HDA UK Media and Political Bulletin – 9 April 2021

Media Summary

NHS ‘evaluating’ threat of fraud in pandemic delivery service

Chemist and Druggist, Valeria Fiore and Grace Lewis, 8 April 2021

The NHS Counter Fraud Authority (NHS CFA) is reviewing potential threats to the pandemic delivery service. The NHS wants to tackle fraud in pharmacies and improve weaknesses in the systems that could allow fraud to take place.

The pandemic delivery service for clinically extremely vulnerable (CEV) patients ended on 31st March, but the service is still available for people who have been notified of the need to self-isolate by NHS Test and Trace.

The Department of Health and Social Care (DH) published a new counter-fraud strategic plan last week, which did not explicitly mention pharmacy fraud. However, the strategy alluded to the DH’s plan of introducing measures to combat certain types of fraud affecting pharmacies, such as prescription fraud. A spokesperson for the NHS CFA confirmed that actions would target fraudulent claims made by contractors and patients alike.

Parliamentary Coverage

 There was no parliamentary coverage today.

 

Full Coverage

NHS ‘evaluating’ threat of fraud in pandemic delivery service

Chemist and Druggist, Valeria Fiore and Grace Lewis, 8 April 2021
The NHS Counter Fraud Authority (NHS CFA) is reviewing “some possible threats and vulnerabilities within the pandemic delivery service”, it has told C+D.

 

The NHS CFA is “aware” of some issues with the service, which was introduced for the first time in April last year, and “remains vigilant in case any additional threats emerge”, the spokesperson added.

 

It considers a “threat” as a “person or group, object or activity” that could commit fraud against the NHS in England, the spokesperson said. Instead, a “vulnerability” is a weakness in the system that “may allow fraud to occur”.

“We remain committed to evaluating the threats and vulnerabilities and finding solutions to mitigate them,” the spokesperson added.

 

The pandemic delivery service for clinically extremely vulnerable (CEV) patients ended on March 31, but the service is still available for people who have been notified of the need to self-isolate by NHS Test and Trace. This is currently commissioned until June 31.

 

In response to a written question in parliament, pharmacy minister Jo Churchill said last month (March 23) that pharmacy contractors and dispensing doctors had claimed for 3,477,259 deliveries to shielded patients between April and December 2020.

 

Tackling fraud in pharmacy “a priority”

 

The Department of Health and Social Care (DH) published a new counter-fraud strategic plan last week (March 30), in which it did not specifically mention pharmacy fraud.

 

However, the strategy alluded to the DH’s plan of introducing “preventative ways of permanently eradicating” certain types of fraud, such as prescription fraud.

 

A spokesperson for the DH told C+D that “tackling fraud within the pharmacy sector remains a priority and the NHS CFA has engaged with pharmacists to understand the types of fraud that take place”.

 

“We are introducing real time exemption checking (RTEC) technology so pharmacists can verify if patients are exempt from prescription charges,” the spokesperson added.

 

An NHS CFA spokesperson told C+D that counter-fraud actions in the pharmacy sector involve fraud committed by both contractors and patients.

 

In 2018, the DH said it would crack down on pharmacy contractor fraud, which it said was “impacting heavily” on the total fraud bill for the NHS.

 

However, a 2019 C+D investigation revealed that only one pharmacy contractor had been sanctioned for fraud against the NHS in a two-year period.

Media Summary

Patients should register with pharmacies says RPS Scotland
P3 Pharmacy, Pharmacy Magazine editoral staff, 7 April 2021

Pharmacy Magazine reports that the Royal Pharmaceutical Society in Scotland has called for patients to be registered with their local community pharmacy in order to ensure continuity of care. This is part of the “transformed” role pharmacists will play in providing patient care by the end of this decade.

According to the report by RPS Scotland, by 2030 pharmacies will be using digital technology to allow patients to access services from any location. It also suggests that patients should also be offered information about safe and effective use of their medicines each time a supply is made.

RPS Scotland’s Pharmacy 2030 vision aims to tackle health inequalities that have been highlighted during the COVID-19 pandemic. Following its publication last week, the report is currently out for consultation and will be followed by separate documents aimed at pharmacists working in other sectors.

Parliamentary Coverage

2021/22 priorities and operational planning guidance
NHS England, 25 March 2021

The 2021/22 priorities and operational planning guidance sets the priorities for the year ahead, against a backdrop of the challenge to restore services, meet new care demands and reduce the care back logs that are a direct consequence of the pandemic, whilst supporting staff recovery and taking further steps to address inequalities in access, experience and outcomes.

Effective partnership working across systems will be at the heart of this and the financial framework arrangements for 2021/22 will therefore continue to support a system-based approach to funding and planning. In this context the priorities for the year ahead are:

A. Supporting the health and wellbeing of staff and taking action on recruitment and retention
B. Delivering the NHS COVID vaccination programme and continuing to meet the needs of patients with COVID-19
C. Building on what we have learned during the pandemic to transform the delivery of services, accelerate the restoration of elective and cancer care and manage the increasing demand on mental health services
D. Expanding primary care capacity to improve access, local health outcomes and address health inequalities
E. Transforming community and urgent and emergency care to prevent inappropriate attendance at emergency departments (ED), improve timely admission to hospital for ED patients and reduce length of stay
F. Working collaboratively across systems to deliver on these priorities.

 

2021/22 priorities and operational planning guidance: Implementation guidance
NHS England, 26 March 2021

The NHS has published implementation guidance, providing further detailed policy and technical information to enable Integrated Care Systems (ICSs) and their constituent organisations to develop and agree operational plans.

Plans should summarise how 2021/22 priorities and operational planning guidance will be operationalised, with a focus on the six months to the end of September 2021 for most areas.

With every part of England now covered by an Integrated Care System, this guidance is aimed at supporting ICSs in delivering their four core purposes of:

• Improving outcomes in population health and healthcare
• Tackling inequalities in outcomes, experience and access
• Enhancing productivity and value for money
• Helping the NHS to support broader social and economic development.

 

Full Coverage

Patients should register with pharmacies says RPS Scotland
P3 Pharmacy, Pharmacy Magazine editoral staff, 7 April 2021

By 2030 patients should be registered with their local community pharmacy to ensure continuity of care, the Royal Pharmaceutical Society in Scotland has said.

In its Pharmacy 2030 document published last week, RPS Scotland outlines its vision for a “transformed” role for pharmacists, who it says will have a greater clinical focus while pharmacy technicians take responsibility for medicines supply.

As well as registering patients, by 2030 pharmacies will be using digital technology to allow patients to access services from any location, according to the professional body’s vision for the coming decade.

The document, for which RPS Scotland sought input from pharmacists working across Scotland, also says patients should be offered a conversation around the safe and effective use of their medicines each time a supply is made.

It emphasises shared decision making and the routine use of clinical examinations and prescribing by pharmacists and explores how the sector can tackle health inequalities.

The 2030 vision is currently out for consultation and will be followed by separate documents aimed at pharmacists working in other sectors.

RPS Scotland director Clare Morrison said: “The Covid pandemic has changed our world and it has changed healthcare. That is why pharmacy needs a new vision. Not because previous strategies weren’t good, but because we need something now that reflects our changed world. Today’s publication is the first step in creating that vision.

“Pharmacy 2030 describes a future where community pharmacies will remain the place rom which people get their medicines, but the pharmacist’s role will be transformed.

“The report explains how pharmacy will tackle health inequalities that have come to the fore during Covid. Importantly, it describes how all of this will be underpinned by better use of data, digital infrastructure and proper workforce development.”

Ian Rudd, director of pharmacy, NHS Highland, said: “I welcome this report from the RPS on its vision for community pharmacy. It highlights many key issues for further discussion across the profession in Scotland. I would encourage all pharmacists to join with the RPS in the conversations that are to follow.”

Scottish pharmacy board chair Jonathan Burton said: “As the only pharmacy organisation with members across all sectors of pharmacy, the RPS is well-placed to engage with the profession and create a single vision for the whole of pharmacy.”

Media Summary

Welsh patients to be first in UK to receive Moderna Covid vaccine

The Guardian, Harry Taylor, 7 April 2021

 

The Guardian reports that Welsh patients will be the first in the United Kingdom to receive doses of the Moderna vaccine outside of clinical trials. The rollout of the third approved vaccine for COVID-19 was described as a “significant” addition to Wales’ vaccination campaign by Welsh Health Minister, Vaughan Gething.

 

Scottish authorities are due to begin administering doses of the same vaccine later this week, having received the first delivery of the circa one million doses ordered through the centralised procurement scheme on Monday. According to Vaccines Minister Nadhim Zahawi rollout in England will begin in “the third week of April”. It is unconfirmed when delivery or administration of the Moderna vaccine will begin in Northern Ireland.

 

The first fallout

PharmaTimes Magazine, Stuart Evans, April 2021

 

Writing in the PharmaTimes Magazine, Stuart Evans explores the rising tensions between the European Commission and AstraZeneca as the first major contractual disagreement in cross-border pharmaceutical trade after Brexit.

 

Evans concludes that, as a vaccines dispute, this particular case benefited from being a high-profile issue requiring a workable solution. Factors for consideration for future cross-border pharmaceutical trade include anticipating potential differences in legal interpretation between countries, and the increasing importance of force majeure clauses and dispute resolution processes.

Parliamentary Coverage

New £20 million fund to grow UK life sciences manufacturing opens for applications

Department for Business, Energy and Industrial Strategy, Office for Life Sciences, Nadhim Zahawi MP, and The Rt Hon Kwasi Kwarteng MP, 7 April 2021

 

Applications are now open for the Medicines and Diagnostics Manufacturing Transformation Fund, a new £20 million fund to boost life science manufacturing across the United Kingdom. This fund will provide capital grant funding for investments related to the manufacture of human medicines, medical diagnostics, and MedTech products.

 

The fund is designed to build national healthcare resilience by improving domestic supply chains and creating high value manufacturing jobs in the sector. The deadline for applications to the fund is 30th June 2021, with any awarded funding to be defrayed by March 2022.

 

Full Coverage

Welsh patients to be first in UK to receive Moderna Covid vaccine

The Guardian, Harry Taylor, 7 April 2021

 

Patients in Wales will from Wednesday become the first in the UK to receive the Moderna vaccine as part of a mass vaccination programme, with the first doses in Scotland set to come later this week.

 

The initial jabs would be given at the West Wales general hospital in Carmarthen, the Welsh government said.

 

It added that 5,000 doses of the Moderna vaccine – the third to be approved for use in the UK – had been sent to centres in the Hywel Dda University Health Board area, covering Ceredigion, Pembrokeshire and Carmarthenshire, on Tuesday.

 

It comes as Scotland received its first delivery on Monday, and a spokesperson told the Guardian that the doses would start to be administered later this week.

 

Scotland is set to get more than a million of the 17m jabs ordered by Westminster, with vaccine procurement centralised rather than devolved.

 

England is yet to receive its first batch for general distribution, with vaccines minister Nadhim Zahawi saying on Tuesday it would be rolled out around “the third week of April”. A spokesperson for the Department of Health and Social Care on Tuesday said it would be rolled out “as soon as possible this month”.

 

The Guardian asked the UK, Welsh and Scottish governments for further details about how the vaccine supply had been divided between the four nations – but none were able to provide details.

 

It has not been confirmed when the jab will be received in Northern Ireland and start to be used to vaccinate people there.

 

The Moderna vaccine was approved by the Medicines and Healthcare products Regulatory Agency (MHRA) on 8 January, with phase 3 trials showing it had 94.1% efficacy against Covid, and 100% against severe illness. Like the Pfizer/BioNTech and Oxford/AstraZeneca jabs, it requires two doses for full protection, according to tests.

 

The Welsh health minister, Vaughan Gething, said it was a “significant” addition to the country’s vaccination programme.

 

“Every vaccine given to someone in Wales is a small victory against the virus and we would encourage everyone to go for their vaccine when invited.”

 

Ros Jervis, director of public health for Hywel Dda said: “We are incredibly lucky to have a third vaccine in Wales, with a long shelf-life and the ability to be easily transported, to help deliver the vaccination programme to small clinics across our rural communities.”

 

The health secretary, Matt Hancock, said he was “delighted we can start the UK rollout of the Moderna vaccine in west Wales”.

 

He added: “Three out of every five people across the whole UK have received at least one dose, and today we start with the third approved vaccine. Wherever you live, when you get the call, get the jab.”

 

The first fallout

PharmaTimes Magazine, Stuart Evans, April 2021

 

Taking a look at the recent dispute between the EU Commission and AstraZeneca over the ins and outs of its contract, Stuart Evans, commercial litigation expert and partner at law firm BLM, examines what this could represent for EU/UK cross-border pharma relations.

 

Earlier this year we saw reports of the EU commission and AstraZeneca coming to loggerheads over vaccine roll-out across the bloc. Amidst criticism of the speed of the EU’s vaccine roll-out programme, AstraZeneca reported production problems in its Netherlands and Belgium plants, claiming it as a reason for a shortfall in vaccine delivery to the EU.

 

An initial deal was struck in August 2020 for 300 million doses to be delivered into the EU, post-regulatory approval, with the option for an additional 100 million. Come late January, EU projections showed a potential shortfall of around 75 million doses by March.

 

Amongst growing pressure to speed up its vaccine roll-out, production issues at AstraZeneca’s European plants threatened delivery further. As attention turned to the company’s agreement with the bloc, the EU announced AstraZeneca had been instructed to share doses from its UK plants, though AstraZeneca argued its UK contract prevented this.

 

The EU maintained that its own contract meant AstraZeneca was obliged to send UK-produced supplies to account for a shortfall within the EU. Commission President Ursula von der Leyen claimed the company had “explicitly assured us in this contract that no other obligations would prevent the contract from being fulfilled”, subsequently sharing extracts of its contract with the company.

 

At such a critical time for the industry, with all efforts focused on vaccine delivery, does this row represent one of the first major contractual fall-outs in our post-Brexit world, and what could it mean for cross-border pharma going forward?

 

Contractual conundrum

 

Much attention has been paid to whether the wording of the initial contract was open for debate. The 42-page document, of which portions were redacted, endeavoured to deal with a large and complex transaction for the supply of millions of vaccines across multiple countries. There has been particular focus on the contract’s reference to ‘best reasonable efforts’. Whilst this particular contract is governed by Belgian law and is therefore subject of detailed local advice, English law by comparison also wrestles with the concepts of ‘best endeavours’ and ‘reasonable endeavours’, with the former more stringent than the latter.

 

In broad terms, ‘best endeavours’ requires the responsible party to take all available steps to achieve the desired results, whilst “reasonable endeavours” requires the responsible party to act by reference to what a reasonable person, acting prudently and commercially, could do to get such results. The AstraZeneca contract introduces slightly different wording, ‘best reasonable efforts’, in a lengthy definition for each party, which may fall somewhere between the two. What this means in the particular circumstances of this case is a matter for debate, reflecting the possibility that the parties could not agree on something more specific.

 

Ultimately, should this be one of the issues litigated by the parties in the Belgian courts, interpreting what exactly that term means under Belgian law is likely to tax legal minds and generate vast amounts of argument. And that’s just one provision in a 42-page document.

 

‘Vaccine War’

 

As the debate escalated, the EU Justice Commissioner stated the UK was in danger of starting a ‘vaccine war’ between itself and the 27 members of the bloc, claiming that Brexit had made it clear ‘the UK doesn’t want to show solidarity with anyone’. Setting aside how true that assertion is, what is clear is that Brexit may complicate contractual obligations and litigation as a result of any alleged breach of those obligations.

 

Whilst in this instance, this was a dispute between the EU and a Swedish company, this should be a prompt to pharmaceutical companies to look at their commercial contracts in terms of cross-border trade.

 

For example, given the problems caused by the pandemic, firms should look closely at force majeure clauses, whether doing business with an EU or non-EU counterpart. A force majeure clause typically operates to excuse performance of the contract by one or both parties upon the occurrence of certain events. Force majeure clauses may exclude foreseeable events, even if such events would put performance of a contract beyond the control of a party. The logic being that if an event is foreseeable, the contracting party should allow and provide for it, rather than relying on a force majeure clause.

 

In respect of contracts which might be affected by Brexit-related developments (which again could include contracts with non-EU counterparts), parties should also consider expressly providing for situations in which their ability to perform – or their costs of performing – the contract are affected by Brexit. Parties are wise to remember that their business could be affected not only by their inability to perform a contract, but also non-performance (whether driven by Brexit or otherwise) of businesses elsewhere in their supply chain. A force majeure clause or a so called ‘Brexit’ clause may be helpful in forgiving non-performance were this to occur, but protection from litigation is likely to be small comfort if a wider supply chain collapses. This is aside from the need to be on top of EU procurement and public law issues.

 

If litigation with an EU counterpart does become necessary, we currently find ourselves in a legal grey area. The UK and EU are now in a situation where reciprocal arrangements when dealing with jurisdiction, and the recognition of judgments under the Brussels Recast legislation, are no longer applicable for cases begun in 2021. Until there is a replacement regime that can clearly provide which national courts have jurisdiction in cross-border disputes, and depending on the dispute resolution terms agreed by the parties, it is possible that litigation with an EU counterpart may become more costly and time-consuming, both to get it up and running and then to enforce any judgment.

 

What are the EU’s options for future vaccine disruption?

 

After much back and forth once the contract was made public, the EU and AstraZeneca have now come to a resolution. The company agreed to supply an additional nine million doses by March, and the EU sought to distance itself from the possibility of legal action at this stage. The bloc will no doubt be focused on seeking to regularise the supply of vaccines from AstraZeneca and looking at viable contingency plans, rather than taking a lengthy route through the courts.

 

There is a resolution clause in the contract that requires the parties to go through an informal dispute resolution process, and there is now at least a short term solution focused on a programme of delivery that representatives from both sides have signed up to, possibly leaving important but less pressing contractual issues to another day.

 

Whilst this particular row looks to be resolving, it’s clear that the forces of COVID-19 and Brexit could continue to cause complications in cross-border pharma trade. In the particular race to control COVID-19, people ultimately want vaccines, rather than to hear about contractual wrangling by their respective governing bodies and external contractors, so in these situations there will be pressure on the affected parties to reach a workable solution if that is feasible.

 

New £20 million fund to grow UK life sciences manufacturing opens for applications

Department for Business, Energy and Industrial Strategy, Office for Life Sciences, Nadhim Zahawi MP, and The Rt Hon Kwasi Kwarteng MP, 7 April 2021

 

  • Applications open for new £20 million fund to support the manufacture of medicines, diagnostics and MedTech in the UK
  • fund will boost the UK offer in life sciences manufacturing, creating economic opportunities and highly skilled jobs across the country
  • supports the government’s ambitions to build back better, ensuring greater resilience in UK supply chains

 

Announced last November by the Prime Minister and opening for applications today, the Medicines and Diagnostics Manufacturing Transformation Fund is designed to boost the country’s ability to respond to future pandemics and put UK companies ahead of global competitors.

 

With two-thirds of life science manufacturing jobs already outside London and the South East, the new £20 million fund will also open up economic and investment opportunities for manufacturers across the whole of England, Northern Ireland, Scotland and Wales, improving our domestic supply chains and safeguarding and creating hundreds of highly skilled manufacturing jobs.

 

The UK has one of the strongest and most productive health and life sciences industries globally, with a turnover of £80 billion and supporting 256,000 jobs, underpinned by a powerful research landscape and high-quality science base.

 

Business Secretary Kwasi Kwarteng said:

 

This £20 million investment will harness the best in UK manufacturing and fund cutting-edge medical technologies to protect the British public in 2021 and beyond.

 

This will not only boost the UK’s already strong vaccine and medicine portfolio but support top quality, local jobs across the country and put the UK in a formidable position to continue responding to the most pressing global challenges of our time.

 

Life Sciences Minister Nadhim Zahawi said:

 

Our life sciences sector is world leading and its incredible response to COVID-19 has reminded us of the crucial importance of the sector to the UK.

 

I am thrilled to see this fund opening for applications and would encourage companies to make the most of the opportunity to expand their operations and create good jobs as we build back better from the pandemic.

 

The pandemic has shown the importance of having a strong domestic medicines and diagnostics manufacturing industry. This new fund has been established to grow and strengthen the UK’s capabilities, as well as encouraging companies to deploy new technologies, build new factories and harness new advances, including bioprocessing, data and using greener manufacturing processes.

 

To date, the UK government has invested over £300 million into manufacturing a successful vaccine, and through the work of the Vaccine Taskforce, established in April 2020, facilities across the UK are working at pace to supply the world’s most promising vaccines so far as part of the biggest vaccination programme in NHS history.

 

Today’s announcement forms part of the government’s plans to bolster secure and resilient onshore UK manufacturing capacity, ensuring universal and equitable access to safe, efficacious and affordable vaccines, medicines and diagnostics for this and future pandemics, taking advantage of our world-leading genomics expertise.

Media Summary

COVID-19: Why India’s COVID spike means the world has to wait for its jabs 
Sky News, Philip Whiteside and Amar Mehta, 5 April 2021

Sky News reports that Delhi is restricting vaccine exports to other countries to meet domestic demand. In India the number of people testing positive for COVID-19 has rapidly increased in the past month and there are warnings the health system could be overwhelmed.

The situation in India has implications for vaccination campaigns globally. The Serum Institute of India is a key manufacturer for vaccines across the world. India’s decision to limit exports has significant implications for the COVAX scheme, which a planned to send around 225 million vaccines to some of the world’s poorest countries – putting lives there at risk.

The halting of Indian vaccine exports has also had an impact closer to home. Only half of the AstraZeneca vaccines ordered in a bilateral deal between the Serum Institute of India and the UK government have been received. This has caused the UK government to slow down the vaccine rollout in April. One of the reasons cited for the delay of the vaccination programme for under-50s is the supply problems in India.

Parliamentary Coverage

There was no parliamentary coverage today. 
 

Full Coverage

COVID-19: Why India’s COVID spike means the world has to wait for its jabs 
Sky News, Philip Whiteside and Amar Mehta, 5 April 2021

On 18 March, some younger Britons who may have been expecting to get their COVID jabs in the coming weeks, were told they would have to wait.

Among the reasons cited why the programme to offer coronavirus vaccinations to the under-50s would be delayed was supply problems in India.

But now it has emerged British under-50s are not alone.

India is a key supplier for vaccines across the world, and over the weekend it was revealed Delhi is restricting exports to other countries because it needs to keep the jabs as it fights to contain a surge in cases.

The number of people testing positive in India has more than quadrupled in a month.

The situation is so serious, there have been warnings the health system could be overwhelmed.

But India’s decision to limit exports has hit a plan to send vaccines to some of the world’s poorest countries – putting lives there at risk.

It has also left other countries scrambling to find alternative sources for COVID inoculations.

In doing so, the move has shone a light on how vaccines are being used as bargaining chips in international diplomacy and how what happens in countries thousands of miles away can mean life or death for someone in another part of the globe, including the UK.

The world’s biggest vaccine maker

The Serum Institute of India (SII) is one of the world’s biggest vaccine manufacturers and is part of a plan to provide vaccines to most of the world’s developing economies.

Among them are countries that might otherwise struggle to get jabs in a world where more advanced nations are hoovering up supplies for themselves, having financed them.

Under a scheme called COVAX, more than a billion AstraZeneca jabs are to be sent to countries around the world in the coming months.

Around 225 million doses of the AstraZeneca jabs were due to be manufactured and sent out by SII by the end of June, under a plan drawn up by the organisers of COVAX.

About 97 million of those doses were due to stay in India but millions more were to be sent to countries in desperate need.

Another company, the South Korean firm SK Bioscience, was due to provide about a third of the AstraZeneca COVAX total for other countries.

One of the organisers of the scheme, the vaccine distributor GAVI, said when the plan was made that between 35% and 40% would be dispatched by the end of March.

So far, India’s External Affairs Ministry says around 17 million doses have been exported under COVAX – which, according to Sky News analysis, is about a two-fifths of what should have been supplied by the end of March under the original plan.

While the COVAX scheme is expected to provide a critical line of defence for many countries that may not have the resources to manufacture their own vaccines, it has also been backed by some of the richest countries, including the UK, which has invested £548m.

Meanwhile, the UK is understood to have struck a deal with SII to supply 10 million of the 100 million AstraZeneca doses it had originally ordered, after funding the drug’s development to the tune of £65m last May.

As of today, SII has supplied only half of what the UK is said to have ordered – leaving the UK government forced to admit vaccine supply in April would be “tighter” than expected, and those aged under 50 would have to wait longer for their first jabs.

India is yet to officially admit to banning exports of AstraZeneca’s vaccine manufactured by SII, but sources have told Reuters it has done effectively that.

The two Reuters sources seemed to confirm earlier claims by SII that it was the Indian government that was holding up supplies, rather than any issues with supply itself.

Housing Secretary Robert Jenrick told Sky News that the hold-up in the supply of the British shipment was down to “lumps and bumps” in the manufacturing process.

But SII chief executive Adar Poonawalla told The Telegraph: “It is solely dependent on India and it has nothing to do with the SII. It is to do with the Indian government allowing more doses to the UK.”

Sky News understands there is no hold, as such, but supplies to other countries going forward may be restricted.

The organisers of COVAX have told those countries which were going to receive doses under the programme to expect a delay.

A joint statement issued by GAVI, WHO and UNICEF places the blame firmly at the door of India’s explosion in COVID cases, saying: “Deliveries of COVID-19 vaccines produced by the Serum Institute of India (SII) to lower-income economies participating in the COVAX Facility will face delays during March and April as the government of India battles a new wave of COVID-19 infections.

“COVAX and the government of India remain in discussions to ensure some supplies are completed during March and April.”

The barrister

Harish Salve, 65, is a member of London’s Blackstone Chambers but also spends part of the year in India, working as an advocate.

“It’s a scary thing. They have lifted all restrictions a while ago, air travel is back to a high level. From January to March, there are loads of festivals and you can’t keep people back. Social distancing and discipline is alien to our culture.

“When the lockdowns were put in place, that was a bad time because people lost jobs and there was a migration crisis. I don’t see that kind of economic pain that we saw last year (this time). Nobody is in favour of a lockdown. They feel they are too drastic.

“There should be stricter enforcement, but I know people who have had weddings, and mass gatherings have returned now.”

“People are concerned and you have this local sentiment, asking ‘why are we exporting vaccines when we need them?’. This will only grow as figures go up.”

‘It will result in deaths’

While it is not known exactly how many planned orders will not be fulfilled, the expectation is that there will be potentially serious consequences.

Dr Michael Head, senior research fellow in global health at the University of Southampton and an expert in vaccine supply chains, told Sky News that, while keeping hold of the vaccines will save lives in India, it will result in deaths in other countries.

He said: “It will cost lives… If there’s more vaccine going into arms in India, then good for India and to some extent the globe, but that obviously therefore means a shortage elsewhere and that will cost lives in, for example, sub-Saharan Africa, where countries were lined up to receive some doses that they therefore won’t.

“A lot of countries will be rather put out by their not receiving vaccines that they’ve been expecting.”

He said part of the problem was the reliance on one supplier – SII – to such an extent, which means that when that one site is unable to export, the world is left “in trouble”.

He added: “The vast majority of people in those countries will remain unprotected for longer as a result of vaccines not getting into their country and (being) distributed around. That will mean the global pandemic carries on a bit longer, so it does increase the risk of new variants emerging relatively undetected…, variants that impact upon vaccine effectiveness.”

Prof Kirsty Le Doare, professor of vaccinology and immunology at St George’s University of London, told Sky News: “In countries like Uganda that rely on AZ vaccine from (the) COVAX initiative, delay in vaccines will mean that our frontline healthcare workers will not be able to receive their vaccines as scheduled.

“This will have a knock-on effect as we prepare for the wave currently in Tanzania and Kenya to hit our borders. Uganda has faired well with the pandemic at present, but… we need the vaccine to protect our fragile healthcare system and to maintain public confidence in vaccines.”

The comms man

Rahul Gossain, 40, works in corporate strategic communication and lives in Delhi
“The cases went up because of the relaxations. People are used to living in social environments so were fed up. Social gatherings are part and parcel of life. As the number of cases went down, so they eased restrictions – offices were opened and so were schools.

“Festivals and cricket matches happened during a period when rates are low and the real impact will be seen in a few weeks.

“Urban India is very concerned but in the rural areas people aren’t wearing masks. There is complacency.

Healthcare has coped really well and people have understood it really well. Things that happened in the US and UK did not happen in India at hospitals, there is understanding of how treatment has to be handled.

“People are grateful they are getting the vaccine but understand they have wait because of India’s population. It’s more of a political thing rather than the public being angry.”

The largest vaccination drive in the world

So far, India has vaccinated 61 million people, out of an adult population of somewhere between 900 million and one billion people.

As of 1 April, its health authorities say anyone aged 45 or over can now go forward for a vaccination, in a drive it is championing as the largest in the world.

That means around 280 million more people are currently due for the jab than have had it so far.

Health policy officials say the programme badly needs to step up a gear, with one senior government official saying on Tuesday the COVID situation was going from “bad to worse”.

“Remember if the cases are more, they will eventually overwhelm the system”, senior health official Vinod Kumar Paul told a news conference.

As well as AstraZeneca, India has approved one of its own vaccines, by maker Bharat Biotech, but the lion’s share of the jabs given out so far are those developed by Oxford University in conjunction with the Anglo-Swedish pharma giant and made by SII.

It is thought other vaccines may come on stream in the coming days.
When compared with countries like the US, Europe, or some of those in South America, India’s COVID rates don’t seem that bad.

In the last two weeks, the case rates rose to around 46 per million per day, which is low compared to the worst country in the world at the moment, Hungary, where nearly 900 out of every one million are testing positive every day, according to OurWorldInData. This excludes micro-states, with small populations, like San Marino.

But, as in Africa, the figures can be deceptive, often masking the true level of infection. Added to that, that figure of about 46 million is more than double what it was a fortnight before. A number of other African and Asian countries are also seeing rapid rate rises, but few have such a large population as India, which makes Indian figures more reliable.

In the last few days, the number testing positive in a day has broken records in some states.

Deaths are also rising sharply, with the numbers doubling in the last two weeks, according to OurWorldInData.

An indication as to whether an outbreak is under control, and also whether figures are likely to be accurate, is how many, out of those tested, test positive. The higher the figure, the more out of control an outbreak, with WHO saying the rate should be below 5% for an outbreak to be considered under control. India is currently seeing 5.5% of people test positive for every test taking place, and that figure is rising.

The holy man

Baba Machendra Puri, 41, is a Naga Sadhu and is taking part in the Kumbh Mela, in Haridwar.
“I am a Naga Sadhu and have been attending all Kumbh melas (gatherings). Bathing at the Kumbh has always been part of our Hindu tradition since time immemorial. We will continue following our Hindu belief and practices. The water that flows from the mountains in mother Ganga not only washes us of our sins but also destroys all diseases and illnesses. I will take the holy dip and am not scared of the pandemic. I will follow all the COVID protocols given to us by the authorities.

“There are thousands and thousands of us here taking the holy dip and following our traditions.”

‘People think this is over already’

A number of major events are contributing to rising rates, including the ongoing Kumbh Mela, where millions of devotees gather in the Indian city of Haridwar, aiming to bathe in the River Ganges, close to where it emerges from the Himalayas.

Earlier this week, pictures showed people thronging together to throw coloured powder at each other and spray water as part of the annual Holi spring festival, despite government attempts to limit gatherings.

At the weekend and in the last month or so, long lines of people were seen forming outside polling stations, many tightly packed together and some not wearing masks.

Unlike in the UK and many parts of Europe, there is no national lockdown in India at present. The state of Maharashtra, one of the worst affected by the current surge, is considering imposing stricter curbs, but opposition parties and industrialists have opposed a lockdown, saying it hurts the poor the most.

Professor Giridhara Babu, head of life-course epidemiology at the Public Health Foundation of India, told Sky News that the latest surge was due to a combination of factors.

He said: “The virus itself is changing; it’s probable we have a more infectious strain. The host immunity, both in terms of vaccination and infection… is changing; and the third factor is environment… the factors around us which promote viral transmission, which include crowd formation, lack of compliance of the appropriate behaviours, and lack of strict regulatory measures such as lockdown – all of these things will favourably allow the transmission of the virus.”

He said India is embarking on its second wave, but during the first, not only did the government effectively lock down the country before the virus took hold, people were largely compliant.

It resulted in India having a comparatively low death rate compared to many countries, despite its decentralised health system, which is heavily reliant on the private sector. Since then, Prof Babu said, things have changed.

“People have this COVID-19 fatigue,” he added. “The second thing is… the role of the vaccine – people think that since the vaccine is around the corner, although they may not have got it, this is definitely the end of COVID.

“Even though the government keeps saying wear masks, even after vaccines, people are in a mood to think this is over already.

“And (at) the government level, I think there are too many things going on… elections… the need to ensure the economy has to be strengthened, all sorts of priorities which were delayed last year.

“But unless we get our act together… I can’t think it will be as favourable as it was last year.”

Rising rates over the last few weeks have led to widespread criticism that domestic needs should be catered to first.

All the government has said officially is that there will be no immediate increase in vaccine exports.

But, according to the news agency Reuters, it spoke to a source that said: “No exports, nothing until the time the India situation stabilises. The government won’t take such a big chance at the moment when so many need to be vaccinated in India.”

China and Russia poised to seize opportunity

Few governments have criticised India, but a number have actively stepped-up action to find alternative suppliers, including South Korea, Philippines, Vietnam and Indonesia, none of which were due to receive doses directly from SII before May, but which may be finding supplies they were due to receive delayed.

Last week, WHO director-general Tedros Adhanom Ghebreyesus hit out at the kind of vaccine nationalism that has left part of the COVAX programme struggling.

He said: “COVAX is ready to deliver but we can’t deliver vaccines we don’t have. Bilateral deals, export bans, vaccine nationalism and vaccine diplomacy have caused distortions in the market with gross inequities in supply and demand.”

He later urged India to continue providing other countries with vaccines.
A spokesman for SII referred Sky News to the Indian government for comment. Indian Ministry of External Affairs spokesperson Arindam Bagchi denied imposing a ban on exports, saying: “We have not imposed any export ban on COVID-19 vaccines. Till now we have supplied vaccines to more than 80 countries across the world.”

With so many possibly more deserving countries now crying out for vaccines, it could mean that the UK will have to wait even longer for the five million doses that would have given the British vaccine rollout the spurt it needed to go beyond the first nine priority groups.

In the meantime, those countries that were relying on AstraZeneca doses to start reducing their rates in the same way the UK has, may increasingly be looking to countries like China and Russia to provide what they need.

Philippines and Vietnam have both approved Russia’s Sputnik V vaccine, along with more than 50 other countries, mainly developing nations.

Chinese vaccine maker Sinopharm, meanwhile, plans to produce its COVID-19 vaccine at a new plant in the United Arab Emirates.

There is likely to be anxiety in some western governments that as developing nations become increasingly reliant on Chinese and Russian vaccines, they may be more willing to overlook any human rights allegations which would otherwise be discussed at the United Nations.

There are some, no doubt, who will say India is only doing what the UK and US are already doing – hanging on to all the vaccines they produce for domestic use and protecting their populations.

The EU hit out in the last month at its inability to acquire UK-made vaccines, despite exporting Pfizer jabs to Britain.

The UK is expected to start exporting vaccines when a raft of other developers and manufacturers, which are currently putting their jabs through late-stage tests, come on stream.

Experts are yet again pointing to the need to plan for future pandemics, to make sure life-threatening interruptions to vaccine supply, like a potential block on exports from one of the biggest jab makers in the world, won’t continue to harm people in years to come, should a new form of COVID appear, or any other virus.

Dr Head said: “It shows another good reason as to why pandemic preparedness is so important. At the minute we’re trying to resolve a pandemic while running around firefighting. If we had vaccine logistics nailed down prior to the next pandemic starting, then it will make issues like this less likely and probably be easier to resolve in the longer run.

“The lessons we should be learning from this to take forward is planning ahead of the next big pandemic.”

Media Summary

EU warns ‘zero’ jabs shipped to UK until AstraZeneca meets bloc’s targets  
Financial Times, George Parker, Sam Fleming and Michael Peel31 March 2021

The Financial Times reports that a senior Brussels policymaker suggested that it is unlikely the UK will obtain AstraZeneca vaccines manufactured in the EU, he said “zero” jabs would be shipped across the Channel if the company failed to meet its commitments to the bloc.

Internal market commissioner, Thierry Breton said that “there is nothing to negotiate” regarding ongoing discussions between London and Brussels over vaccine production.

Breton said production from the Seneffe plant in Belgium and the Halix factory in the Netherlands “more or less” matches AstraZeneca’s commitments to Brussels, and so must be reserved for the EU.

Britain signed an undisclosed initial agreement with AstraZeneca several months before the company made a deal with the EU — although the final UK contract was only sealed the day after the deal with the European bloc.

British officials have discussed “sharing” doses made in Leiden with the EU and the two sides put out a statement last week declaring they wanted to find a “win-win situation and expand vaccine supply for all our citizens”. However, some EU officials are uncertain what the UK can currently offer the EU given the bloc has exported 21m doses of all vaccines to Britain with no production flowing the other way.

Parliamentary Coverage

DHSC counter fraud strategy: 2020 to 2023
Department of Health and Social Care, 30 March 2021

The DHSC counter fraud strategy: 2020 to 2023 sets out the department’s plan to prevent and tackle fraud across the healthcare system.

Fraudulent activity in the NHS takes money away from important patient care and reduces resources available for health services. NHS funding will increase by £33.9 billion by 2023 to 2024, thus a counter-fraud response to protect this investment has become even more important.

Additionally, as the DHSC counter fraud strategy is published, the country continues to respond to the COVID-19 pandemic. During a national emergency, some may take advantage of the situation to commit fraud.

The DHSC strategy will provide direction and a structure focused on accountability, convening and working together. The objective of the strategy is to be a system-wide approach to tackling fraud which protects taxpayer’s money for better patient care.

Full Coverage

EU warns ‘zero’ jabs shipped to UK until AstraZeneca meets bloc’s targets

Financial Times, George Parker, Sam Fleming and Michael Peel31 March 2021

This article is subject to copyright terms and conditions. Please access the full article here.

Media Summary

There was no media coverage today.

 

Parliamentary Coverage

Letter to medicines and medical products suppliers

Steve Oldfield, Chief Commercial Officer, Department of Health and Social Care, 30 March 2021

Steve Oldfield, Chief Commercial Officer at DHSC, has written to industry and the wider supply chain setting out the Government’s latest advice and guidance on supply of medical goods:

  • He said that they had not seen the level of disruption to supply that underpinned planning assumptions, but current levels of preparedness needed to be maintained for some months.
  • He noted the growing third wave in Europe and the likely impact here in the UK, with a “residual risk of COVID-19 impacting global borders”.
  • DHSC has asked NHS Supply Chain to maintain contingency stock in the centralised stock build for the foreseeable future and urged suppliers to continue to hold their UK stockpiles.
  • DHSC has committed to a review of these measures and will report back with recommendations during the summer.
  • The letter urges suppliers to continue preparations to be ready for the introduction of import controls in October 2021 and January 2022.
  • Meanwhile DHSC continues to work with all partners to address the challenges to supply into NI from 1 January 2022.

Challenges and opportunities for UK from new EU pharma policy

European Scrutiny Committee, 30 March 2021

The European Scrutiny Committee has asked the Government for a detailed response to EU plans which could have a significant impact on the way medicines are developed and marketed in the UK. The call for an explanation of the Government’s position comes in the latest regular report by the Committee which scrutinises proposed or new EU legislation that could have an impact on the UK.

The request for information from the Government follows the publishing of the EU’s new, wide-ranging strategy for the future of the pharmaceutical sector, adopted by the European Commission in November 2020. The aim of the strategy is to ensure that EU citizens have access to innovative and affordable medicines, as well as to support the competitiveness, innovative capacity and sustainability of the sector.

The four strands of the EU strategy are:

  • Reviewing and where necessary tailoring incentives, such as patent protections, to satisfy unmet medical needs – for example the need for new antibiotics.
  • Supporting competition and innovation in the sector, by for example simplifying legislation.
  • Focusing on resilience of supply and environmental sustainability.
  • Promoting regulatory convergence and international standards to encourage safe, high quality and affordable treatments globally.

In light of the new EU strategy, and the agreement by the UK and the EU to cooperate in the pharmaceutical sector, the European Scrutiny Committee has written to the Minister of State for Health, Edward Argar MP. The letter said the Committee required from the Minister an outline of the Government’s plans in response to the EU strategy.

The letter also asked:

  • What would be the risks or opportunities for the UK in the event of divergence between UK and EU approaches to pharmaceutical innovation.
  • What opportunities the Government sees for UK-EU research cooperation in the development of pharmaceutical products.
  • Whether the Government sees any benefits for the UK in encouraging other countries to strengthen their regulatory and intellectual property standards.
  • What the Government’s own ideas are for addressing unmet medical needs, ensuring accessibility and affordability of medicines, and promoting innovative, sustainable and patient-oriented pharmaceutical development.

Community pharmacy vaccine service launches

Northern Ireland Executive, 29 March 2021

On Monday Health Minister Robin Swann launched a new community pharmacy COVID-19 vaccination service in Northern Ireland. The new service will see almost 350 community pharmacies throughout Northern Ireland begin to administer the vaccine – at present this applies to those aged 50 years and over. This latest development follows the official opening of the COVID-19 vaccination centre at the SSE arena in Belfast earlier in the day.

Minister Swann said: “Community pharmacy teams have remained dedicated to providing the public with vital health care and support through what have been very challenging times. Pharmacists have a wealth of expertise, skills and experience which makes them very well-placed for delivering the COVID-19 vaccine. The addition of this new service will help speed up the roll-out of the existing programme by increasing capacity and local accessibility to vaccines for the general population, particularly for those who may find it more difficult to travel to one of the mass vaccination centres.”

 

Full Coverage

There was no media coverage today.

Media Summary

Moderna’s COVID vaccine to be rolled out in UK from April

The Financial Times, Jasmine Cameron-Chileshe, 28 March 2021

The Financial Times reports that the Government announced yesterday that Moderna’s Coronavirus vaccine will be rolled out in the UK from next month. Culture Secretary Oliver Dowden confirmed the jab made by the US company was expected to be administered by the NHS from April.

The UK has ordered 17m doses of the two-dose vaccine, which was approved by the MHRA in January and is 95 per cent effective in preventing the disease. It is the third Coronavirus vaccine to be rolled out in the UK after the BioNTech/Pfizer and Oxford/AstraZeneca jabs.

Despite recent concerns over supplies, the Government said it would be able to offer second doses within 12 weeks and remained confident in its ability to inoculate all adults by the end of July, Dowden told the BBC’s The Andrew Marr Show on Sunday.

It is hoped that the introduction of Moderna jabs next month will ease pressure on the supply of vaccines for under-50s, who have been warned that their inoculations could be delayed following delays in the delivery of the Oxford/AstraZeneca vaccine made by the Serum Institute of India.

This was reported in a number of outlets, including The Telegraph and the Evening Standard.

Britain ready to seal COVID vaccine deal with EU

The Times, Oliver Wright and Bruno Waterfield, 28 March 2021

The Times reports that Britain is close to striking a vaccine deal with the European Union under which the EU will remove its threat to ban the export of Pfizer-BioNTech jabs to Britain. In return the Government will agree to forgo some long-term supplies of the Oxford-AstraZeneca vaccine that had been due to be exported from Holland.

A European Commission spokesman said: “The discussions with the UK are ongoing. We do not have any comments to make at the moment on the content of those discussions. But as you know our common aim is to ensure that we have good co-operation in terms of supply chains in terms of producing the vaccine.”

Ministers have insisted that the delivery of second doses in the UK would still be carried out on schedule, even if planned shipments from a plant in the Netherlands were blocked. India has also halted the shipment of about five million Oxford-AstraZeneca doses due in the UK this month, resulting in the Government suspending plans to roll out first doses to under-50s.

This was reported in a number of outlets, including City A.M. and the Evening Standard.

EU medicines regulator approves new vaccine production sites

AP News, Editorial staff, 26 March 2021

AP News reports that the EU’s medicines regulator has approved new manufacturing sites for Coronavirus vaccines made by Pfizer-BioNTech, Moderna and AstraZeneca in the Netherlands, Germany and Switzerland, in a move to boost Europe’s supply of the shots and speed vaccination efforts across the continent. The new approvals come amid the 27-nation bloc’s struggles to ramp up COVID-19 vaccination and repeated delivery delays and manufacturing problems.

The EMA also said it was granting “more flexible storage conditions” to the Pfizer-BioNTech vaccine, which was cleared on the basis that it needed ultra-cold freezer temperatures for storage and delivery. The approval “is expected to facilitate the rapid roll-out and distribution of the vaccine in the EU by reducing the need for ultra-low temperature cold storage conditions throughout the supply chain,” the regulator said.

The approvals come after EU leaders failed to settle a fight about the distribution of COVID-19 shots among member states but pledged to strengthen vaccine export controls and production on EU soil amid a shortage of doses and spikes in new cases.

This was reported in a number of outlets, including Politico and Euronews.

50 to 64-year-olds added to 2021/22 flu programme

P3 Pharmacy, Pharmacy Magazine editorial staff, 26 March 2021

P3 Pharmacy reports that people aged 50 to 64 are expected to be included as an eligible cohort in the 2021/22 flu vaccination programme according to NHS England & Improvement’s latest Primary Care Bulletin. It advises that the flu reimbursement letter is currently being updated to reflect the inclusion and will be republished imminently.

Pharmacy providers are asked to await the updated flu reimbursement letter for more information, before amending their orders for vaccines. The 50-64 age group was included for the first time in the 2020/21 programme as a measure to help reduce the impact of COVID-19.

 

Parliamentary Coverage

House of Commons Question – 26 March 2021

Mr Steve Baker (Conservative, Wycombe): To ask the Secretary of State for Health and Social Care, if he will publish an updated timetable for the estimated (a) regulatory approval and (b) delivery to the NHS of the (i) Novavax and (ii) Johnson & Johnson COVID-19 vaccines; and if he will make a statement.

Nadhim Zahawi (Conservative, Stratford-on-Avon): Reviews are underway by the Medicines and Healthcare products Regulatory Agency (MHRA) to assess the Johnson & Johnson (known by Janssen in Europe) and Novavax vaccines. Any vaccines that are made available will have been authorised because they pass the MHRA’s tests on safety and efficacy. If and when those vaccines are authorised by the MHRA, we expect to receive the doses for both vaccines in the second half of this year.

House of Commons Question – 25 March 2021

Chi Onwurah (Labour, Newcastle upon Tyne Central): To ask the Secretary of State for Health and Social Care, whether he plans to write off the £ 370 million advance payments provided to community pharmacy owners to cover costs incurred during the COVID-19 outbreak.

Jo Churchill (Conservative, Bury St Edmunds): Discussions are ongoing with the Pharmaceutical Services Negotiating Committee about additional funding for costs incurred during the COVID-19 pandemic. As part of its ongoing assessment of COVID-19 costs incurred by the sector, the Government will take account of the £370 million increased advance payments paid to community pharmacies.

The COVID-19 support package for community pharmacy also included general COVID-19 business financial support, funding for Bank Holiday openings, social distancing measures and the medicine delivery service to shielded patients and free personal protective equipment, as well as non-monetary support, including the removal of some administrative tasks, flexibility in opening hours and the delayed introduction of new services.

 

Full Coverage

Moderna’s COVID vaccine to be rolled out in UK from April

The Financial Times, Jasmine Cameron-Chileshe, 28 March 2021

This article is subject to copyright terms and conditions. Please access the full article here.

This was reported in a number of outlets, including The Telegraph and the Evening Standard.

Britain ready to seal COVID vaccine deal with EU

The Times, Oliver Wright and Bruno Waterfield, 28 March 2021

Britain is close to striking a vaccine deal with the European Union that will remove the threat of the bloc cutting off supplies.

After a week of frantic behind-the-scenes diplomacy the two sides are expected to seal an agreement as soon as this weekend under which the EU will remove its threat to ban the export of Pfizer-BioNTech jabs to Britain. In return the Government will agree to forgo some long-term supplies of the Oxford-AstraZeneca vaccine that had been due to be exported from Holland.

Senior diplomatic sources said the secret talks, which began last Saturday conducted by the former EU Ambassador Sir Tim Barrow, had helped restore trust despite the public rhetoric.

Two sources said the decision to use Barrow rather than Lord Frost, the minister responsible for EU relations, had been key to unlocking a deal.

“For us it was very significant that Johnson did not use Frost but instead went through the Foreign Office,” said one EU diplomat. “It showed that he was really serious about finding a compromise and trying to build trust.”

Barrow was dispatched to Brussels hours after the Government was forced to admit just over a week ago that it would have to delay extending the UK’s vaccination programme to the under-50s because of a shortfall.

On Wednesday the two sides issued a joint statement saying they were working to “ensure a reciprocally beneficial relationship between the UK and EU on COVID-19”.

In a call with President Biden, Boris Johnson is said to have emphasised that “global access to vaccines will be key to defeating the pandemic”.

France’s Foreign Minister claimed yesterday that because of supply shortages, Britain would struggle to source second doses for those who have already had their first. In provocative comments Jean-Yves Le Drian claimed that the UK programme had been over-optimistic about supplies. He suggested on France Info radio that the EU should not help Britain with a problem of its own making. “The UK is proud to have vaccinated many people with the first dose, but they will have a problem with the second dose,” he said.

“We can’t accept any sort of blackmail. The UK is pushing for the first jab, knowing there will be problems with the second one. Europe does not have to pay the price for this policy.”

Ministers have always insisted that the delivery of second doses in the UK would still be carried out on schedule, even if planned shipments from a plant in the Netherlands were blocked.

India has also halted the shipment of about five million Oxford-AstraZeneca doses due in the UK this month. This resulted in the Government suspending plans to roll out first doses to under-50s.

According to the UK Government’s latest data, 55 per cent of adults aged over 18 have received a first jab and 5.3 per cent have had a second dose. Johnson said that the UK had sufficient supplies to ensure that people would be given their second jabs on time. “We will have the second doses that people need within the 12-week window, which means around 12 million people in April,” he said.

A European Commission spokesman said: “The discussions with the UK are ongoing. We do not have any comments to make at the moment on the content of those discussions. But as you know our common aim is to ensure that we have good co-operation in terms of supply chains in terms of producing the vaccine.”

A study of more than 200 healthcare workers has found that people infected with COVID-19 produced six times the immune response after a single dose of the Pfizer vaccine. The research looked at antibodies and T-cells, which can lessen symptoms.

The study, a pre-print version of which is on The Lancet website, was led by Oxford and Sheffield universities and backed by the Department of Health. It suggests that being infected is similar to receiving the first jab in priming the immune system. However, its authors cautioned that people who have had COVID-19 should still get two doses to ensure long-lasting protection.

Over-70s and frontline health and social care workers will start to receive booster jabs from September under plans revealed last night by Nadhim Zahawi, the Vaccines Minister.

This was reported in a number of outlets, including City A.M. and the Evening Standard.

EU medicines regulator approves new vaccine production sites

AP News, Editorial staff, 26 March 2021

The European Union’s medicines regulator on Friday said it has approved new manufacturing sites for Coronavirus vaccines made by Pfizer-BioNTech, Moderna and AstraZeneca, in a move that could significantly boost Europe’s supply of the shots and speed vaccination efforts across the continent.

The European Medicines Agency said in a statement that it had approved sites in the Netherlands, Germany and Switzerland for the COVID-19 vaccines made by the companies.

The new approvals come amid the 27-nation bloc’s struggles to ramp up COVID-19 vaccination and repeated delivery delays and manufacturing problems.

The EMA said it had approved a factory in Leiden, the Netherlands, to make the active substance for AstraZeneca’s vaccine, bringing the number of such licensed sites to four.

The EU regulator said it was also giving the green light to a site in Marburg, Germany, to make both the active substance and completed vaccine developed by BioNTech and Pfizer.

In addition, the EMA said it was granting “more flexible storage conditions” to the Pfizer-BioNTech vaccine – which was cleared on the basis that it needed ultra-cold freezer temperatures for storage and delivery.

That approval “is expected to facilitate the rapid roll-out and distribution of the vaccine in the EU by reducing the need for ultra-low temperature cold storage conditions throughout the supply chain,” the regulator said.

Last week, an expert committee at the EMA recommended new manufacturing lines at a facility in Visp, Switzerland for the Moderna Inc. vaccine.

These changes are “intended to scale up production capacity and increase supply of the vaccine for the EU market,” the regulator said.

All COVID-19 vaccines meant for use in the EU must have their manufacturing sites approved by the EMA after a regulatory evaluation.

On Thursday, EU leaders failed to settle a fight about the distribution of COVID-19 shots among member states but pledged to strengthen vaccine export controls and production on EU soil amid a shortage of doses and spikes in new cases.

At the end of the summit, the bloc’s 27 nations were still locked in a dispute over how an upcoming batch of 10 million doses could be allocated to narrow the vaccine gap between member states, and the leaders decided to push the talks to a future meeting of their ambassadors.

This was reported in a number of outlets, including Politico and Euronews.

50 to 64-year-olds added to 2021/22 flu programme

P3 Pharmacy, Pharmacy Magazine editorial staff, 26 March 2021

People aged 50 to 64 are expected to be included as an eligible cohort in the 2021/22 flu vaccination programme, according to NHS England & Improvement’s latest Primary Care Bulletin (March 24).

It advises that the flu reimbursement letter is currently being updated to reflect the inclusion and will be republished imminently.

Pharmacy providers are asked to await the updated flu reimbursement letter for more information, before amending their orders for vaccines.

The 50-64 age group was included for the first time in the 2020/21 programme as a measure to help reduce the impact of COVID-19.

Media Summary

France may be added to COVID red list regardless of risk to food supply

The Times, Graeme Paton, 25 March 2021

The Times reports that Boris Johnson yesterday confirmed that the Government was considering adding France to its “red list”, severely limiting direct travel from the country. He said the measures may have to be introduced “very soon” to prevent mutant strains of the virus being imported.

The Prime Minister admitted that the move could severely interrupt cross-Channel trade, with particular threats posed to the flow of food and medicines to the UK. Lorry drivers are likely to be exempt but will have to be tested when they enter the UK.

“There is a balance to be struck and what we don’t know is the exact state of the efficacy of the vaccines against the new variants and we have to balance that against the very serious disruption that is entailed by curtailing cross-Channel trade,” Johnson said.

This was reported in a number of outlets, including The Guardian and The Independent.

Coronavirus: EU and UK try to end row with ‘win-win’ on vaccines

BBC News, Editorial staff, 25 March 2021

BBC News reports that the UK and the European Union have said they are working together to improve their relationship, after weeks of tensions over COVID vaccine supplies. In a joint statement, they said they wanted to “create a win-win situation and expand vaccine supply for all”.

The European Commission earlier proposed tougher export controls on vaccines, amid tensions over supplies of the Oxford-AstraZeneca jab. Prime Minister Boris Johnson warned that “blockades” were not “sensible”.

The tougher export controls are most like to affect vaccine-exporting countries that have higher vaccination rates than the EU, such as the UK and US. The key criteria for the proposed regulations are “reciprocity” and “proportionality”.

The BBC’s Europe Editor, Katya Adler, suggests that while the tone of the EU-UK statement was positive, actual progress between the two sides has been described by an insider as “slow, cumbersome and difficult”, on both sides.

This was reported in a number of outlets, including The Financial Times and The Independent.

 

Parliamentary Coverage

Report – Beyond Brexit: food, environment, energy and health

European Union Committee, 23 March 2021

The European Union Lords Select Committee has published its 22nd report of the 2019-2021 session: Beyond Brexit: food, environment, energy and health. In this inquiry, the Committee examined aspects of the EU-UK Trade and Cooperation Agreement (TCA) that fall within the remit of the EU Environment Sub-Committee; exploring the provisions in the TCA, any challenges that arise and how they could be resolved, and where UK-EU relations should go from here.

The Committee recognised that many of the sectors analysed as part of the report – including the healthcare sector – benefit substantially from the tariff-free access to the EU market secured by the TCA, but will be affected in other ways. The report’s chapter dedicated to healthcare looks at a number of issues of relevance to the HDA and its member companies, including continuity of supply, mutual recognition procedures, and inspections:

  • Health Minister Edward Argar MP told the Committee that the TCA “delivers on reciprocal healthcare, delivers continuity of supply, and delivers on health security”.
  • Dr Richard Torbett, Chief Executive of the ABPI, told the Committee: “The fact that we will have a tariff-free flow of trade in medicines and active pharmaceutical ingredients, which are important for manufacturing, is very welcome.” He added, “We were very pleased to see a pharmaceutical annex to the deal that includes provisions for the mutual recognition of good manufacturing standards and inspections.”
  • The BioIndustry Association agreed: “Mutual recognition of GMP reduces the duplication of bureaucracy for medicines manufactured by one party and exported to the other.”
  • Dr Richard Torbett also told the Committee that the Government had unilaterally decided to recognise the EU’s batch testing for two years, but noted, “After that the implication is that we would have to duplicate all those processes.”

Conclusions and recommendations included:

  • It is beneficial for the UK’s pharmaceutical and manufacturing industries that the TCA allows tariff-free export of medicines and medical devices to the EU.
  • While mutual recognition of Good Manufacturing Practices is helpful for the medical industry, it is disappointing that such recognition has not been extended to other regulatory processes such as batch testing. The Committee noted that the EU has reached mutual recognition agreements with other third countries, and urged the Government to seek a similar agreement.
  • The Committee welcomed the grace period that the Government has secured to allow businesses time to adjust their supply routes to accommodate the post-Brexit application of the Falsified Medicines Directive in Northern Ireland. It also welcomed the Government’s continuing engagement with the sector: if disruption once the grace period has elapsed is to be minimised, it will be essential to explore the alternative possibilities mentioned by the Minister, such as bonded warehouses and cabotage.

 

Full Coverage

France may be added to COVID red list regardless of risk to food supply

The Times, Graeme Paton, 25 March 2021

Travel to and from France may be banned to control the spread of the Coronavirus despite the risk of “very serious disruption” to food and medicine supplies, according to Boris Johnson.

The Prime Minister confirmed yesterday that the Government was considering adding France to its “red list”, severely limiting direct travel from the country. He said the measures may have to be introduced “very soon” to prevent mutant strains of the virus being imported.

He admitted that the move could severely interrupt cross-Channel trade, with particular threats posed to the flow of food and medicines to the UK.

The South African and Brazilian variants, which are more resistant to vaccines, account for up to 40 per cent of cases in parts of France.

The Times was told yesterday that the Prime Minister was coming under pressure from Chris Whitty, England’s Chief Medical Officer, to implement tougher border controls.

Ministers have added 35 countries to the red list, which bans direct travel and prevents foreign nationals who have been in the countries in the previous 10 days from entering the UK. Britons can enter the UK from red-list countries — travelling via a third nation — but have to quarantine for 10 days in a hotel.

The measures affect South America, southern Africa and parts of the Middle East but have not applied to Europe since Portugal was removed from the list earlier this month.

Applying the measures to France would pose huge logistical difficulties because of the flow of trade via cross-Channel ferries and through the Channel tunnel. Lorry drivers are likely to be exempt but will have to be tested when they enter the UK.

The move would also pile pressure on Eurostar, which has been crippled by the lockdown on either side of the Channel, leaving the passenger rail service on the brink of collapse.

At the Commons Liaison Committee yesterday, the Labour MP Yvette Cooper said 2,000 to 3,000 cases of the Brazilian and South African variants had been found in France and asked why the country was not on the UK red list. Johnson said it was “something that we will have to look at”.

“There is a balance to be struck and what we don’t know is the exact state of the efficacy of the vaccines against the new variants and we have to balance that against the very serious disruption that is entailed by curtailing cross-Channel trade,” he said.

“We will take a decision, no matter how tough, to interrupt that trade, to interrupt those flows, if we think that it is necessary to protect public health and to stop new variants coming in. It may be that we have to do that very soon.”

The threat of adding France to the red list was made just as the country removed the remaining travel restrictions imposed on the UK. For the past three months lorry drivers have been forced to register a negative COVID test before crossing the Channel from the UK but will no longer need to do so.

Tests will still be required to drive to Denmark, the Netherlands and Germany.

This was reported in a number of publications, including The Guardian and The Independent.

Coronavirus: EU and UK try to end row with ‘win-win’ on vaccines

BBC News, Editorial staff, 25 March 2021

The UK and the European Union have said they are working together to improve their relationship, after weeks of tensions over COVID vaccine supplies.

In a joint statement, they said they wanted to “create a win-win situation and expand vaccine supply for all”.

The European Commission earlier proposed tougher export controls on vaccines, amid tensions over supplies of the Oxford-AstraZeneca jab.

Prime Minister Boris Johnson warned that “blockades” were not “sensible”.

The joint UK-EU statement said that “openness and global co-operation” would be key to tackling the pandemic.

“We are all facing the same pandemic and the third wave makes co-operation between the EU and UK even more important,” it said. “We will continue our discussions.”

But there was little harmony earlier on Wednesday when the Commission announced plans for all vaccine shipments to be assessed on the destination country’s rate of vaccinations and exports. The proposals, which will be put before EU leaders on Thursday, are seen as focused on the UK and US in particular.

Analysis by Katya Adler, Europe Editor

The tone of the EU-UK statement was positive, but actual progress between the two sides was described to me by an EU diplomat as “slow, cumbersome and difficult”. On both sides.

That doesn’t mean impossible, but at their summit on Thursday, some EU leaders – along with the European Commission – will still be pushing for tougher controls on vaccine exports. And they could hit the UK.

EU insiders say they had hoped never to use the controls. They say they want them as a means of exerting pressure on vaccine companies and on countries with vaccine production sites that are not exporting to the EU.

With a third wave of the pandemic hitting much of mainland Europe, EU leaders are coming under increasing pressure to show voters they are taking action to ramp up both the supply of jabs and their vaccine rollout, on both of which they are trailing behind the UK.

EU Health Commissioner Stella Kyriakides rejected a suggestion that the aim was to punish the UK. “We’re dealing with a pandemic and this is not seeking to punish any countries,” she said.

Asked whether the UK might retaliate, Mr Johnson told MPs he did not believe “that blockades of either vaccines or of medicines, of ingredients for vaccines” would be “sensible”. Companies might draw conclusions about future investments “in countries where arbitrary blockades are imposed”, he added.

What is the EU planning?

The tougher export controls are most like to affect vaccine-exporting countries that have higher vaccination rates than the EU, such as the UK and US.

The key criteria for the proposed regulations are “reciprocity” and “proportionality”:

  • The EU says there is no reciprocity if a country importing vaccines from the EU restricts exports itself either by law or other means, so “it may be appropriate to consider whether exports to this country are justified”.
  • Member states and the Commission will also consider the epidemiological situation in that non-EU country, its vaccination rate and existing availability of COVID-19 vaccines.

There will be no outright export bans, which are opposed by countries such as the Netherlands and Belgium.

Vaccine manufacturers would be assessed to see if they were fulfilling their contract with the EU, although no specific algorithm is planned.

Is the UK being targeted?

In an interview with the BBC, the EU’s Internal Market Commissioner Thierry Breton insisted the bloc’s issues were with AstraZeneca and not the UK Government. “I know that there’s some tension… but as long as we have transparency, I think [relations] will be able to be normalised,” he said.

He said if AstraZeneca had provided the agreed 120 million doses to the EU, member states would have been at the same rate of vaccination as the UK: “We have been heavily penalised and we just want to understand why”.

AstraZeneca denies that it is failing to honour its contract with the EU.

A UK Government spokesperson said: “We are all fighting the same pandemic. Vaccines are an international operation; they are produced by collaboration by great scientists around the world. And we will continue to work with our European partners to deliver the vaccine rollout.”

Last week, European Commission President Ursula von der Leyen complained that the EU had exported more than 10 million doses to the UK, but the UK had so far exported none in return.

Her colleagues added that this had to be seen in the context of the EU being both a global COVID hotspot and also the biggest exporter of vaccines. Since the end of January, EU countries have exported 43 million doses of vaccine to 33 countries not subject to export authorisation, they say.

UK sources insist vital components are being sent to the continent, for example for the Pfizer vaccine, and they have emphasised the UK’s role in investing early in vaccine development, BBC correspondent Nick Beake reports.

This was reported in a number of outlets, including The Financial Times and The Independent.

Media Summary

EU threat to vaccine exports exposes mutual risks to global supply chain
Financial Times, FT Reporters, 18 March

The Financial Times reports that the EU’s threat to restrict the export of COVID-19 vaccines has exposed the mutual harm that countries could inflict on one another due to the interdependent nature of the global vaccine supply chain.

Ursula von der Leyen, European Commission President, said on Wednesday that Brussels was considering “all options” to ensure Europeans were vaccinated as soon as possible. Her plans, which are likely to be discussed at an EU summit next week, could stop vaccine shipments to countries that did not show “reciprocity” to the EU by allowing supplies to reach the bloc.

Coronavirus vaccine supply chains are intrinsically global. US biotech Moderna produces vaccine ingredients in Switzerland, fills and finishes the doses in Spain and ships from there to all buyers outside the US. Pfizer similarly has all of its non-US production situated inside the bloc. EU facilities are understood to be dependent on imports for their vaccine production, including the lipid nanoparticles needed in mRNA vaccines and the plastic bags used in bioreactors.

For this reason, Jacob Kirkegaard, Senior Fellow at the Peterson Institute for International Economics and the German Marshall Fund, says that protectionist measures would cause significant damage. The EU would be “taking a sledgehammer to something brittle”, risking retaliation and reputational damage for minimal gain, he added. “It’s an altogether bad political idea — and it fails to give Europe a material amount of extra vaccines now.”

Retesting 1.7m vaccines and Indian delay blamed for UK shortage
Financial Times, George Parker, Sarah Neville, Jasmine Cameron-Chileshe & Stephanie Findlay, 18 March

The Financial Times reports that Britain’s vaccine rollout has been knocked off course by the delayed arrival of vaccines from India and a need to check 1.7m doses to ensure their stability. At least 12m people will still receive a second COVID-19 vaccine dose in April but supply will be “tighter than this month” according to Matt Hancock

The Health Secretary confirmed in the House of Commons that there had been a delay to the “scheduled arrival from the Serum Institute of India” of Indian-made doses of the Oxford/AstraZeneca vaccine.

The need to retest a batch of 1.7m doses would also constrain supplies, Hancock said, without providing further detail on the provenance of those vaccines or why they have to be checked. The need for such additional testing was “to be expected” from time to time and showed the “rigour” of UK vaccine safety processes, he added.

Hancock also warned the EU not to impose emergency controls on exports of vaccines — including the Belgium-made Pfizer jab — to Britain. “We fully expect those contracts to be honoured,” he said.

Moderna COVID vaccine expected to arrive in the UK in April, company says
The i, Paul Gallagher, 18 March

The i reports that Moderna is expected to start delivering its order of 17 million COVID vaccine doses to the UK in April, although it is unclear whether their arrival could solve the problem of the expected shortfall of the Oxford/AstraZeneca jabs next month.

The Government signed a deal with the US company last year and said at the time that it expected delivery to arrive in the Spring. Problems over the supply of the AstraZeneca vaccine led scientists to question why officials had yet to name a time when the Moderna doses would arrive, but the US company has said they will be sent from next month. A spokesman said: “Moderna expect to begin deliveries to the UK in April, within the spring delivery window previously communicated. Moderna is on track to meet quarterly contractual commitments.”

The UK Government signed a deal with Moderna for an initial 5 million doses before ordering another 2 million doses in November. It then ordered a further 10 million doses in January. Final clinical results found that the vaccine’s efficacy against COVID-19 was 94.1% and the vaccine’s efficacy against severe COVID-19 was 100%.

 

Parliamentary Coverage

House of Commons – Written Question, 17 March

Julian Sturdy (Conservative, York Outer): To ask the Secretary of State for Health and Social Care, if his Department will make an assessment of the potential merits of writing off the repayment of advance funding extended to community pharmacy in 2020 to maintain services during the COVID-19 outbreak.

House of Commons – Written Question, 17 March

Julian Sturdy (Conservative, York Outer): To ask the Secretary of State for Health and Social Care, what assessment his Department has made of whether the performance of community pharmacy during the COVID-19 outbreak necessitates the creation of a new national pharmacy contract.

House of Commons – Written Question, 17 March

Julian Sturdy (Conservative, York Outer): To ask the Secretary of State for Health and Social Care, what assessment his Department has made of the adequacy of current funding arrangements for community pharmacy.

House of Commons – Written Question, 17 March

Alex Norris (Labour, Nottingham North): To ask the Secretary of State for Health and Social Care, what assessment his Department has made of the effect of the COVID-19 outbreak on the cashflows of community pharmacies; what estimate he has made if the number of community pharmacies that (a) have closed in each of the last three financial years and (b) will close in the financial year 2021-22; and if he will make a statement.

Full Coverage

EU threat to vaccine exports exposes mutual risks to global supply chain
Financial Times, FT Reporters, 18 March

This article is subject to copyright terms and conditions. Please access here.

Retesting 1.7m vaccines and Indian delay blamed for UK shortage
Financial Times, George Parker, Sarah Neville, Jasmine Cameron-Chileshe & Stephanie Findlay, 18 March

This article is subject to copyright terms and conditions. Please access here.

Moderna Covid vaccine expected to arrive in the UK in April, company says
The i, Paul Gallagher, 18 March

Moderna is expected to start delivering its order of 17 million Covid vaccine doses to the UK in April although it is unclear whether their arrival could solve the problem of the expected shortfall of the Oxford/AstraZeneca jabs next month.

The Government signed a deal with the US company last year and said at the time that it expected delivery to arrive in the Spring. Problems over the supply of the AstraZeneca vaccine led scientists to question why officials had yet to name a time when the Moderna doses would arrive, but the US company has said they will be sent next from month. A spokesman said: “Moderna expect to begin deliveries to the UK in April, within the spring delivery window previously communicated. Moderna is on track to meet quarterly contractual commitments.”

Problems with a shipment of the AstraZeneca jab from India has impacted that supply chain with 5 million doses said to be delayed as a result, meaning people in their 40s are likely to have to wait until May to get their Covid-19 vaccine.

Professor Martin Marshall, chairman of the Royal College of GPs, said news of constraints in supply was “disappointing” and “a bit of a setback”, and the focus in April in England will be on giving second doses to people who were vaccinated earlier in the year.

“The impact of this shortage of supplies will happen on the group that we were hoping to start on in April, which is the people under the age of 50 without any pre-existing conditions, who are now going to have to wait until May,” he told the BBC.

Scientists said issues over the AstraZeneca vaccine supply has made it all the more urgent that the Moderna vaccine will arrive on time.

Lawrence Young, Professor of Molecular Oncology at Warwick Medical School, said: “Vaccine supply was always going to be challenging – particularly at the current rates of daily vaccinations. This highlights the difficulties in manufacturing these complex vaccines along with need for stringent quality control. We are also limited by having just two approved vaccines (Pfizer/BioNTech and AstraZeneca/Oxford) currently in use.

“Millions of doses of the Moderna vaccine, which was approved for use by the UK Medicines regulator (MHRA) in January, were secured for delivery in the spring – where are they? We have also secured 60 million doses of the Novavax vaccine which is currently awaiting regulatory approval.

“We are in a very precarious situation with a significant proportion of the adult population unvaccinated (approximately 21 million in the 18-49 age group) and the continued threat of more transmissible virus variants popping up in different parts of the country. This could mean that we need to revisit the timetable for easing out of lockdown.”

The UK Government signed a deal with Moderna for an initial 5 million doses before ordering another 2 million doses in November. It then ordered a further 10 million doses in January. Final clinical results found the vaccine to be 94.1 per cent effective.

Media Summary

COVID vaccine: India shortfall behind UK’s supply delay
BBC News, Editorial Team, 18 March

BBC News reports that an expected reduction in the UK’s COVID vaccine supply next month is due to a delay in the delivery of five million Oxford-AstraZeneca doses from India.

The shipment, produced by the Serum Institute of India, has been held up by four weeks. The Serum Institute is the world’s largest manufacturer of vaccines and is making one billion doses of the AstraZeneca jab this year. Earlier this month, it agreed to supply 10 million doses for the UK, but only half of these will arrive this month with the rest delayed for several weeks. The rest of the UK’s AstraZeneca doses are being produced domestically and the company says there are no supply issues with these doses.

A spokesperson for the Serum Institute said: “Five million doses had been delivered a few weeks ago to the UK and we will try to supply more later, based on the current situation and the requirement for the government immunisation programme in India.” Meanwhile, NHS England warned of a reduction in supply in April in a letter to local health organisations on Wednesday, although the Department of Health insists it is still on track to offer a first dose to all adults by the end of July.

Dominic Cummings calls for ‘very hard look’ at handling of COVID crisis
The Guardian, Ian Sample & Jessica Elgot, 17 March

The Guardian reports that Boris Johnson’s former Chief Adviser Dominic Cummings has called for an investigation into the government’s handling of the Coronavirus pandemic.

Cummings told MPs there was a need for “a very, very hard look” at what went wrong and why, adding that problems at the DHSC had prompted him, along with Sir Patrick Vallance, the Government’s Chief Scientific Adviser, to argue for a separate taskforce to procure vaccines for the UK.

Shortages of PPE such as masks, visors and gowns in Spring 2020 forced the Government to order in supplies at inflated prices, with some items being found to be defective once they arrived. Cummings said the Government’s procurement system was an “expensive disaster zone” before last year and it “completely fell over” when the pandemic struck.

“In Spring 2020 you had a situation where the Department of Health was just a smoking ruin in terms of procurement and PPE and all of that. You had serious problems with the funding bureaucracy for therapeutics. We also had the EU proposal which looked like an absolute guaranteed programme to fail – a debacle,” he said. “Therefore Patrick Vallance, the Cabinet Secretary, me and some others said: ‘Obviously we should take this out of the Department of Health, we should create a separate taskforce and we have to empower that taskforce directly with the authority of the Prime Minister.”

This story was also reported in Health Service JournalThe Telegraph and The Independent.

 

Parliamentary Coverage

COVID-19 vaccination deployment next steps on uptake and supply
Written Letter, Emily Lawson, NHS Chief Commercial Officer & Dr Nikita Kanani, Medical Director for Primary Care, 17 March

In a letter published Wednesday, NHS England said they had been notified by the Vaccines Task Force that there would be a significant reduction in weekly supply available from manufacturers beginning week commencing 29 March.

The letter states that the reduction will continue for a four-week period. NHS England emphasised the importance to focus efforts on reaching as many people in cohorts 1-9 and said inviting patients outside of cohorts 1-9 is “only permissible in exceptional circumstances”. They added that vaccination centres and community pharmacy-led vaccination services should close unfilled bookings from the week commencing 29 March and ensure no further appointments are uploaded from 1 to 30 April.

The Government have reassured that they are still on track to meet their 15 April (To vaccinate all adults aged 50 and over with a first dose) and end of July (All UK adults to be offered first dose) deadlines.

You can read the letter here.

Further funding for community pharmacies’ response to COVID-19
Written Statement, Vaughan Gething, Welsh Minister for Health and Social Services, 16 March

Welsh Health Minister Vaughan Gething has announced that a further £3.5m will be provided to Welsh community pharmacy contractors. In total, this means an additional £9.1m will have been allocated this financial year in recognition of the vital role pharmacies played during the height of the pandemic.

In a statement, the Welsh Health Minister highlighted that he has also enacted a deferment of further repayments against the £55m advanced payment until the 2021-22 financial year in order to support the cash flow situation for community pharmacies.

You can read the statement in full here.

Full Coverage

COVID vaccine: India shortfall behind UK’s supply delay
BBC News, Editorial Team, 18 March

An expected reduction in the UK’s Covid vaccine supply next month is due to a delay in the delivery of five million Oxford-AstraZeneca doses from India.

The shipment, produced by the Serum Institute of India, has been held up by four weeks, the BBC has been told.

NHS England warned of a reduction in supply in April in a letter to local health organisations on Wednesday.

The Department of Health insists it is still on track to offer a first dose to all adults by the end of July.

A spokesperson for the Serum Institute said: “Five million doses had been delivered a few weeks ago to the UK and we will try to supply more later, based on the current situation and the requirement for the government immunisation programme in India.”

A source told the BBC that although the original aim had been to deliver the next five million in March, there was not a stipulated time for the delivery of the doses.

Housing Secretary Robert Jenrick said the UK had less supply of the vaccine “than we might have hoped for in the coming weeks but we expect it to increase again through the course of April”.

He told BBC Breakfast the vaccine rollout would be “slightly slower than we might have hoped but not slower than the target we had set ourselves” of offering a first dose to all people aged over 50 by 15 April, and all adults by the end of July.

He said that anyone who had an appointment for a second jab “should have complete confidence” that they will go ahead.

“The month of April will be different – and it was always going to be – because I think this will be the month that second jabs exceed first jabs,” he added.

More than 25 million people in the UK have had a first dose of a Covid vaccine, while around 1.7 million have had a second jab.

After opening up appointments to all over-50s on Wednesday, the NHS in England was then told not to offer jabs to younger age groups throughout April.

Prof Adam Finn, a member of the government’s Joint Committee for Vaccinations and Immunisation (JCVI), said the disruption to supply meant the UK’s rollout would be going from “extremely fast to somewhat less fast”, rather than “juddering to a halt”.

He told BBC Radio 4’s Today programme that the supply issues could have an impact on infection rates but should not have an impact on hospital admissions, as those who are most vulnerable to Covid-19 were being prioritised for the jab.

The Serum Institute is the world’s largest manufacturer of vaccines and is making one billion doses of the AstraZeneca jab this year for low and middle income countries.

Earlier this month, it agreed to supply 10 million doses for the UK, but only half of these will arrive this month with the rest delayed for several weeks.

These supplies were always part of the contract and the UK is not taking vaccines away from supplies for lower-income countries.

All the rest of the UK’s AstraZeneca doses are being produced domestically and the company says there are no supply issues.

Pfizer, which produces its vaccine in Belgium, says its deliveries to the NHS are also on track.

Although, on Wednesday, European Commission President Ursula von der Leyen said if Covid vaccine supplies in Europe do not improve, the EU “will reflect whether exports to countries who have higher vaccination rates than us are still proportionate”.

We were always warned supply was fragile – and these developments are a reminder of that.

The UK has its own plants that are supplying one to two million doses of the AstraZeneca vaccine each week.

There are also stocks coming from Pfizer’s Belgium plant – these would be the ones that would be susceptible to any restrictions on exports the EU is threatening.

The Indian supplies were supposed to give the UK the “bumper” end to March, allowing the government to push ahead with vaccination of the under-50s within weeks.

This has now been put on hold, given significant numbers will need their second doses from the start of next month.

The government is still on track to hit its target to offer all adults a vaccine by the end of July – and therefore this development does not affect the lifting of restrictions.

By late Spring the first doses of Moderna – the third vaccine to have been approved in the UK – should start arriving.

But the delay to the second shipment from India means rollout is going to take a little longer than was hoped at the start of this week.

Health Secretary Matt Hancock is due to give a statement to MPs in the Commons later on Thursday.

Shadow health secretary Jonathan Ashworth tweeted that people “across the country” would be “anxious and worried” about news of delays.

Labour is also backing a call from bereaved families for a public inquiry into the handling of the Covid pandemic, saying it should take place once the end of the government roadmap for leaving lockdown restrictions is reached.

Boris Johnson has previously promised an “independent inquiry” into the pandemic.

In addition, the European Medicines Agency (EMA) is due on Thursday to release the findings of an investigation into cases of blood clots in a handful of Oxford-AstraZeneca jab recipients.

Several European countries have paused the use of the vaccine but the regulator has said there was “no indication” it caused the clots.

The World Health Organization has urged countries not to halt vaccinations.

A further 141 people in the UK have died within 28 days of a positive test, according to figures updated on Wednesday from the UK government. A further 5,758 people have tested positive.

Dominic Cummings calls for ‘very hard look’ at handling of COVID crisis
The Guardian, Ian Sample and Jessica Elgot, 17 March

Boris Johnson’s former chief adviser Dominic Cummings has called for an investigation into the government’s handling of coronavirus and described the Department of Health and Social Care as a “smoking ruin” when the crisis struck.

Cummings told MPs there was a need for “a very, very hard look” at what went wrong and why, adding that problems at the DHSC had prompted him, along with Sir Patrick Vallance, the government’s chief scientific adviser, to argue for a separate taskforce to procure vaccines for the UK.

“It is not coincidental that we had to take it out of the Department of Health. We had to have it authorised very directly by the prime minister,” Cummings told the Commons science and technology committee.

“In spring 2020 you had a situation where the Department of Health was just a smoking ruin in terms of procurement and PPE and all of that. You had serious problems with the funding bureaucracy for therapeutics. We also had the EU proposal which looked like an absolute guaranteed programme to fail – a debacle,” he said.

“Therefore Patrick Vallance, the cabinet secretary, me and some others said: ‘Obviously we should take this out of the Department of Health, obviously we should create a separate taskforce and obviously we have to empower that taskforce directly with the authority of the prime minister.”

The remarks will be an embarrassment for the health secretary, Matt Hancock, and may be seen in Westminster as an attempt to assign credit to No 10 for the successful vaccine programme while leaving Hancock bearing the brunt of the responsibility for problems with procurement of personal protective equipment.

At a Downing Street press conference on Wednesday afternoon, Hancock sought to dismiss Cummings’ attacks on his department, saying the vaccine rollout had “been a huge team effort” and involved both the government and the vaccines taskforce it set up, as well as the NHS which he said had “led the way in terms of the delivery” of jabs.

He added: “One of the striking things about being involved in the vaccine rollout is that the spirit is a positive, mission-driven can-do spirit that we all share.”

A number of influential figures have told the Guardian they support a public inquiry into the handling of the pandemic.

Shortages of PPE such as masks, visors and gowns in spring 2020 forced the government to order in supplies at inflated prices, with some items being found to be useless once they arrived.

Cummings said the government’s procurement system was an “expensive disaster zone” before last year and it “completely fell over” when the pandemic struck.

The shadow health secretary, Jonathan Ashworth, said it was a “scathing intervention” from the man who had been Johnson’s most trusted aide. “To describe the Department of Health and Social Care as a ‘smoking ruin’ is a clear admission of fundamental mistakes that have contributed to us tragically experiencing one of the highest death rates in the world,” he said.

Downing Street said: “Covid challenged health systems around the world. From the outset, it was always our focus to protect the NHS and save lives. We have procured over 9 million items of PPE, we have established the NHS test and trace system, which has contacted millions of people and asked them to isolate. [The health department] and the NHS were central to the rollout of the vaccination programme.”

Cummings appeared before the committee to explain the rationale behind the proposed Advanced Research and Invention Agency (Aria), a radical new funding agency that would back high-risk, high-return projects that have the potential to transform society.

Asked about the genesis of the idea, Cummings said its creation was one of the conditions he insisted upon when he was asked by the prime minister to join No 10. The agency is based loosely on the 1960s US Advanced Research Projects Agency (Arpa).

“The prime minister came to speak to me the Sunday before he became prime minister and said: will I come to Downing Street to help sort out the huge Brexit nightmare?” Cummings said. “I said: ‘Yes, if first of all you are deadly serious about actually getting Brexit done and avoiding a second referendum. Secondly, double the science budget; third, create some Arpa-like entity; and fourth, support me in trying to change how Whitehall works, because it’s a disaster zone.’ And he said: ‘Deal.’”

Cummings said the meeting took place in his living room with just himself and Johnson present.

He denied he had been given a specific pay rise, despite a £45,000 increase being justified on the record by the No 10 spokesperson Allegra Stratton. Cummings claimed he asked for his pay to be cut to match his £100,000 Vote Leave salary – less than the £145,000 usually offered to someone in his role. He said it went up to the usual salary expected in his role after the 2019 election.

Cummings said he did not regret his departure at the end of last year and said he had always planned to quit around that time. “I think I made the right decision to resign when I did. I actually said to the prime minister back in July that I would leave by Friday 18 December at the latest, so the whole thing was not exactly as it appeared,” Cummings said.

During the session, the former Vote Leave campaigner criticised the EU over its handling of vaccines and said the past year had demonstrated the importance of not having the EU set science and technology regulations in the UK.

“As things have been proved every day now, science can cooperate globally without having to be part of the nightmarish Brussels system which has blown up so disastrously over vaccines,” he said. “Just this week we’ve seen what happens when you have an anti-science, anti-entrepreneurial, anti-technology culture in Brussels married with its appalling bureaucracy in its insane decisions and warnings on the AstraZeneca vaccine. I think we are extremely well out of that system.”

Asked about the recent threat of budget cuts to UK science funding, Cummings said that when he left Downing Street in November, “the numbers pencilled in” for UK Research and Innovation were “very generous improvements to its core budgets, not just for this year but throughout the whole spending review period, through to 2025.”

“If that’s changed in the last 12 weeks then that’s obviously bad,” he added. “If 2020 isn’t enough of a galvanising shock to say we ought to take science and technology seriously – both funded properly and embedded in government decision-making intelligently and strip out the bureaucracy that causes so much harm – then I don’t know what would be.”

Last week the UKRI, which oversees science funding in Britain, told universities that its budget for international development projects had been nearly halved, from £245m to £125m. The move means hundreds of research projects on problems ranging from antimicrobial resistance to the climate crisis will have to be shelved or cut back.

From Factory to Pharmacy

As part of our mission to build awareness, understanding and appreciation of the vital importance of the healthcare distribution sector, we developed an infographic explaining the availability of medicines. It identifies the factors that can impact drug supply, as well as the measures that HDA members undertake day in, day out to help mitigate the risks of patients not receiving their medicines.

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