Intended for healthcare professionals


Covid-19 vaccine shortages: what is the cause and what are the implications?

BMJ 2021; 372 doi: (Published 19 March 2021) Cite this as: BMJ 2021;372:n781

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  1. Ingrid Torjesen
  1. London

The government has announced that the covid-19 vaccination programme will downshift a gear because of “significantly constrained” supplies of the covid-19 vaccine. Ingrid Torjesen looks at the reasons and the consequences

Vaccination centres were notified by NHS England late on 17 March that there would be a significant reduction in weekly supplies of covid-19 vaccines from 29 March for four weeks “as a result of reductions in national inbound vaccines supply.”

How much are supplies constrained?

On 18 March the prime minister, Boris Johnson, said that the supply problems were caused by a delayed shipment from the Serum Institute of India and because a batch currently in the UK needed to be retested. “As a result, we will receive slightly fewer vaccines in April than in March, but that is still more than we received in February,” he said. 10 million doses of the Oxford-AstraZeneca vaccine have been ordered from the Serum Institute of India.1 Of these, five million are thought to have been delivered in March, and the remaining five million doses were due to be delivered imminently and have been delayed.

Matt Hancock, the health secretary, told MPs in the House of Commons on 18 March that 1.7 million doses already in the UK were being retested to check their stability. Most AstraZeneca vaccines are being manufactured in the UK. A spokesperson for AstraZeneca said: “Our UK domestic supply chain is not experiencing any disruption, and there is no impact on our delivery schedule.”

Has the Indian government blocked the shipment from India?

Reports in the media suggest this is the case. Adar Poonawalla, chief executive of the Serum Institute of India, told the Telegraph that the delay “is solely dependent on India, and it has nothing to do with the Serum Institute of India. It is to do with the Indian government allowing more doses to the UK.”2

The vaccine programme in India has so far been limited to people over the age of 60 and those over the age of 45 with comorbidities. The Indian government is thought to be considering whether it needs to stockpile more vaccines to expand its programme and whether to implement new localised lockdowns.2

Johnson denied that the Indian government was responsible. “The Indian government hasn’t stopped any export,” he told journalists and blamed the delay on “various technical reasons.” A spokesperson for the Serum Institute of India said that the institute could not comment on the matter. The Indian government did not respond to requests for a comment by the time of publication.

What does it mean for the vaccine rollout?

The delayed five million doses would have enabled vaccination of people over 40 to begin by the end of March, but this will not now happen. Existing vaccines will be prioritised for the nine priority high risk groups and second doses.

NHS England said that no one under 50 should be offered a first dose unless they fall into one of these groups—for example, if they are clinically vulnerable, an unpaid carer, or a health and care worker. Vaccine centres and community pharmacy vaccination services should close unfilled bookings from 29 March and not upload any new appointments for April to booking systems. Staff there will be redeployed or stood down.

Johnson said that the UK was still on course to hit its vaccine targets: offering a first dose to all over 50s and clinically vulnerable people by 15 April and one to every adult by the end of July. “We’ve always said that, in a vaccination programme of this pace and this scale, some interruptions in supply are inevitable,” he said.

Will the shortage postpone the lifting of lockdown measures?

No, according to Johnson. He said that hitting the vaccine targets would enable unlocking as planned, as long as the government’s four tests were met. “There is no change to the next steps of the roadmap,” he said. “We remain on track to reclaim the things we love—to see our families and friends again, to return to our local pubs, our gyms and sports facilities, and, of course, our shops.”

Will second doses be delayed?

Not according to Johnson. “We will have the second doses that people need within the 12 week window, which means around 12 million people in April,” he said.

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