杏吧原创

The hospital in Brighton where I work received its first batch of 975 doses of the vaccine made by Pfizer and BioNTech on Monday and ran its first vaccination clinic on Tuesday. They run daily from 8am to 8pm. The vaccines arrive in 195 vials containing five doses each and must be diluted in saline before being drawn up into five syringes for five patients.

The molecule consists of mRNA, which is unstable and breaks down naturally in a short time. This is cased in a lipid layer so that it can enter the muscle cells. The lipid shell is also fragile, and the vaccine can only be moved a handful of times before the molecules break down. Usually, any medication that needs to be split into separate doses will be processed in a pharmacy, but this vaccine is so unstable that if it is drawn up in the pharmacy then by the time it reaches the patient it may be ruined, so all this needs to happen near to the patient, bringing a pharmacy procedure into the clinical area.

The drawing up process is laborious. First the vaccine must be 鈥渨oken up鈥� with 10 very gentle and slow inversions of the vial, and this must be repeated after adding the saline to mix thoroughly but very gently. The made up syringes are placed in a clean tray with all the care of laying a newborn baby in a crib. This process takes about 10 minutes in experienced hands (and seemed to take about 30 minutes in mine).聽The injection must be given within three hours of drawing it up or be wasted as it will have degraded.

National news had reported that two healthcare staff who had received the vaccine on Tuesday had experienced allergic reactions. The immediate result was that all teams administering the vaccine were told to check if any patient had ever had a severe allergic reaction and to not give vaccinations to those who had.

The clinics were set up for hospital staff and for patients over 80. The patients were recruited from those about to be discharged or those due to attend the hospital for an outpatients appointment anyway. I was told that our hospital had accounted for an eighth of all vaccinations done nationally in its first two days.

Patients had been surprised and pleased to have been phoned over the weekend and booked in. In general, while they were positive about the vaccine, they also seemed a little tired and perhaps overwhelmed by the busy clinic. 鈥淲hy are you giving it to us? You should give it to younger people,鈥� one of them asked me. 鈥淲e鈥檙e testing it out on you,鈥� I joked. Patients waited in a supervised area for 15 minutes after the injection but none experienced any adverse symptoms during the time I spent there.

I am especially interested in how the clinics work because the vaccination programme is set to move into communities from next week, to be run by general practitioners (GPs). It will be an enormous challenge to deliver this vaccine in the community. The alternative vaccines, from Moderna, and AstraZeneca and the University of Oxford, are expected to be approved soon and certainly would be more straightforward to deliver as they don鈥檛 need to be kept at very low temperatures and may not be so fragile. But it seems they will also come in multi-dose vials so will need to be prepared by experienced staff, and it may be difficult to access enough staff with this level of expertise in the community. Healthcare assistants aren鈥檛 allowed to prepare or administer the vaccines at present.

The Pfizer/BioNTech vaccine has a great safety and efficacy profile and the UK government has bought millions of doses so we have to use it. I am sure that within the next few weeks solutions will emerge, either by widening the staff groups who are allowed to prepare and administer the vaccine, or by freeing up those specialist staff who are able to do it now.

We will also need mass vaccination sites that can easily get through the increments of 975 vaccines without waste. These are being prepared around the country with all hands to the pump. Certainly GP surgeries would struggle with larger numbers of people.

All over the country healthcare professionals, leaders and managers are wrestling with the logistics, being pulled away from their normal roles and coming together to solve this problem. It is a huge privilege to be involved with it and to see how we can overcome some seemingly immense obstacles when the prize is so great 鈥� and within reach for the first time.