British doctors say rolling out the Pfizer Inc.-BioNTech SE Covid-19 vaccine beyond hospitals will take longer than anticipated because of logistical challenges and complications thrown up by news in the U.K. of allergic reactions after the injection.
Following two severe allergic reactions on Dec. 8, the first day of the U.K. vaccination campaign last week, doctors were told to monitor patients for 15 minutes after each injection.
Logistical hiccups and the additional time required to monitor patients after a shot have added friction to an already-cumbersome immunization program and could signal challenges to come for the U.S. as health officials start vaccinating patients there.
Extra time required for observation means some U.K. doctors' offices pulled out of the local vaccination campaign before it started Monday because they don't have enough space to accommodate people in a socially distanced manner and still deliver the expected number of doses.
"You don't necessarily get through as many people because you've got the 15 minutes" waiting time, said Ruth Rankine, primary care director at the NHS Confederation, the membership body representing health-care staff in the U.K.'s state-run National Health Service. Each shot takes around eight minutes to administer, according to NHS exercises in preparation for the vaccine.
Initial planning for community rollout included a 15-minute waiting period after injections, but the requirement was dropped as more data about the vaccine became available, Mrs. Rankine said. The allergic reactions last week, however, prompted the U.K.'s Medicines and Healthcare products Regulatory Authority to reinstate the guidance on observation.
Combined with the general challenges of this vaccine, some doctors in the network of practices that make up the backbone of the NHS -- who are known as general practitioners, or GPs -- say they are rethinking how they vaccinate patients. Some have cleared their offices of other appointments or delayed taking part in the vaccination program, doctors say. Others haven't passed evaluations required to prove they are ready to deliver the complex vaccine.
Politicians had said the plan was to vaccinate all over-50s by the spring, but a person familiar with the rollout said there is "no definitive timeline. We want to make sure everything is done safely rather than to specific dates." The plan remains to vaccinate quickly and safely, the person said.
Around 100 local practice hubs, or groups of doctors offices across England, will this week start delivering the vaccine to nursing-home workers and people over 80 years old, who are also high-priority groups in other countries where the vaccine is being rolled out, including the U.S. There are more than 1,000 such hubs in England.
The clock started ticking Monday as soon as doctors offices received thawed-out vials of the vaccine, which is stored at temperatures of around minus 94 degrees Fahrenheit.
They have 3 1/2 days to deliver at least 975 doses of the two-dose shot, based on how long the vaccine lasts in the refrigerator and how long it takes to prepare for injection.
The U.K. became the first country in the West to begin vaccinating its general public last week, with the first shots of the Pfizer vaccine given in dozens of British hospitals.
Local family doctors are the first line of defense at the NHS. They routinely deal with around six million appointments a week in England and are adding vaccine delivery to their workload.
"We shouldn't forget that they are doing this on top of everything else that they are having to do," Mrs. Rankine said. "It's a really busy time for GPs anyway right before Christmas," when people get appointments in before the holidays and winter pressures add to the load.
The new vaccine requires specialist training, additional space and multiple checks to administer. Some doctors say doing all this while keeping patients socially distanced and following one-way systems on site isn't possible.
Unlike a flu shot that comes in ready-to-go vials, the Pfizer vaccine, which uses new technology called mRNA, must be diluted with sodium chloride solution and turned upside down and back again 10 times before being injected. Two people need to check the dose beforehand. Doctors are allocating around 8 minutes per shot, not including wait times. The flu vaccine takes under a minute to administer, Mrs. Rankine said.
Those taking part are required to offer their service seven days a week, and some are shifting other appointments to different offices to concentrate on vaccine delivery.
Doctors have to use at least 95% of the 975-doses in each refrigerated shipment, or they won't get paid for each shot they deliver. In case of surplus doses -- because of too few over-80s who can get to the doctors' office, or fewer-than-expected people turning up -- doctors have been advised to use the doses on health-care staff. "The overriding principle will be to avoid wastage," according to the British Medical Association, a trade union for doctors in the U.K.
Doctors will get 12.58 British pounds, or $16.78, for each shot delivered, paid after the second injection.
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