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Views And Reviews The Bottom Line

Partha Kar: Delivering covid vaccine—a team effort

BMJ 2020; 371 doi: (Published 26 November 2020) Cite this as: BMJ 2020;371:m4598

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  1. Partha Kar, consultant in diabetes and endocrinology
  1. Portsmouth Hospitals NHS Trust
  1. drparthakar{at}
    Follow Partha on Twitter: @parthaskar

Ripples of hope have emerged in recent weeks, with the possibility of a working covid-19 vaccine. There are still many hurdles—demonstrating safety and efficacy, overcoming production challenges, and convincing the public amid a torrent of fake news and anti-vaxxer rhetoric. But an overarching optimism has arisen, after the tough months the world has lived through this year.

The next phase will be hugely important for the NHS—delivery. Expect heated discussions around who will get a vaccine “first”: if it’s healthcare professionals, why not teachers or shielded groups? As ever, the debate will be played out in public, shot through with politics, bias, and vested interests. We must also consider the practicalities of delivering the vaccine during a pandemic, with distancing and other restrictions, as well as the vaccine’s storage and delivery requirements.

Beyond these issues, a bigger question will be what has to “give” to make this happen. The pandemic has disrupted everything—economies, lives, healthcare—so the delivery of a covid vaccine must be the top priority. In my view, it would be wrong to say that the NHS can carry on as normal while it’s delivered. Some other work will have to cease as we embark on this nationwide programme, and we’ll need clear lines around what has to stop.

It would be similarly wrong to say that one sector of the health workforce can deliver the vaccine alone. Primary care should form the basis of any covid vaccination programme, but we’ll need all hands on deck to deliver it successfully. Every other feasible healthcare resource will have to be involved in some way, or primary care will become overwhelmed, unable to deliver either its core services or the vaccination programme. This will include the need for space, too—potentially using resources such as cinemas, sporting grounds, and event halls. We’re on the cusp of ending a pandemic, and it should involve everything we have at our disposal.

We’ll also need a clear narrative around how the programme will be financed and how payment mechanisms will work, to avoid the lazy stereotyping and conspiracy theories we’ve heard so much during the pandemic.

Regarding workforce support, we must avoid falling back on the NHS’s tried and tested approach of guilt-tripping professionals into burning themselves out. It’s all too easy for people to suggest that it’s a “moral obligation” for staff to do that bit extra. The NHS workforce remains a finite resource and can do only so much. If individuals burn out as they attempt to fulfil that obligation, it helps no one and ultimately undermines patient care.

The NHS is good at narratives about working together, even if multiple structural changes over the years have been about creating new organisations, be they vanguards, primary care networks, or integrated care systems. The covid vaccination programme just may be the moment when all in the NHS workforce forget the colour of their individual lanyards and instead focus, as a team, on the blue and white NHS logo—the N, after all, stands for National. What better time than a pandemic to show up a joined-up effort across the board?


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