The coronavirus has torn through nursing homes in the U.K., as it has in the U.S., taking tens of thousands of lives. Now, the U.K. hopes it is turning the tide, thanks to a homegrown vaccine that has yet to be authorized elsewhere in the West.
More than four million of the most at-risk people in the U.K., almost 8% of the adult population, have been vaccinated with at least one shot of vaccine.
Among them are more than half of the frailest group of all: the 300,000 elderly residents of nursing homes who can't travel to get a shot. The key to reaching them has been mobile vaccination teams armed with a shot developed by the University of Oxford and AstraZeneca PLC.
Together with a network of family doctors and vaccination hubs in sports centers, hotels and cathedrals, this shot has helped the country to stay on track toward a target of vaccinating its 15 million most vulnerable people by mid-February.
The government says the AstraZeneca vaccine, which has also been authorized in India, Morocco and some countries in Latin America, has been a game changer in reaching people tucked away in smaller nursing homes.
Doctors say that it is more efficient to deliver because it doesn't need diluting and that after the injection patients don't need monitoring for anaphylaxis. Both steps are time restraints when administering the other vaccine available in the U.K., one manufactured by Pfizer Inc. and BioNTech SE.
The AstraZeneca shot can be stored for six months at regular fridge temperatures of 2 to 8 degrees Celsius, meaning it can be moved several times and used in very small batches. The Pfizer shot, which has also been authorized in the U.S. and in Europe, is delivered in large batches and must be stored at minus-70. Once thawed it must be used in 3 1/2 days.
Helen Salisbury, a local doctor in Oxford, vaccinated some of her older homebound patients on Jan. 15 with the AstraZeneca vaccine. "It's much easier to carry around and we can take it from house to house," Dr. Salisbury said. "I went on my bike."
That versatility means supplies of the AstraZeneca shot are being prioritized for nursing homes, according to a letter sent to all family doctors in England on Jan. 13 that also offered them a cash incentive for giving first doses to residents.
Before the arrival of the AstraZeneca shot in early January, only larger nursing homes of more than 50 beds could be efficiently accessed with the Pfizer vaccine, according to the government's vaccine delivery plan, even after permission was granted to split the 975-dose boxes into smaller 75-dose trays. Now, smaller residential facilities, including those with fewer than 25 beds, are getting the vaccine, the plan says.
Speaking Monday, Scotland's Chief Medical Officer Gregor Smith pointed to studies showing that a life can be saved with as few as 20 vaccinations in nursing homes, compared with 600 vaccinations among over-70s living in the community. Giving priority to people in care homes at the front of the vaccination campaign, Dr. Smith said, "is time well spent."
Uddhav Bhatta, the manager of Langley Haven Dementia Care Home in Slough, west of London, had his first Pfizer shot in mid-December and his second last week. But residents had to wait until Jan. 14 for AstraZeneca's vaccine.
"It would have been difficult to come out with the Pfizer vaccine" to the nursing home, Mr. Bhatta said the doctor told him.
One thing now holding them back: a shortage of both vaccines, and here the AstraZeneca shot is at a disadvantage.
Unlike the new, gene-based technology used in the Pfizer vaccine and one from Moderna Inc., which is cleared for use in the U.K. but won't be supplied until the spring, the AstraZeneca shot relies on conventional vaccine production using a weakened form of a common-cold virus, known as an adenovirus. This makes it slower to grow than the mRNA vaccines, even if it is easier to administer.
Moderna's vaccine has less stringent shipping and storage requirements than Pfizer-BioNTech's, but they are still more restrictive than AstraZeneca's and the vaccine must be kept at minus-4 degrees Fahrenheit or refrigerated for up to 30 days once thawed.
AstraZeneca's shot has been available in the U.K. since Jan. 4, and the company said it had delivered 1.1 million doses to the country as of Jan. 13. The plan is to deliver two million doses a week in the near future and ship 100 million throughout the country by the end of this year.
The government says that it has the infrastructure and vaccinators it needs to administer such quantities and that the "rate-limiting factor is the supply of vaccine."
AstraZeneca says certain steps in the three-to-four month process of manufacturing the vaccine can't be accelerated. It takes between 58 to 60 days to grow the cells needed for the virus to replicate inside and then a further 28 days to prepare the vaccine via a process known as fill-and-finish before packaging and releasing in batches. Around 60 quality tests are performed during the process, and each batch is tested by the U.K. medicines regulator before being cleared for clinical use.
This is where the new vaccines based on mRNA technology, like Pfizer's and Moderna's, have an advantage. Their manufacturing process is a lot quicker. It takes about two hours to make the RNA. It must then be purified, formulated and encapsulated into lipid nanoparticles before being put into vials and tested.
"In total to make the RNA drug substance, the active ingredient, that would take around two days," said Zoltán Kis, a research associate at the Future Vaccine Manufacturing Hub at Imperial College London. Quality testing then takes about two weeks, he added.
On Monday, British Health Minister Matt Hancock said the government was over halfway toward its target of offering a first shot to all residents in its more than 10,000 nursing homes for older people in England by the end of this month.
In Scotland, more than 80% of people living in nursing homes and 55% of those caring for them have had a first dose of vaccine, according to First Minister Nicola Sturgeon.
Nursing homes aren't yet out of the woods. Covid-19 deaths among nursing-home residents in England began to rise again at the end of last year and continued to rise at the start of this one, after a period of relatively few fatalities throughout the summer and fall.
Five of Langley Haven's residents died of Covid-19 in April during the first wave of the pandemic. The home, which cares for 30 residents, didn't have another case until last week, when five residents and a member of staff tested positive for the virus, Mr. Bhatta said.
"It's a big relief [to have the vaccine] but we still don't know how infective" those who have had the shot are, he adds, "so we have to be careful."
Vaccine trials didn't determine whether immunizations against Covid-19 symptoms stopped patients from passing on the virus that causes the disease. Scientists are studying those vaccinated in recent weeks to determine whether the shots do have an impact on transmission.
Last week, Covid-19 broke out in the first nursing home in Scotland where residents were vaccinated with the Pfizer-BioNTech vaccine, in December.
"There's a myth out there that vaccination makes you Superman or Wonder Woman," said Donald Macaskill, chief executive of Scottish Care, an umbrella group representing nursing homes. "Our hope is that as time goes by and we get a population base that has been vaccinated, then these incidents will become fewer and fewer."
