Well before scientists were sure that a vaccine would be ready for use in the UK by the end of this year, the government regulator – the Medicines and Healthcare products Regulatory Agency (MHRA) – put out an urgent call for help. Its appeal, issued in September, was evidence that even if a vaccine were to be developed and approved soon, things would be far from plain sailing.
The call to tender stated: “The MHRA urgently seeks an artificial intelligence (AI) software tool to process the expected high volume of Covid-19 vaccine-adverse drug reactions (ADRs) and ensure that no details from the ADRs’ reaction text are missed. For reasons of extreme urgency under Regulation 32(2)(c) related to the release of a Covid-19 vaccine, MHRA have accelerated the sourcing and implementation of a vaccine specific AI tool…”
The Cabinet Office, which coordinates policy across government departments and their responses to crises, was alerted. A company called Genpact won the £1.5m tender soon after. The MHRA said then that based on previous vaccination campaigns, there would be between 50,000 and 100,000 reports of suspected side effects for every 100 million doses over a six to 12-month period.
This weekend there is real hope inside government that an end is in sight to the pandemic. News that the UK had become the first country in the world to approve the Pfizer/BioNTech coronavirus vaccine, which the MHRA says offers up to 95% protection against Covid-19, has been hailed as a potentially decisive moment.
There are, however, no celebrations in Whitehall. Rather there is much caution, just as there was back in September. It is not only the administrative challenge of vaccinating much of the population safely that is worrying officials, but the prospect of doing so just as the deep mid-winter approaches – a time when NHS staff would, even in a normal year, be run off their feet.
This year it is worse, however. The pandemic is still claiming hundreds of lives a day and a Covid-19 third wave may be round the corner, after festive relaxations, to add to intense pressures already on the NHS. And on top of it all, there are the hugely disruptive, and to some extent unknown, effects of Brexit on the UK’s trade and ability to import and export that are about to reveal themselves. Those concerns also preoccupy an overloaded government machine and Cabinet Office.
As Sam Lowe, a former member of the Department for International Trade’s Strategic Trade Advisory Group, now a senior research fellow at the Centre for European Reform, says, there is a possibility that the two issues will intersect and collide, making matters worse. “There are going to be delays at the borders and it is going to take the EU and UK a while to get used to trading under the new system and it is possible that imported equipment necessary for dealing with the pandemic gets caught up in that,” says Lowe.
“It is a big thing for the Cabinet Office There are two huge logistical challenges happening simultaneously.”
To illustrate the point, as The Observer reports, civil servants in the Ministry of Defence and military staff have discussed with officials in the Vaccine Taskforce how the military could help – including with transporting batches of the vaccine by military aircraft – if Brexit causes delays at borders, or indeed in the event of any other emergency.
Inside the NHS, the immediate worries are about workload and sheer weight of demand – dealing with sick patients at the same time as managing vaccinations for an entire population, with a strained and insufficient workforce. Even before the pandemic the NHS says it was short of 100,000 staff, from doctors to nurses and ancillary workers. In the coming weeks NHS leaders say it is not just patients with Covid who will urgently need treatment, but those who have been on waiting lists for other procedures for months as a result of the pandemic, desperate to have their serious conditions dealt with, and who now cannot wait any longer without serious risk to their lives.
Chris Hopson, chief executive of NHS Providers, told the Observer: “Clearly the perfect storm would be if we have the combination of a third surge at the end of January, triggered perhaps by the looser rules over Christmas, and a cold snap, and the massive backlog of treatment for people that was delayed from the first phase – and having to do the vaccinations at the same time. That would be the nightmare scenario. We don’t how likely that is but it is certainly a possibility that can be envisaged.”
He added: “We are going to be doing a great deal of the vaccination in January, February, March when we are always the most stretched. We are obviously looking for volunteers beyond the NHS, St John’s Ambulance for instance, but if we have to use significant numbers of our staff for the vaccination that means that they won’t be able to do other work.”
Scott Erwin, a workforce planning specialist, formerly of McKinsey, who runs his own technology company Hirehand, said the government and NHS would face enormous manpower and scheduling challenges when organising the vaccination programme. They would need to call on a range of different groups, including retired people with medical and nursing experience, medical students, ambulance staff and even airline cabin crew to help.
But these people would usually not be available full time, creating big logistical problems. “There is no magic tree that can grow nurses overnight,” he said. “You will need to have these people coming in on an intermittent basis and they will usually be only partially available.
“So the level of complexity given the shortage of supply of the workers will mean that you require very strong execution on the part of the NHS. The concern would be that there just aren’t the people there. They will often be doing this in addition to their other work making it an incredible scheduling challenge.”
NHS staff shortages are mirrored inside government as the double challenge approaches. Thousands of civil service posts remain unfilled.
Crucial Whitehall staff have had their leave suspended for two months from the start of the year as ministers brace themselves for the impact of Brexit, deal or no deal. Insiders say that the civil service remains about 2,500 workers short of “full staffing”.
Senior Whitehall figures were concerned by a conference call with the Cabinet Office’s contingency planning team at the end of last month. It reported that 16,000 staff have now been recruited across the civil service to deal with both Covid-19 and Brexit, but that 2,500 posts were still vacant. Sources said it also reported probable disruption to food, livestock and medicine imports, chemical supplies and to fisheries, immigration and data controls.
Mike Clancy, general secretary of the Prospect union, said: “The government is facing the twin challenges of battling Covid and preparing for Brexit and it has been found wanting on both.”
Outside of the government, care home bosses are also concerned they simply do not have the time to properly deal with the challenges of testing for Covid, vaccinations, and potential supply shortages thrown up by Brexit. Vic Rayner, executive director of the National Care Forum, said: “We’ll be busy scrambling around in January, would be my guess, trying to work out how we cope with the fact that we haven’t got enough incontinence pads, or whatever it might be.”
Health service leaders have been assured that ways will be found to deliver the vaccine itself, and everything necessary to administer it.
But Lowe stresses that with or without a Brexit deal, the end of the UK’s transition out of the EU on 31 December will create significant additional disruption at ports and on the roads in the new year with inevitable effects on supply chains.
“A deal does not remove the need for customs declarations, import and exports procedures or regulatory barriers to trade,” he says. “Those controls will be ones that will be new. They have not had to take place during our membership of the single market or customs union or during the transition. They are additional controls.”
Lorry drivers and British port officials say they have been left frustrated by the government’s last-minute approach to Brexit, after the logistics industry has spent years asking for clarity on post-Brexit arrangements.
The main plank of the new arrangements for Brexit, they say, is an IT system known as the Goods Vehicle Movement Service which will allow drivers to present a reference at Dover. The French equivalent has been in place for 18 months, but the British version is still under wraps and a beta version will launch later this month, giving businesses a few days to find out if it works.
Duncan Buchanan, policy director of the Road Haulage Association, is blunt about his fears for what will unfold in January. “It’s going to be a disaster for supply chains, somewhere between a shambles and a catastrophe. No one can be sure what goods are not going to cross the border. You do not know what is not going to be on your shelves because something is stuck on a truck somewhere.”
Buchanan said he had “complete confidence” that the supply chain would be able to deliver actual vaccines up to 31 December – but the cost of importing other goods including food and delivering it would rise and the process would take longer.
The wider implications for key sectors of the economy could be stark. Already several car companies have cut back production in the belief that selling cars into the EU single market will be more difficult from next year, with or without a deal.
There is speculation in the north east that Nissan is poised to announce the closure of its giant factory near Washington, County Durham, following reports in the German press, while Honda has already announced the closure of its factory near Reading.
Make UK, the manufacturing trade body, has strongly criticised the government for failing to protect the automotive and aerospace sectors from the ravages of Covid-19 and a hard Brexit.Clancy added: “Covid may have caught us largely unawares but Brexit has been on the horizon for four years so there really is no excuse for systems remaining untested and vital staffing requirements remaining unmet.”
Meanwhile, more than a third (35%) of the public say they are unlikely to take the Covid-19 vaccine when it becomes available, according to a new Opinium poll for the Observer, while 48% worry that it will not be safe, 47% worry it will not be effective and 55% worry that it will have side effects.
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