longer than the previously recommended gap of three weeks.

Are the vaccines safe? 

Dr June Raine, chief executive of the Medicines and Healthcare products Regulatory Agency (MHRA), told the BBC’s Andrew Marr show on Sunday that there ‘should be no doubt’ about the safety of the Pfizer/BioNTech vaccine.  

It was well-tolerated in the trial, with no serious safety concerns reported by an independent data monitoring committee. About 4% of people reported fatigue and 2% reported a headache after the second dose. Trials also suggest it works equally well in people of all ages, races and ethnicities.  

In advanced trials of over 20,000 people, researchers said in The Lancet journal that the Oxford vaccine was safe and effective, with only three serious safety events related to the vaccine, at least one of which occured in the control group. The data also suggested it can reduce the spread of Covid, as well as protect against illness and death.

The US Food and Drugs Administeration (FDA) found no safety concerns with the Moderna vaccine and that serious adverse reactions were rare.

How many doses of vaccines is the UK getting and when will they arrive?

The government has ordered 40 million doses of the Pfizer/BioNTech vaccine in all, enough to vaccinate 20 million people as each person requires two doses.

It has also ordered 100 million doses of the Oxford vaccine with around 40 million due to be available by the end of March, and pre-ordered 17 million doses of the Moderna vaccine with supplies due in spring 2021.

How will the vaccine be stored?  

The Pfizer vaccine has to be kept at minus 70 Celsius to reach maximum efficacy – much lower than the average vaccine. Pfizer has developed a transport box packed with dry ice and installed with GPS trackers. Each reusable box can keep up to 5,000 doses of the vaccine for 10 days. Once delivered, vaccines can be stored at fridge temperature – between two and degrees Celsius – for up to five days. 

The Oxford Vaccine can be stored at normal fridge temperature for up to six months, making it easier to move around the country and administer in settings such as care homes.

Moderna’s vaccine requires long-term storage at minus 20 Celsius, but is stable for 30 days at normal fridge temperature.

Who is able to get the vaccine in the UK? 

The government’s Joint Committee on Vaccination and Immunisation (JCVI) has confirmed its priority list for the first phase of the vaccine rollout.

These are: 

⦁ residents in a care home for older adults and their carers 
⦁ all those 80 years of age and over and frontline health and social care workers 
⦁ all those 75 years of age and over 
⦁ all those 70 years of age and over and clinically extremely vulnerable individuals 1  
⦁ all those 65 years of age and over 
⦁ all individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality 
⦁ all those 60 years of age and over 
⦁ all those 55 years of age and over 
⦁ all those 50 years of age and over 

1. Guidance on clinically extremely vulnerable individuals. This advice on vaccination does not include pregnant women and those under the age of 16 years

However, while care homes are at the top of the priority list, residents are unlikely to receive the vaccine first. Prime minister Boris Johnson has acknowledged the ‘logistical challenges’ to delivering the Pfizer/BioNTech Covid vaccine to care homes.  

The second phases of the programme is likely to include those at occupational risk including first responders, the military, those involved in the justice system, teachers and public servants. 

The overall immuniastion campaign has now shifted to giving as many people as possible their first dose of the vaccine. Initially, the aim was to give the second dose of the Pfizer vaccine three weeks after the first. But the aim is now to give as many people vulnerable people as possible a dose.

When will nurses get vaccinated?  

On 11 January, the health secretary has promised that all GP staff, as well as frontline health and social care workers, will be vaccinated by 15 February – and hopefully ‘sooner’.

Is anyone excluded from taking the vaccine? 

Due to a lack of data, the JVCI does not recommend Covid-19 vaccine in pregnancy and advises that only children at very high risk of exposure and serious outcomes should be offered vaccination. Almost all children will have asymptomatic infection or mild disease.  

How will the vaccine rollout work?  

In England alone, vaccines are being delivered to: 

⦁ 50 mass vaccination sites, of which seven became operational this week
⦁ 206 hospitals hubs 
⦁ 1,200 GP-led immunisation centres by 15 January

How is vaccine rollout working in care homes?

GP and primary care network teams have been leading the vaccine rollout in care homes. The deadline for these services to administer the first dose to care home residents was 24 January.

Social care leaders have stressed to Nursing in Practice that registered nurses in care homes can help in the fight against Covid-19 by vaccinating their own residents. But NHS England said that while care home nurses with the necessary training could vaccinate residents, this would be unlikely and they should be supervised by primary care network (PCN) teams.

Health and social care staff visiting are tested twice weekly using lateral flow tests, which is a rapid test that delviers results in 30 minutes but was found to have missed half of Covid-19 cases in a study published in the BMJ. Professionals who are not automatically tested regularly through their employer must be tested before care home visits.

What involvement will general practice and community services have in delivering the vaccine? 

Practices wishing to deliver the vaccination will need access to a local vaccination site, usually one for each primary care network (PCN) grouping. These will be expected to be open from 8am to 8pm seven days a week, and deliver at least around 1,000 vaccinations a week.  

The vaccine will also be given to housebound patients via home visits, as well as staff and residents in care homes. Community providers will also likely play a role in this service, particularly with housebound patients. NHS trusts are also likely to provide the vaccination programme via regional vaccine centres.  

The RCN says the roll-out will be a ‘huge logistical operation’ and expects nurses will play a pivotal role. It has created a Covid-19 vaccine resource for members.  

Who will administer the vaccine?  

Practice nurses, school nurses, midwives, GP returners, paramedics and others are experienced vaccinators who will be expected to help deliver the vaccine. 

The Department of Health and Social Care changed the law to allow a wider group of staff to undertake training to administer vaccines, including dental staff and individuals with appropriate first aid training. It’s possible also that nursing support workers, nursing associates, assistant practitioners, and student nurses on placement may be called upon to assist, with appropriate training and supervision. You can find Public Health England training resources here. 

national recruitment campaign is underway to recruit additional staff nationally to support the delivery of the Covid-19 vaccination programme including clinical vaccinating and non-clinical support roles.  

If you feel there are any important questions we have not answered here write to [email protected] or [email protected]. We’ll do our best to find out the answer.  

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Healthcare staff will not be at the front of the queue for the vaccine, with care home staff and the over-80s at the top of the list.