COVID-19 vaccination in the United Kingdom

On 28 November 2020 the new role of Parliamentary Under-Secretary of State for COVID-19 Vaccine Deployment was set up within the Department of Health and Social Care in the Government of the United Kingdom, with Nadhim Zahawi the first to take office.[22]

There are several COVID-19 vaccines at various stages of development around the world. By February 2021 the British Government had placed orders for a combined total of 457 million doses across 8 different vaccines,[23][24][25][26] and as of 23 August 2021 this had increased to more than 540 million doses.[27] This does not equate to the number of people that can be immunised as most vaccines require more than one dose.

In September 2021, the UK government cancelled their 190-million-dose Valneva order, citing supply concerns.[28]

The breakdown of the vaccines currently being considered for the vaccination programme is as follows:[29][30]

Vaccine	Origin	Progress	Doses ordered	Approval	Deployment
Pfizer–BioNTech	US/Germany	phase III clinical trials	189 million[27]	2 December 2020	8 December 2020
Oxford–AstraZeneca	UK/Sweden/India	phase III clinical trials	100 million	30 December 2020[31]	4 January 2021[32]
Moderna	US	phase III clinical trials	77 million[24]	8 January 2021[24]	7 April 2021[33]
Janssen (Johnson & Johnson)	US/Belgium/Netherlands	phase III clinical trials	20 million	28 May 2021[34]	Pending
Novavax	US/India	phase III clinical trials	60 million	3 February 2022[35]	Pending
GSK/Sanofi Pasteur	UK/France	phase III clinical trials	60 million	Pending	Pending
CureVac	Germany	phase III clinical trials	50 million[26]	Pending	Pending

On 2 December 2020, the UK became the first country to give approval for use of the Pfizer–BioNTech vaccine,[36][37] later branded as Comirnaty.[38] This was in the form of a temporary authorisation given by the Medicines and Healthcare products Regulatory Agency (MHRA) under Regulation 174 of the Human Medicines Regulations 2012.[39] Regulatory approval is reserved under the devolution settlement. The first batch arrived in the UK the next day and was initially stored at an undisclosed central hub before being distributed to hospital vaccination centres across the country.[40]

On 30 December 2020, the UK also became the first country to approve the Oxford/AstraZeneca vaccine.[31]

On 8 January 2021, the Moderna vaccine was approved as the third vaccine to enter the programme.[24]

On 28 January 2021, the results of the Novavax vaccine trials, which were undertaken in the UK and in South Africa, showed it was 95.6% effective against the original SARS-CoV-2 strains and 85.6% against the Variant of Concern 202012/01, then prevalent in the UK. The company stated it had begun the process of requesting clearance for use in the UK.[41] The Novavax vaccine was the first to be tested in clinical trials for efficacy against the UK's prevailing Variant of Concern 202012/01.[42] In clinical trial subjects without HIV infections, the vaccine was also 60% effective against the 501.V2 variant, a SARS-CoV-2 strain first detected in South Africa.[42]

On 28 May 2021, the Janssen vaccine was the fourth vaccine to be approved in the UK.[34]

On 3 February 2022, the Novavax vaccine was the fifth vaccine to be approved in the UK.[35]

On 14 April 2022, the UK became the first country to approve the Valneva vaccine. This is the sixth COVID-19 vaccine that the MHRA has approved.[43]

This timeline lists the general availability of vaccine appointments in England, by date. The dates differed slightly in Scotland, Wales and Northern Ireland (not listed here).

A vaccination centre in Finchley, north London, March 2021

On 8 December 2020, Margaret Keenan, 90, became the first person in the world (outside trials) to receive the Pfizer–BioNTech vaccine as the rollout of vaccinations began.[44] William Shakespeare, 81, from Warwickshire became the second person, and the first man, to be vaccinated.[66] Both vaccinations took place at University Hospital Coventry. On 4 January 2021, Brian Pinker, 82, became the first person (outside trials) to receive the Oxford–AstraZeneca vaccine. The vaccination took place at the Churchill Hospital, Oxford.[32] England Health Secretary, Matt Hancock said this was a "pivotal moment" in the programme as this vaccine was easier to transport and store, requiring only ordinary fridge temperatures. Six hospitals in England began the Oxford vaccine rollout using the first batch of around 530,000 doses.[67]

The Queen and Prince Philip, then 94 and 99 respectively, received their vaccinations within their Windsor Castle residence on 9 January 2021.[68] Prince William cited their example, a week later, to encourage everyone to take up the vaccine[69] after hearing that a degree of vaccine hesitancy had set in.

The rollout to the over 70s and clinically extremely vulnerable began on 18 January 2021,[48] representing the fourth priority group and the final group needed to complete the government's initial 15 February target.[70]

Over 20 million first doses were administered by 28 February 2021.[71]

Prime Minister Boris Johnson is given the vaccine by nurse Lily Harrington at St Thomas' Hospital.

On 19 March, Prime Minister Boris Johnson received his first dose of the AstraZeneca vaccine at St. Thomas' Hospital. By this point, more than 26 million people had received their first dose of a COVID-19 Vaccine.[72]

On 7 April 2021, Elle Taylor, 24, became the first person in the UK (outside trials) to receive the Moderna vaccine. The vaccine was administered on Miss Taylor, an unpaid carer from Ammanford, at Glangwili General Hospital, Carmarthen.[73]

Queuing for the Oxford-AstraZeneca vaccine in Finchley, North London, March 2021

On 9 December 2020, the MHRA issued updated guidance, after two cases of anaphylaxis and another case of a possible allergic reaction following the vaccination. In the statement, June Raine, MHRA Chief Executive said:[74]

Any person with a history of anaphylaxis to a vaccine, medicine or food should not receive the Pfizer/BioNTech vaccine. A second dose should not be given to anyone who has experienced anaphylaxis following administration of the first dose of this vaccine.

Raine went on to say that such side effects have been known to happen with any vaccine but are "very rare". She continued to confirm that existing appointments should not be cancelled but people with a history of serious allergies should discuss this beforehand. Furthermore, she expressed confidence in the safety, assessment and monitoring of the vaccine. Guidance was given that vaccine recipients should be monitored for at least 15 minutes after vaccination and centres must be prepared for such events including the availability of an anaphylaxis pack.[74] The two people affected were quickly treated and recovered well.[74]

The Department of Health and Social Care confirm that although the vaccine triggers the creation of antibodies, vaccination does not affect the result of an antibody test to detect whether someone has previously contracted the virus. This is because there are differences between the antibodies triggered and those being tested for.[75]

As of 20 December 2020, Public Health England say there is "no evidence" to suggest that the recently identified Variant of Concern 202012/01 (a new variant of SARS-CoV-2) would be resistant to the Pfizer–BioNTech vaccine currently being used in the programme, and people should still be protected.[76] Further laboratory work is still being prioritised to increase current understanding of this.

As of 8 April 2021, the JCVI issued advice to the government stating "that it is preferable for adults aged under 30 with no underlying conditions to be offered an alternative to the Oxford-AstraZeneca vaccine where available, following reports of extremely rare blood clots in a very small number of people."[77]

As of 7 May 2021, the JCVI issued advice to the government stating "the JCVI has advised a preference for adults aged 30 to 39 without underlying health conditions to receive an alternative to the Oxford/AstraZeneca vaccine – where available and only if this does not cause substantial delays in being vaccinated, on extremely rare cases of concurrent thrombosis (blood clots) and thrombocytopenia (low platelet count) following the first dose of the Oxford/AstraZeneca vaccine."[78]

As of 16 June 2021 it is expected that vaccination will become mandatory for those working in aged care (excluding those medically exempt).[64]

During the rollout of the Pfizer–BioNTech vaccine first doses, the UK government announced on 30 December 2020 that future deployment would focus on that initial dose, rather than giving the required two doses as quickly as possible. The announcement of this plan coincided with the approval of the Oxford–AstraZeneca vaccine, and so represents the strategy to rollout the two vaccines. The government stated that prioritising the first dose was on advice from the Joint Committee on Vaccination and Immunisation (JCVI) and further assured that everyone would still receive their second dose within 12 weeks of their first.[31] Despite this, Margaret Keenan, who was the first person outside of trials to receive a dose of the Pfizer–BioNTech vaccine, returned to hospital on 29 December 2020 for her follow-up injection. This was exactly three weeks after her first, in accordance with the original plan until the announcement of the new strategy. By receiving her second dose, Keenan completed the vaccination process.[88]

The new plan to increase the gap between first and second doses from 3 to 12 weeks, was criticised as "unfair" by the British Medical Association (BMA) on 31 December 2020, as appointments booked for 4 January 2021 or later would have to be rescheduled.[89] In response, all four Chief Medical Officers (CMO), plus England's Deputy CMO Jonathan Van-Tam, signed an open letter explaining the policy shift.[90] They said by prioritising first doses, more people would have substantial protection faster, and the second dose adds relatively minor additional protection in the short term. They went on to say that for every 1,000 people given the second 'booster' dose, 1,000 new people would not be able to have up to 70% protection and would instead remain totally unprotected.

During his address announcing England's third national lockdown on 4 January 2021, Boris Johnson indicated a preliminary target for the vaccination programme, saying:[70]

By the middle of February, if things go well and with a fair wind in our sails, we expect to have offered the first vaccine dose to everyone in the four top priority groups identified by the Joint Committee on Vaccination and Immunisation.

He went on to confirm this would include all elderly residents of care homes and indeed everyone over the age of 70, as well as all frontline health and social care workers, and all those who are "clinically extremely vulnerable".

Vaughan Gething, Minister for Health and Social Services in the Welsh Government, matched England's targets by announcing that all people in groups 1–4 would be offered a first dose by mid February.[91]

A vaccination plan was published by the Scottish Government on 14 January.[92] Part of this plan, subsequently withdrawn after objections from central government, projected the numbers of doses of vaccines delivered weekly to Scotland from the British Government until May, estimating that by mid-March there would be enough doses there to supply every person in the priority groups with their first doses, and enough doses by July to supply every adult with both doses.[93] Extrapolating from these figures, Sky News estimated that supply for the UK overall would be sufficient to meet the British Government's aim of immunising all 15 million priority individuals in the country by mid-February, and vaccinating all adults in Britain with their first dose by mid-July.[93]

The JCVI advised the governments on how to prioritise the rollout. The top priority for the programme was to prevent deaths and to ensure that the National Health Service (NHS) would not be overwhelmed, and as older people are more at risk of hospitalisation or death from COVID-19, prioritisation was primarily based on age.[94]

The table shows the priority groups for the first phase of the roll-out.[94] An estimate of the number of people in each group in the United Kingdom is also shown[95] (but note that some people fall into more than one group).

Breakdown of sizes of high-priority groups for COVID-19 vaccination in the UK[96]

"Clinically extremely vulnerable" is defined as:[97]

• solid organ transplant recipients
• people with specific cancers:
  • people with cancer who are undergoing active chemotherapy
  • people with lung cancer who are undergoing radical radiotherapy
  • people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
  • people having immunotherapy or other continuing antibody treatments for cancer
  • people having other targeted cancer treatments that can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
  • people who have had bone marrow or stem cell transplants in the last 6 months or who are still taking immunosuppression drugs
• people with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD)
• people with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell disease)
• people on immunosuppression therapies sufficient to significantly increase risk of infection
• people with spleen problems, e.g. splenectomy (spleen removal)
• adults with Down's syndrome
• adults on dialysis or with chronic kidney disease (stage 5)
• other people who have also been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs.

Women who are pregnant and children under 16 are not defined as clinically extremely vulnerable for the purpose of the vaccination programme.[94]

Polish group Omni Calculator developed a tool which estimates when individuals will receive the vaccine, based on age, employment, and health status.[98][99]

"People with underlying health conditions which put them at higher risk of serious disease and mortality" is defined as:[100]

• people with long-term lung conditions (such as severe asthma, COPD, bronchiectasis and cystic fibrosis)
• people with long-term conditions affecting the heart or blood vessels (such as congenital heart disease, heart failure and peripheral arterial disease):
• people with diabetes
• people with chronic kidney disease
• people with long-term liver conditions (such as cirrhosis and hepatitis)
• people with conditions affecting the brain or nerves (such as dementia, Parkinson's disease, motor neurone disease, multiple sclerosis, epilepsy, cerebral palsy or stroke)
• people with learning disabilities
• people with a condition or treatment that makes you more likely to get infections (such as HIV or some treatments for lupus, psoriasis or rheumatoid arthritis)
• people with severe mental health conditions (such as schizophrenia and bipolar disorder)
• people with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell disease)
• people on immunosuppression therapies sufficient to significantly increase risk of infection
• People with severe obesity (a BMI of 40 or above)

[94]

The JCVI released an interim statement on 26 February 2021 regarding the rollout of the vaccine in Phase 2. It was decided that Phase 2 would not rollout by occupation or ethnicity but instead solely on age. The order therefore in Phase 2 is as follows:[101]

The JCVI also noted that males from BAME backgrounds and those with a BMI over 30 were at an increased risk, and therefore stated that it "strongly advises that individuals in these groups promptly take up the offer of vaccination when they are offered", with local officials advised to "promote vaccination in these groups".[101] Poorer neighbourhoods should also be subject to an outreach programme by local officials. The UK government said it aimed to offer all adults over the age of 18 a vaccine before 31 July 2021.[102]

The decision not to prioritise people in high-risk public-facing occupations such as teachers, police officers and bus drivers was criticised by the Association of School and College Leaders, NASUWT and the Metropolitan Police Federation. Asthma UK also criticised the lack of prioritisation of those with mild or moderate asthma in either Phase 1 or Phase 2.[102] JCVI chair Wei Shen Lim defended the rollout plan, stating "speed of deployment is the most important factor" and that rollout by occupation would slow down vaccinations.[102]

Healthy individuals under the age of 18, and all under 16s, were not part of the initial vaccine rollout, on the grounds of their relatively low risk from the virus and the then limited availability of evidence relating to COVID-19 vaccines' effects on young people.[94][101] On 19 July 2021, the vaccine rollout was expanded to vulnerable adolescents from the age of 12 and young people in the three months prior to their 18th birthday.[103] They were joined by all 16- and 17-year-olds on 4 August.[104] The Vaccinations Committee did not endorse vaccines for healthy 12- to 15-year-olds, on the grounds of only 'marginal gain' to the health of individual children.[105] However, the UK's chief medical officers agreed to the rollout of a single dose of the Pfizer vaccine to this age group on 13 September in order to reduce disruption to education.[106] Second doses, three months or more after their first, were expanded to this age range on 29 November.[107]

On 15 and 16 February 2022, plans were announced across the UK to expand the Pfizer vaccine rollout to children from the age of five;[108] the Vaccinations Committee approved this, taking into account an estimate that over 85% of all children aged 5 to 11 had experienced COVID-19 infection by the end of the previous month.[109] That plan was later reversed, with no children under 12 being eligible after 1 September 2022 except for those in high-risk groups.[110]

In September 2021, booster doses began to be given to members of the following groups, six months after their second vaccine dose:

• people over the age of 50
• vulnerable people over 16
• health and social care workers
• adult members of the households of immune-suppressed individuals[111]

It was decided in November that healthy people in their forties would also be eligible for a booster vaccination.[112] Later that month, booster vaccinations were expanded to everyone over the age of 18 who had received their second dose more than three months earlier, whilst some people with severe immunosuppression became eligible for a fourth dose in response to the SARS-CoV-2 Omicron variant.[107] In December, the booster programme was further expanded to offer all adults a booster dose by the end of 2021.[4]

Further booster doses were offered from February 2022 for people who had received their previous dose around six months earlier and were:

• aged 75 years or older,
• resident in a care home for older adults,
• aged 12 years or over and immunosuppressed.[113]

In autumn 2022, booster doses will be offered to:

• residents and staff in care homes for older adults,
• front line health and social care workers,
• people aged 50 years or older,
• people aged 5 years or older who are in a clinical risk group or who have immunosuppressed household contacts,
• people aged 16 years or older who are carers.[113]

Numerous popup vaccination events took place during the programme. Venues included Mosques, Churches, and community centres, and food banks[129]. Tottenham Hotspur stadium hosted three vaccine events delivered by Morris House Group Practice during 2021 delivering over 10,000 vaccines and pushing Haringey to the top of the vaccine delivery at that time[130].

A Covid-19 Vaccination Bus operating in Haringey with the vaccine team and Mayor of Haringey, Adam Jogee

Many areas operated vaccine buses to increase convenience and enable patients not able to travel to be vaccinated[131].

As of 28 May 2021, there were a total of 1,992 vaccination sites operating in England,[lower-roman 2] These were made up as follows:[132]

• 
  Vaccination site locations in Wales, as at 15 January 2021
• 
  Vaccination site locations in England, as at 5 February 2021
• 
  Vaccination site locations in Scotland, as at 14 January 2021

A protest against COVID-19 vaccination in London during September 2021

Polling suggested that levels of vaccine hesitancy were fairly low in the UK compared to other parts of the world. YouGov's first survey on the subject in the middle of November 2020 suggested that 15% of British adults would refuse to get a COVID-19 vaccine which had fallen to just 6% (the lowest of any country polled) by April 2021.[7] Research by Ipsos MORI in May suggested that 99% of people who had received their first dose intended to take their second and 95% were certain they would. Whilst, indicating that 94% of the wider public had either had their first dose or intended to do when offered.[133] Research by the Office for National Statistics suggested that 96% of people over 16 had a positive attitude to the COVID-19 vaccine in early summer 2021.[134]

Though a large majority of people in all social groups were willing to take the vaccine, polling suggested that some demographics were more likely to display reluctance than others. Younger individuals were more likely to be uncertain than their elders.[7] Whilst, members of ethnic minority groups were more likely to be reluctant than white responders.[133] The November 2020 YouGov poll suggested that "leave" voters in the 2016 EU referendum were less likely to want the vaccine than "Remain" voters though this gap had closed by the spring.[7] Areas which showed higher levels of hesitancy towards the start of vaccine process included Inner East London, Outer West London, North East England, West Wales and the Valleys though reluctance fell significantly in these areas as the months went by.[134] Though the previously cited survey sampled public opinion in Great Britain (England, Scotland and Wales) one poll conducted in September 2021 suggested that the level of vaccine hesitancy in Northern Ireland was fairly high in comparison.[135]

It was suggested by commentators that the vaccine rollout strengthened support for the government with the Conservative Party enjoying an uptick in support in polls of voting intentions around spring 2021.[136] The so called "vaccine bounce" was widely cited by observers as one of the reasons for the party's gains at local elections in May 2021.[137] Polling at around this time suggested that 85% of British voters felt their government had handled the vaccine rollout well in comparison to less than a fifth of their French and German counterparts.[138] Analysts also suggested that this phenomenon may have contributed to a waning in support for Scottish independence in the run up to the 2021 Scottish parliament election.[139] The 'Mood of the Nation 2021' report by the consultancy firm BritainThinks based on research conducted in October and November 2021 found that whilst the optimistic mood around COVID-19 of the summer had rebaited the successful vaccine rollout remained one of few present day subjects which the general public in the UK cited as providing a sense of national pride.[140]