Two new COVID-19 vaccines are due to arrive in the UK. As the country begins to emerge from lockdown, recent announcements about the Moderna and Novavax vaccines will boost confidence in its vaccination rollout.
With more than 30 million first doses administered, the rollout is going well. It currently relies on two vaccines: Oxford/AstraZeneca and Pfizer/BioNTech.
The UK government aims to have the entire adult population vaccinated with at least one dose by the end of July. But recently, the country has been hit by delays in anticipated supplies. During April, the focus will be on second doses instead of inoculating more people with their first doses. This has raised concerns about the vaccination programme remaining on track.
The two new vaccines will help with this. The Moderna vaccine gained UK authorisation in January and is already widely used elsewhere. The Novavax vaccine is expected to file for UK authorisation soon after successful phase 3 trials.
While some of the AstraZeneca vaccine is manufactured in the UK, the country is reliant on imports. A large proportion of vaccines administered in the UK are imported from India or the EU. While the government is adamant that it will meet its targets, the health secretary, Matt Hancock, has called vaccine supplies “lumpy”.
A letter from NHS England on March 17 advised vaccination sites of a significant reduction in supply from March 29. Vaccination centres were told to process as many adults over 50 as possible, to use up stock with a short shelf life, and to close down online bookings.
A key reason for this step is diminished supplies of the AstraZeneca vaccine from India. An order of 10 million doses of vaccines was only partially fulfilled, with 5 million doses remaining in India. India has imposed a de facto export ban for vaccines while the country focuses on domestic vaccinations to ward off a new wave of infections.
But export stops are not the only reason for the insecurity in the vaccine supply chain. The Serum Institute of India, the world’s largest vaccine manufacturer, also reported material shortages affecting production. This is not an isolated issue, and global agreement and coordination is needed to alleviate bottlenecks.
In addition, 1.7 million doses of the AstraZeneca vaccine had to be retested as part of the ongoing quality assurance for product stability. While strict quality standards are essential and difficulties in scaling up production at a global scale are not unexpected, there is an urgent need for alternatives.
The cavalry is coming
As countries struggle to secure sufficient supplies of vaccines and companies cannot scale up production fast enough. Enter the Moderna vaccine. Dr Anthony Fauci, chief medical advisor to the US president, said of the vaccine’s arrival there: “the cavalry is coming”.
Yet in the UK, Moderna’s immediate impact, while welcome, will be limited. While 17 million doses have been ordered in total, only 500,000 are expected to arrive in April. This is enough to cover only one average day of vaccinations.
Novavax will be another valuable addition to the UK’s arsenal of vaccines. Supplies for the UK market will be manufactured by FUJIFILM Diosynth Biotechnologies in Stockton-on Tees.
Originally, the serum would then have been sent to the EU to be filled into vials ready for use. But on March 29, drug company GlaxoSmithKline announced that it had reached an agreement in principle with Novavax and the UK Government Vaccines Taskforce. They will support manufacturing of up to 60 million doses of the Novavax COVID-19 vaccine candidate by using a site in County Durham to “fill and finish” instead of the EU. Deliveries are expected from June.
This will ensure that the Novavax production for the UK market is entirely UK-based.
Boris Johnson is among the heads of state who have signed an international call for more united action around the world, acknowledging “that nobody is safe until everyone is safe”. Nevertheless, amid global shortages and vaccine nationalism, domestic vaccine production operation will reassure many.
On March 29, some UK lockdown rules relaxed and residents in England are now permitted to meet in groups of six or as two households coming together. The end of shielding for vulnerable patients has also begun. To the relief of many, outdoor activities and sports resumed. For those who had received their vaccinations, there was reason to celebrate their “deconfinement”. But some age groups now face a longer than expected wait for their doses.
The anticipated arrival of two new vaccines can boost the morale of those worried about the wait. The announcement of the domestic production of Novavax has reassured those unsettled by discussions of export bans.
But we have to ackowledge the complexity of vaccine supply chains. Essential ingredients and tools for the manufacturing process including cell cultures, single-use tubing and specialised chemicals, bags and filters, are still likely to be imported.
There are other changes on the vaccine horizon which offer hope for people waiting to be vaccinated. AstraZeneca, Pfizer/BioNtec, and Moderna are all currently upgrading their production facilities in Europe. New manufacturing sites are being approved and processes scaled up.
Along with the collaboration with GlaxoSmithKline to advance the Novavax vaccine, this increase in production will bring some comfort to those adults under 50 still waiting for their vaccine.
Liz Breen, Director of the Digital Health Enterprise Zone (DHEZ), University of Bradford, Reader in Health Service Operations, University of Bradford and Sarah Schiffling, Senior Lecturer in Supply Chain Management, Liverpool John Moores University