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Adam Smith Inst - Vaccination acceleration worth a shot

The COVID-19 pandemic rages on with an average of over 40,000 daily new confirmed cases in the United Kingdom (UK), an all-time high. Over 400 people a day die with the virus, and lockdown measures necessitated by the virus continue to cause further harms. The fastest and safest way out of this crisis, the Adam Smith Institute argues, is mass vaccination.

Despite being the first country in the world to begin vaccinations, the United Kingdom has fallen behind and at the current rate Phase 1 (one dose for vulnerable groups) will not be completed until late 2022. Meanwhile even on the current Government target of 1m doses a week Phase 1 will not be completed until August 2021. The report’s authors argue the Government and devolved administrations should adopt a far more ambitious target of 6 million doses a week administered across the UK.  

This slow rollout is incredibly costly. Every additional week of the pandemic costs the taxpayer £6 billion, while reducing economic activity by £5 billion. The free market think tank argues there are also countless harder to quantify costs, such as declines in pediatric vaccinations, cardiovascular admissions, cancer treatments and endoscopic services, and mental health.

Since November the daily average deaths from COVID-19 in the UK has reached over 400 people with over 75,000 confirmed deaths since the pandemic began. More British civilians have died from Covid since February than were killed in the entire Second World War. The Adam Smith Institute says that an acceleration in the vaccination programme could help to save up to 50,000 lives. 

Israel shows that this acceleration is both possible and desirable. Israel has managed to vaccinate at a rate 10-times faster than the UK per head and has over 12% of its population already vaccinated with a first dose.

The huge costs of the pandemic justify a “war effort” to accelerate vaccinations and end the crisis, report authors Matthew Lesh, James Lawson and Jonathon Kitson say. They argue that with such a national priority the full power of the private sector, armed forces, and volunteers should be utilised along with the pharmacy network who are experienced in administering flu jabs, the use of drive-in centres, 24/7 services and accelerated acquisition and recognition of further vaccines. 

The Adam Smith Institute offers up a series of easy to implement ideas: 

1. Armed Forces and Reservists

Distribution - Vaccination centres & overall logistics capabilities

Call on the Armed Forces to support the vaccination effort, using existing buildings or constructing field hospitals where necessary to expand the number of vaccination centres. Military logistical experts are already working with the NHS at a top planning level, but should be running the logistical effort. If we are going to tackle this like a war, let the people who know how to fight one do it.

2. Pharmacies 

Distribution - Vaccination centres & skills

The centralised network of vaccine distribution allows the most vulnerable to get the vaccine first. However, pharmacies could extend vaccine centre capacity significantly (while being guided by the same Phase 1 priority groups). Government could allow pharmacies to purchase vaccines, and/or distribute them to pharmacies as extra vaccination centres. Pharmacies broke records last year when it came to flu jabs (distributing 1.7 million vaccines in two months) and are well placed to distribute COVID-19 vaccines.

3. Hospitality and other venues

Distribution - Vaccination centres 

Some pubs and bars have already offered their venues as vaccination clinics (e.g. BrewDog). With most hospitality venues closed due to Government restrictions, they can be used to help remove the bottleneck on vaccination venues.They also benefit from commercial grade refrigeration (most of which will now be empty) which could be used to store the Oxford/AstraZeneca vaccine at the required 2-8 degrees celsius. Venues that are not typically used for vaccinations could be overseen by local medical professionals serving as devolved management. To incentivise participation, the Government could compensate venues and/or provide opportunities for former/furloughed staff members (see “Jabs Army” and logistics volunteers below). Venues not commonly used for vaccinations may need to be granted immunity from lawsuits (except for cases of gross misconduct) as well as support for insuring their premises for this purpose.

4. Public venues

Distribution - Vaccination centres 

Places of worship, public housing, community centres, sports stadiums, school gyms, etc., provide further venue capacity. Particularly while stadiums and schools are closed, their car parks/grounds/pitches (ideally) and halls (properly ventilated) offer clear opportunities to distribute vaccines. Venues not commonly used for vaccinations may need to be granted immunity from lawsuits (except for cases of gross misconduct) as well as support for insuring their premises for this purpose.

5. Drive-in centres

Distribution - Vaccination centres & safe waiting areas

Following best practice from around the world is having someone else learn hard lessons for you. Israel’s drive-in centres reduce the problem of aerosol transmission risk within waiting rooms. Guidance on what constitutes a safe clinical area could be temporarily updated to make it clear this is an acceptable alternative.

6. Mobile vaccine centres

Distribution - Vaccination centres and hard to reach patients

Mobile vaccine centres - flu jabs have been in the past distributed by private companies which turn up to private sector organisations and vaccinate whole offices. Although offices are for the most part closed, the idea of mobile vaccine centres should be used to reach more isolated populations. At a small scale, this could entail converted food vans with sufficient refrigeration. 

7. 24/7 services 

Distribution - Vaccination centres & staffing

The vaccination programme should expand to 24/7, and funding should be made available to staff vaccination clinics with overtime payments and night shift subsidies. This will also reduce potential wastage when it comes to unused vaccines, not used due to missed appointments and clerical errors.

8. Walk-in services for “spare” appointments/doses

Distribution - Wasted appointments/doses

There will be unused doses for a variety of reasons. If there are spare does at then end of a given period (day, week) and vaccination centres are not running 24/7 the Government should allow walk in clinics, perhaps time limited beyond the 8.00am-8.00pm window of vaccination. This will reduce the risk of vaccinations expiring due to clerical or logistic errors.

9. Extend criteria

Distribution - Maximum appointments 

The NHS is currently providing vaccines largely to the first two priority groups, which includes those aged over 80, care home residents and healthcare workers. While these groups should continue to be prioritised, as there are more vaccines on the way it will be necessary to drop this stringent criteria. Initially this could include offering vaccinations to all those aged over 55, and vulnerable younger individuals, followed by allowing any individual regardless of age.

10. “Jabs Army” and logistics volunteers

Distribution - Staffing

Hire furloughed staff providing additional income, and paying a premium above furlough. Hospitality staff who are unable to work due to Tier 3 and above lockdowns would be an obvious pool of workers.These volunteers could either be trained to administer vaccines and/or take on logistics roles. Building up this additional staffing capacity will take time, particularly if onboarding requirements are too onerous (see below).

11. Volunteer vaccinator onboarding requirements

Distribution - Staffing

Retired doctors and nurses have complained that there is too much bureaucracy when they have attempted to sign up to help the vaccination programme. Unless a medical professional has been struck off, they should be allowed to return to support the vaccination programme. Unnecessary requirements will cause delays, and in any event the rehired medical professionals will be working with current members of staff who are already aware of the requirements such as fire safety. 

12. Increase payments to GPs and local health professionals

Distribution - Staffing and venue

GPs are currently paid £12.58 per dose to deliver vaccines, to allow for extra training, post-vaccine observation, and other associated costs. Nevertheless, the costs to GP remain substantial considering they must provide staff from their existing workforce. A simple way to encourage more focus and effort on vaccinations would be to substantially increase the payment per dose. This will ensure GPs put as much effort as possible into providing the all-important vaccinations.

13. Online booking platforms

Distribution - Appointment friction

Vaccination is currently booked mainly by GPs sending letters. The NHS should explore an online booking system(s), perhaps using ‘Commercial-off-the-shelf’ solutions rather than trying to develop its own system. They could commission existing private sector operators with experience in booking systems to develop the system.

14. Reward Attendance

Distribution - appointment no shows

If “no-shows” prove to become a problem and a bottleneck to meeting targets, rewards could be provided for attendance, paid either after both doses, or only after successfully completing a full 2 dose vaccination course. The configuration would depend on the volume of “no-shows” for appointments at each stage. For traditional vaccination centres this would likely be a cash reward/voucher, but for re-purposed hospitality venues could be a shared reward (e.g. a takeaway pint).

15. Online delivery of vaccines (home injection kits)

Distribution - vaccination centres 

If distribution remains a bottleneck despite all other measures a more radical option to consider would be the use of home injection kits delivered online, for those willing and able to do so. Given the small risk associated with allergic reactions and the requirement to self administer the vaccine, this initiative could be limited in scope, only to those of high COVID-19 risk, who have experience of self-injecting (e.g. diabetics), without any history of allergies, upon completion of a self assessment form. The injection itself would then be supervised online over a video call, as well as patient wellbeing after the  injection is completed. Supervisors would have patient details and a fast-track line to dispatch an ambulance in any rare cases of an adverse reaction.

16. Marketing

Distribution - Appointment booking

As with other critical phases of the pandemic, the Government should explore the full range of marketing opportunities to build up awareness and understanding of the vaccination programme, counter misinformation, and encourage a constant stream of fully booked appointments, so that supply of patients does not become the main bottleneck. 

17. Prizes

Distribution - incentives

Awards for the best employees and centres. Centres which consistently are vaccinating at higher rates should be financially rewarded, and exemplary service by individuals who are finding ways to vaccinate as many as possible should be recognised. 

18.  Crowdsourcing

Distribution - idea generation

There is a huge reservoir of talent and ideas in the country. Unfortunately, most of these people do not have time or ability to influence the Government, but online platforms could be utilised to crowdsource new ideas, locations and incentive systems to improve the rollout. A £5m prize fund could be established to compensate winning ideas that are successful. There should also be a system of reporting blockages and shortages, anonymously.

19. Oxford AstraZeneca



Supply - Delivery times and volumes

Further clarification of delivery schedules and negotiation of increasingly rapid supplies. If necessary, the Government should pay a higher per dose supplement for accelerating the delivery schedule. Support could also be provided to unblock supply chain issues (e.g. around glass vials), with Government underwriting purchase commitments or making prepayments if necessary. 

20. Market commitments

Supply - input materials

There have been concerns throughout the pandemic that input materials are a bottleneck to manufacturing vaccines. The Government should support pharmaceutical suppliers in reviewing their supply chain, and potential sources of delay. Where necessary, Government should support the secondary markets, pre committing to purchase input materials above market rate or otherwise incentivising a market response.

21. Moderna vaccine

Supply - Pharmaceutical suppliers

Grant immediate approval of the Moderna vaccine for order and distribution (given its approval by the U.S. Food & Drug Administration, while UK processes complete)

22. Novavax vaccine

Supply - Pharmaceutical suppliers

Proactive planning for and stockpiling of the Novavax vaccine (pending completion of its phase 3 clinical trials and UK approval processes)

Report author and ASI Fellow James Lawson, says:

“Vaccinations are the fastest and safest way out of this miserable crisis. We are moving too slowly, Israel is now vaccinating ten-times faster than the UK per head. Central planning has failed, instead Boris should summon the spirit of Dunkirk against the virus — Britons of all backgrounds should offer up our time, premises and skills to speed up the supply and distribution of the vaccine to bring an end to this pandemic. It’s certainly worth a shot”

Notes to editors:  

For further comments or to arrange an interview, contact Matt Kilcoyne: | 07904 099599.

James Lawson is a Fellow of the Adam Smith Institute. He is also a business advisor, supporting executives to transform their operations through AI and digital technologies.

Jonathon Kitson is an independent researcher and forecaster. He has written on defence procurement, forecasting and vaccination strategy. He tweets @KitsonJ1.

This paper is written in a personal capacity and does not reflect the views of these authors’ employers or clients, past or present.

Matthew Lesh is the Head of Research at the Adam Smith Institute.

The Adam Smith Institute is a free market, neoliberal think tank based in London. It advocates classically liberal public policies to create a richer, freer world.


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