COVID-19 vaccination programme weekly update: 20 April 2021

Our National Vaccination Strategy was published on 11 January and is based on the detailed planning NHS Wales had been doing.  Our strategy is focused on 3 key areas:

Our priorities – we continue to work closely with the UK Government on supply.  Based on what we know about supply and the priority cohorts set by the JCVI, we have set key milestones

Our vaccination infrastructure – making sure that people can access their vaccination offer - the places to go to get vaccinated, people to give the vaccination and the appointment and digital recording and reporting system set up

Keeping up to date and informed about the vaccination programme – we are committed to providing information to keep everyone in Wales updated about the vaccination programme.

An update to our National Strategy was published on 23 March 2021, further to the Update published on 26 February to reflect on progress and provide further information about our current and future priorities.

Our priority list of people to receive the vaccine has been agreed by endorsing the UK’s independent Joint Committee on Vaccination and Immunisation (JCVI). The same priority list is being followed by all four nations in the UK and has the support of all 4 Chief Medical Officers (CMOs) within the UK.

As set in the progress section below, we have completed the first phase of the programme: 

• all older person care home residents and staff
• frontline health and social care staff
• those 50 years of age and over
• the clinically extremely vulnerable individuals
• those with underlying health conditions with put them at higher risk of serious disease and mortality

We are now moving into phase 2 of the programme. Subject to supply, our aim is to offer the vaccine to all eligible adults in Wales by the end of July. 

As we continue to operate on the principle of no one left behind, the NHS will go back and offer those in priority groups 1-9 who for various reason have not yet taken up their offer. 

That means, we are now vaccinating:

• everyone aged 40 to 49
• household contacts of severely immunosuppressed 
• anyone who, for whatever reason, was missed in priority groups 1-9, so that no one is left behind

We have a 50% gateway in place for moving from one cohort to the next, some health boards have already vaccinated over 50% of adults in their 40s in their area, so have now started inviting the 30-39 age group. 

So far more than 1,699,000 people have received their first dose of the vaccine in Wales. Our second dose programme is running substantively alongside our first dose programme and over 610,800 people have received their full course of vaccine. The second dose is essential for longer term protection so it’s really important that second dose offers are taken up. In total, more than 2.3 million vaccines have been administered.

Our infrastructure has been built from the ground up and is a blended delivery model. This is aimed at providing a mix of sites in order to maximise speed of roll out, ensure safety, meet the needs of the characteristics of the vaccines, be as conveniently located as possible and, importantly make sure we give equitable access across the country and all communities. 

During the past week vaccinations were being administered in 551 locations across Wales, including:

• 46 mass vaccination centres;
• 392 general practice locations
• 14 pharmacies
• 46 hospital locations
• and there were 49 mobile teams operating

Achievement of markers and milestones

We have completed phase 1 of our programme, which includes 2 milestones. 

Milestone 1

In our Vaccination Strategy we said that subject to supply we would: 

offered the vaccine to all individuals in cohorts 1–4 by mid February. That includes all older person care home residents and staff; frontline health and social care staff; those 70 years of age and over; and clinically extremely vulnerable individuals.

We confirmed on 12 February that we had achieved this milestone.  

We also outlined 3 markers to deliver as part of our journey to achieving milestone 1 by mid-February:  

• marker 1 was to have offered a first dose of the vaccine to all frontline Welsh Ambulance Trust staff by 18 January
• marker 2 was to have offered the vaccine to all older person care home residents and staff by the end of January
• marker 3 was to have 250 GP practices deploying the vaccine by the end of January

These first groups are now being offered their second dose of the vaccine, which is important for longer term protection.  Around 80% of care home residents, and their care staff, have now received their full course of the vaccine, with 90% of care home staff having had at least one dose.

Milestone 2

We said we would, subject to supply: 

• offered the vaccine to all individuals in cohorts 1-9 by mid April. That includes all those aged 50 and over
• deployed 1.5million vaccinations
• we achieved this milestone on 4 April

We also outlined 3 markers we expected to achieve during milestone 2 by mid-April:   

• 1 million vaccine doses administered by 7 March. This was achieved ahead of the target date on 27 February
• 1 million first doses administered by 14 March. This was achieved ahead of the target date on 9 March
• to administer over 1.5 million doses during Milestone 2. This was achieved.

In summary:

• all those in priority groups 1-9 have been offered the vaccine and over 90% have now received their first dose
• up-take is very high - over 95% for some groups, including care home residents, and those aged 75 and over
• so far 1,699,092 people have received their first dose of the vaccine in Wales
• 610,882 people have received their full course of vaccine. In total, more than 2.3 million vaccines have been administered
• we are maintaining the best first dose vaccination rate in the UK, as the following 7 day rolling average chart shows, and a greater proportion of people in Wales have had both doses of the vaccine in Wales than in any other part of the UK. Last week we were ranked third in the world – behind only the United Arab Emirates and Israel.

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There are always plans in place to ensure that no one is left behind, so it is never too late for someone in the first priority groups to come forward for their vaccination. 

We have begun phase 2 of our vaccination programme and our current priority is milestone 3 in our strategy. 

We have said, subject to supply, it is our aim to offer everyone in the current 10 priority groups their first dose of the vaccine by the end of July. People aged 40-49 are being called for their appointments across Wales, with some areas having already reached the 50% gateway which is the threshold for beginning to invite the next group, the 30-39 year olds, to be vaccinated.

Supply is the limiting factor in our programme. We are aware of an expected reduction to the supply of Moderna vaccine to the UK. We are working through what this means for our programme in Wales. We will continue discussions with the UK Government with a focus on ensuring we meet the milestones in our national strategy.

The final advice of the JCVI on prioritisation during phase 2 of the programme was published on 13 April. This confirms that the quickest way to vaccinate everyone is to continue with an age-based approach to rollout for the rest of the population starting with the oldest adults first. Whilst also continuing efforts to extend coverage to those in priority groups 1-9.  

People’s safety will always come first, we continually and closely review vaccine safety reports and we are confident in our vaccines and certain that we must keep momentum. We continually and closely review vaccine safety reports and the independent regulator, the MHRA, continues to review the evidence on safety.

JCVI have advised that women who are pregnant should be offered vaccination at the same time as non-pregnant women, based on their age and clinical risk group. There is now extensive post-marketing experience of the use of the Pfizer and Moderna vaccines in the USA with no safety signals so far. These vaccines are therefore the preferred vaccines to offer to pregnant women. Clinicians should discuss the risks and benefits of vaccination with the woman, who should be told about the limited but emerging evidence regarding safety for vaccination in pregnancy. Pregnant women who commenced vaccination with AstraZeneca, are advised to complete their vaccination course with the same vaccine. 

The Green Book chapter 14a also confirms that women who are planning pregnancy, are in the immediate postpartum (having given birth), or are breastfeeding can be vaccinated with any vaccine, in accordance with their age and clinical risk group.

There has been a safety signal in relation to the AstraZeneca vaccine that we have been closely monitoring. The MHRA has issued new advice concluding there is a possible link between AstraZeneca COVID-19 Vaccine and extremely rare form of blood clots. The risk is of a very specific and very rare type of clot with a low platelet count (known as thrombocytopenia). The benefits of vaccination continue to outweigh any risks but MHRA advises careful consideration be given to people who are at higher risk of specific types of blood clots because of their medical condition. 

JCVI has also issued advice in relation to AstraZeneca deployment that we are following. They have advised that: 

• those aged 18-29 with no underlying conditions should receive an alternative COVID-19 vaccine where an alternative is available
• those people who have had a first AstraZeneca vaccine dose should continue to have the second dose
• information should be given to individuals offered vaccination and healthcare professionals should be updated to reflect these considerations

We take this advice very seriously and will ensure the updated advice is followed for people’s safety. The NHS in Wales will operationalise the advice in the smoothest way possible and will make available the right vaccine at the right time for individuals. Subject to vaccine supply, those under 30 will be offered an alternative vaccine. This is a precautionary measure and there are no serious safety concerns. For the majority of the population, the AstraZeneca vaccine is still considered to be a safe and effective vaccine.

People who have had a first AstraZeneca vaccine dose should continue to have the second dose. If people have concerns, then they should discuss these with a healthcare professional, who will be fully informed of vaccine side effects, effectiveness and benefits and risks.

We must be led by the available evidence and clinical advice on this issue and will continue to deploy vaccines where it is considered safe to do so and the benefits continue to outweigh the risks. It is important to note that this type of blood clot together with lowered platelets can rarely occur naturally in unvaccinated people as well as in people with COVID-19 disease.

In Wales over 1 million people have received the Oxford AstraZeneca vaccine since January. Public Health Wales are aware of 1 confirmed case and 1 possible case of rare clotting events after AstraZeneca vaccine reported, with no deaths. Thorough investigations continue of all reported cases.

For comparison of risks, if 1 million people in their 40s were infected with COVID-19 it would result in around 1000 deaths. The risk varies by age and on the presence of clinical risks. 

Dr June Raine, the chief executive of the MHRA, said:

From these reports, the risk of this type of rare blood clot is about four people in a million who receive the vaccine.

This works out at a risk of one in 250,000, or 0.0004%.

It is usual to expect some side effects from a vaccine, however while the MHRA continues to investigate these cases, as a precautionary measure anyone that develops symptoms after vaccination is advised to seek prompt medical advice, such as: 

• shortness of breath, chest or persistent abdominal pain, leg swelling
• blurred vision, confusion or seizures
• unexplained pin-prick rash or bruising beyond the injection site 

Furthermore anybody with new onset of severe or persistent headache that does not respond to simple painkillers starting four days or more after vaccination should speak to their doctor.  

A range of information on our vaccination programme is available on our website, including guidance published relating to the priority groups.  

It is important that we maintain the current high-levels of vaccine uptake. Every dose administered and every person protected really does make a difference. The vaccines are safe and effective and we urge everyone to take up their offer when it is their turn.

Public Health Wales is publishing daily and weekly surveillance data releases.

Welsh Government statisticians are also publishing some of the more operational statistics attached to the programme each week.