COVID-19 vaccination programme weekly update: 27 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 in 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. 

Our second dose programme is running substantively alongside our first dose programme. The second dose is essential for longer term protection so it’s really important that second dose offers are taken up. 

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 491 locations across Wales, including:

• 49 mass vaccination centres
• 372 general practice locations
• 12 pharmacies
• 33 hospital locations
• there were 20 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.  87.9% of care home residents have now received their full course of the vaccine, with 90.4% 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.
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
• 1.5 million doses administered 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 1,785,347 people have received their first dose of the vaccine in Wales
• 701,099 people have received their full course of vaccine. In total, more than 2.4 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.

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70% of our adult population have had a first dose and one in four adults in Wales have completed the two-dose course.

Phase 2 of our Vaccination Programme is underway 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.

The third enhanced vaccination report from Public Health Wales also shows that coverage of vaccination has increased in all reported socioeconomic and ethnic groups since February. Inequality gaps in coverage of at least one dose of COVID-19 vaccine between ethnic and socioeconomic groups in older adults in Wales have narrowed since March further and, as set out in our vaccination strategy updates, this will remain a key focus for the vaccination programme. 

Pregnant and breastfeeding women. 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. You don’t have to make the decision alone, and we would encourage you talk it through with your doctor or midwife. 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.

Adults who are immunosuppressed have a weaker immune system to fight infections naturally and are more likely to have poorer outcomes following COVID-19 infection. There is growing evidence that the COVID-19 vaccines may reduce the chance of someone who has been vaccinated passing the virus on. Vaccinating household contacts will help limit the spread of the virus to these vulnerable adults.

Consequently the JCVI has advised that people over 16 who live with individuals with severely weakened immune systems should be offered COVID-19 vaccination as a priority. The Welsh Government, like the other UK nations, has accepted this advice and there will be a form online this week for individuals who are household contacts of someone who is immunosuppressed to complete.

Latest real world evidence on vaccination effectiveness. Two recent studies (not yet peer reviewed) have found the chances of becoming infected by COVID-19 fell sharply after a first dose of either the AstraZeneca or Pfizer vaccines. The vaccines worked just as well in the over-75s and those with underlying health conditions, as other people. Vaccine effectiveness - Nuffield Department of Medicine (ox.ac.uk) 

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. 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.

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.