This most recent report by the Comptroller and Auditor General examines the rollout of the Covid-19 vaccination programme in England up to the end of October 2021, focusing on events up to the end of October 2021 and assessing whether the programme is well placed to meet its objectives in full. The National Audit Office presents findings, such as an estimated total wastage of around 4.7 million doses, or 4% of total supply, in the vaccine programme in England.
Background
By October 2021, four vaccines had been approved for use and the rollout of first and second doses of Covid-19 vaccinations to adults had taken place. The programme had also commenced the roll-out of first doses to 12- to 17-year-olds, and booster vaccinations.
Facts and figures
According to the report, the following figures were true by the end of October 2021:
- £5.6 billion had been spent on the Covid-19 vaccine programme (including procurement costs for the UK and deployment costs for England)
- 87 million Covid-19 vaccine doses were administered in England
- 85% of people aged 18 and over in England had received two doses of the vaccine, compared with a planning assumption of 75%
- The UK had contracted or agreed to purchase more than 340 million doses of the vaccine for delivery by the end of 2022
- 71% percentage of Covid-19 vaccinations administered by GPs and community pharmacies against an initial planning assumption of 56%
- £2.9 billion total spent to purchase Covid-19 vaccines for the UK out of a total spend of £3.3 billion by the Vaccine Taskforce
- £2.2 billion total spent on Covid-19 vaccine distribution and deployment in England
- 4% estimated percentage of Covid-19 vaccine doses damaged or not used in England (‘wastage’) against a planning assumption of 15%–20%
- 48%–86% range in percentage of adults vaccinated with two doses by ethnic group (48% for people of Chinese origin up to 86% for people of White British origin)
- £8.3 billion total funding available for the Covid-19 vaccination programme up to the end of March 2022, consisting of £4.6 billion for the Taskforce, primarily to purchase vaccines, and £3.7 billion for vaccine deployment
Key findings
The rollout of vaccinations to the public
- The vaccine programme met stretching and unprecedented targets to offer two doses of Covid-19 vaccine to most adults in a short space of time.
- Uptake has exceeded expectations and has been higher than for previous flu vaccination programmes
- Despite national and local efforts to address inequalities, lower vaccination rates persist in some groups
- The programme has not met some later objectives, including one to vaccinate most 12- to 15-year-olds by late October 2021
- Overall, the programme has taken steps to make the vaccine convenient to access; GPs and community pharmacies have administered many more doses than originally planned
- A combination of existing staff, returning healthcare staff, newly trained vaccinators and volunteers have administered the vaccines
- NHSE&I and NHS Digital (NHSD) created new digital tools to support the vaccine deployment, making effective use of imperfect existing data
Update on overall costs, procurement and supply
- Up to the end of October 2021, the programme had spent £5.6 billion out of total available funding of £8.3 billion for the two years to the end of March 2022
- By the end of October 2021, the Taskforce had contracts or agreements in place with six suppliers for more than 340 million doses of vaccine to be delivered to the UK by the end of 2022
- Up to the end of October 2021, there was an estimated total wastage of around 4.7 million doses, or 4% of total supply, in the vaccine programme in England; this included 1.9 million doses unused after changes to clinical advice about the AstraZeneca vaccine
Success factors and future risks
- The Covid-19 vaccine rollout was the biggest vaccination programme in UK history. Those delivering it employed a number of successful approaches to achieve most of its objectives up to October 2021
- There are considerable risks to the programme’s continuing success
- Up to the end of 2021, DHSC, BEIS and other national bodies had not yet identified what a sustainable long-term model of regular Covid-19 vaccination would entail
Comments on value for money
NAO says: “Initiated in 2020, the vaccine programme has operated at unprecedented pace, scale and complexity, and in conditions of profound uncertainty, to achieve the pressing objectives of supporting the creation of vaccines, securing access to them, and administering them to the population as quickly as possible. It is through the collective efforts of many national and local public bodies, scientists, vaccine manufacturers, and individual staff and volunteers, as well as government’s power as a coordinator and funder, that so many of the programme’s objectives have been met and in some areas exceeded.
“In our review, we saw many examples of good practice, including clarity of purpose and priorities, timely and data-driven decision-making, and a willingness to innovate and adapt where necessary balanced with the repurposing of existing infrastructure and expertise. National and local partners showed an ability to adapt quickly, for example the rapid shift to deliver more vaccinations through GPs and pharmacies. The evidence indicates that the programme has saved lives and reduced the incidence of serious illness and hospitalisation.
“Given the unprecedented circumstances of the pandemic and the programme’s achievements up to October 2021, we assess that it has provided value for money to date. By the end of October, the programme had spent £5.6 billion to achieve its objectives. Much about Covid-19, the vaccines market and the UK’s future requirements remains unpredictable but far more is now known than in 2020. The programme needs to identify a clear path to a future sustainable model, securing the benefits of its many innovations and ensuring it has a full picture of costs and workforce requirements as it takes key decisions. It needs to challenge anew all elements of its cost base and adapt accordingly. Most importantly, it needs to maintain the high levels of vaccine uptake it has achieved among the general population and increase levels for groups where uptake still lags behind.”
