The vaccine roll-out has been one of the biggest logistical challenges of our lifetime, involving a legion of NHS staff and volunteers (including, it was revealed yesterday, the actor Hugh Bonneville). Here, a pharmacist who’s helping in a hub in London reveals in fascinating detail what it’s like on the vaccination front line (speaking anonymously for patient confidentiality) — while one of the Covid vaccine trial volunteers tells his uplifting story.
One of the first patients of the day is a frail woman in her 80s — all I can see of her face are her bright, clear eyes.
I go through all the formalities (‘Are you unwell with a fever? Have you ever had a serious allergic reaction? Are you waiting for a Covid test result or had the virus in the last 28 days?’), and she answers, her voice muffled by the crumpled blue face mask.
As I inject the Pfizer vaccine into her arm, her eyes well with tears. But these aren’t tears of pain from the needle, she reassures me, but of joy at finally receiving the protection she needs to be able to leave her house.
Royal Navy personnel administer the Oxford-AstraZeneca Covid-19 vaccine at a coronavirus vaccination centre set up at Bath Racecourse, Somerset, January 27, 2021
‘I haven’t been out since March,’ she says. ‘I’ve lost countless friends to this thing and it’s been a tough old year. I am just grateful to have been given this chance.’
This is something I hear too often these days — both in my day job as a pharmacist in a GP practice and now in the vaccine centre.
Many vulnerable people have spent almost a year not seeing any human faces, except through windows or on screens.
After she has been vaccinated, the woman sits in the booth for 15 minutes so I can monitor her for immediate side-effects. She then happily gets up and leaves — another satisfied patient.
Downton Abbey actor Hugh Bonneville, volunteering at a vaccination centre in Sussex
A quick look up and I spot a manager talking to a fireman at the door. It turns out he works at the local fire station and he asks if we can call them if we have leftover vaccines.
We have scheduled deliveries of the Pfizer and AstraZeneca vaccines throughout the week — we’re told about the quantities a week in advance so the local NHS GPs can book up appointments.
Once the vaccines are out of the fridge and prepped, both must be used within six hours — they won’t keep until the next day. The vials come with multiple doses inside and there are often a few left over once we have finished booked appointments. To avoid disposing of the rest, we have a back-up ‘overflow’ list of high-risk patients and essential workers who can make it to the centre pronto, who we will call at the end of each day.
The firemen are emergency workers, so, of course, we are keen to help if we can. We’re given a list of 30-odd names to squeeze in and their contact numbers. We manage to vaccinate two (they seemed to appreciate our efforts) and add the rest to the overflow list.
I HANDLE THE JABS LIKE LIQUID GOLD
I have been doing this for around a month since the roll-out started, working most weekdays and weekends. Our vaccine centre — a large community hall — is run by the local GP surgeries, including the one I work at, and the practices provide staff for each session.
The hall was converted to make it fit for purpose, which involved ordering dividers to create individual booths and pharmacy-grade fridges (which stay at 2c to 8c) to store the vaccines.
There are around 20 people working in each shift: morning and afternoon (six hours each). I will often do both shifts because there is usually a shortage of vaccinators or ‘mixers’, and I can do both.
The mixer’s role is to keep track of the valuable vaccine stock and, in the case of the Pfizer jab, physically make up the vials. Today, it is my turn to mix. I take out the first six vials — around an inch long — of the concentrated Pfizer vaccine from the fridge and leave it for ten minutes to get to room temperature. You have to be very gentle with it — it feels like handling liquid gold.
A patient receives an injection of the Oxford/AstraZeneca Covid-19 vaccine by Royal Navy medics at Bath racecourse, January 27, 2021
Then I add 1.8ml of saline and invert it ten times to mix it properly — careful not to shake it. This gives me enough for six vaccine doses, each just a tiny 0.3ml per dose. This is based on the latest recommendations to get the most out of each vial. (The AstraZeneca vaccine is delivered ready-made and vials just need to be taken out of the fridge ten minutes before use — each dose is 0.5ml.)
We have people from all walks of life helping out. Some, such as pharmacists like myself working full-time, are paid (though it’s 25 per cent less than my day job), but many are volunteers. Today, we have two new faces: a GP volunteer vaccinating in her spare time and a mother who has come in to work as a marshal after home-schooling her three children. How she can have the energy to put in another exhausting shift astounds me.
The marshals are arguably the most important people here. They keep an eye on the number of people coming in and out, which vaccine booths are free, and wipe down the booths and chairs once patients leave. It’s lovely to work with people you wouldn’t usually get to, coming together for a great cause. Each shift starts with a debrief and plan for the next few hours. The mixers work out how many doses to prepare for the booked appointments (we may need more later — for example, to vaccinate carers accompanying patients).
The manager checks we have all had a negative lateral flow test (a throat swab) in the past 72 hours — and we wait 25 minutes for today’s test results. Sadly, one of the regular marshals tests positive and is sent home to do a PCR test. She never came back. I hope she’s OK. One person down, so we call the staff’s contacts for someone to volunteer in her place. Luckily, the wife of one of the GPs is available.
HUNDREDS TURN UP WITHOUT A BOOKING
Vaccinators aren’t allowed just to collect more doses because it can so easily get out of control. As a mixer, I keep a careful tab on the numbers of patients coming in by asking the marshals and reception desk. This helps me ensure we have enough ready to go, so no one is waiting too long for theirs. Sadly, people fall through the cracks. I see a 70-something man in a booth; he has been there for some time. Although it is not my job today, I approach him and ask if he has been seen. It turns out he is clinically vulnerable and has been waiting for over an hour.
Boxes of the AstraZeneca/Oxford Covid-19 vaccine are pictured inside a storage fridge at a temporary Covid-19 vaccination centre set up at Derby Arena
A marshal has forgotten to tell the vaccinator he’s waiting, so I flag someone down to help. Although frustrated about the wait, he’s happy to be here and says he understands the pressure on us. There are queues most days, but we get through them quite quickly. We let patients in 20 at a time, for 20-minute appointments (on Pfizer days, as there is a 15-minute wait after the jab) — or five-minute appointments on AstraZeneca days. On average, we can see about 600 patients a day with Pfizer jabs, and 900 on AstraZeneca days — but some days don’t go to plan. It is a cold, rainy Thursday and we have 300 appointments booked in the morning. I take a look outside — the shift hasn’t started yet but the queue outside has already formed. By 9am, it is stretching half a mile down the road.
A patient says his GP told him to come in without an appointment. It seems they’ve heard we have a batch of AstraZeneca vaccines today, which means we can often squeeze in more appointments.
As it turns out, as well as the 300 booked appointments, there are around 300 walk-in patients for that morning session alone — all jammed into an hour-and-a-half-long queue in the cold and rain. Many are elderly and vulnerable, and I can’t help but question the GPs’ decision to send them our way without much thought for the practical consequences. Even worse, in the chaos — and because we have to stick to social distancing while queuing — it is impossible to tell who has booked and who is trying to get a walk-in appointment, so everyone must wait their turn. Some people with booked appointments leave, unable to stand in the rain. Most people are cheerful and friendly but I see some disappointed faces and overhear heated conversations about the long waits. I agree with them — this is unacceptable, especially as many of them are frail. This is not a walk-in service.
At one point we run out of the forms patients fill in at reception — these act as consent forms and record the details so their GPs can be alerted that they’ve had their first dose.
A marshal runs to the newsagent and photocopies 500 more, then runs back. It is chaos.
People queue up for their Covid jab at a vaccine centre in Brighton, East Sussex, January 28, 2021
MIX-UP THAT SENT MANY PEOPLE HOME
It’s another day and we have a stock of both vaccines — this often happens (weekly, we get two Pfizer deliveries and one AstraZeneca). Usually, we use up the Pfizer stock first because, while it is made in the warehouse at -70c (-94f), it can only be stored at 2c to 8c (35f to 46f) for five days.
The AstraZeneca vaccine can stay in our fridges for up to six months.
We get a call that nearby care homes need vaccines, and the AstraZeneca one is better for them as it’s easier to transport.
The manager takes a quick look at the bookings and says we have enough Pfizer jabs to cover our day’s appointments, so they can have our AstraZeneca stock. A man with a van soon arrives to collect it.
But after he leaves and the mixers start their shift, they realise we only have enough Pfizer jabs for the morning session. Normally we’d simply switch them to the AstraZeneca — but we’d just given those away.
This is a disaster. We have to cancel 200 afternoon appointments. Cue a scramble to contact these patients and reschedule them for a few days later.
Sadly, one of these is a 75-year-old who, despite having a booking, was caught in Thursday’s queue, so didn’t get hers done. Understandably, she was not pleased.
VACCINATING A DEMENTIA PATIENT
Some patients are particularly vulnerable and need extra time and care, including those with dementia. We see the milder cases, those living in the community. They tend to understand the vaccine process (more severe cases are seen in care homes). I approach a booth where there’s a man in his late-70s sitting with his carer. He has dementia and I talk to him carefully, to make sure he understands what is happening. I tell him what I am doing.
‘Now I am going put my hand on your shoulder — can you roll up your sleeve?’ I say. ‘You might feel a sharp scratch on your arm, but please don’t worry’ — and he seems calm. To ensure patients know which vaccine they’ve had, they’re all given a little card with the jab and the date recorded on it; they must keep it safe until they’re called for their second dose. Some lucky ones also get an ‘I’ve had my Covid vaccination’ sticker!
Next, I see a man in his 20s who has Down’s syndrome.
He is chatting happily to his sister and though he jumps a bit as the needle goes in, he laughs it all off. As they wait after the jab, I ask his sister if she’d like to be vaccinated. She’s not his professional carer, but for all intents and purposes she is a carer.
The vaccinator has some discretion in such cases, but still I run it by the manager. The carer says she doesn’t want to take a dose from someone more vulnerable, but I reassure her there’s enough to go around. She and her brother are giddy with excitement.
DEALING WITH A FEAR OF NEEDLES
The next day starts with a man my age, in his late-30s. He is scared of needles and says he felt compelled to have this jab as he’s considered clinically vulnerable owing to a chronic lung disorder. I tell him to focus on his breathing — taking slow, deep breaths — then talk to me about the shoes he’s wearing. When I can see he is distracted and calm, I inject quickly before he has time to be scared, and he’s fine about it. I often remind my patients how tiny the needle is.
In fact, one woman couldn’t believe she’d been injected as she didn’t feel a thing. I took that as a compliment.
THANKS FOR THE CHOCOLATES!
People are so relieved to be vaccinated we’ve had countless boxes of chocolates, biscuits, even a freshly baked cake. There are no rules on this but, because of Covid, we throw away anything home-cooked. If it’s sealed, one of us will take it home — we’re not allowed to eat on site.
The next in my vaccine booth is one of the oldest patients I have seen. He is 92, a jubilant and delighted man, proud to be here. He tells the room he’s loving this experience and boasts that he is the oldest person here.
Next, I’m greeted by a woman in her late-80s wearing a floral dress and matching face mask. She says she’s dressed up for this grand occasion and rare outing.
I’m astounded that she looks so positive and happy after being cooped up for so long — I spent two weeks in isolation last November after a colleague tested positive for Covid, and I felt awfully low and lonely.
As she leaves, I see a middle-aged woman start clapping and cheering as she walks out, clearly elated and so grateful. There is a very lovely atmosphere here today.
‘BUT I DON’T WANT THE PFIZER JAB’
IN the booth sits a middle-aged man. When I explain he’s having the Pfizer jab, he interrupts to say he’d prefer the AstraZeneca as his friends say it is better.
I try to be understanding, telling him that both options are as effective as we need them to be and studies in thousands of people show they’re both safe.
But not convinced, he tells me to try to change his views. Conscious of the time, I tell him it’s not my job as I’m not selling any particular brand. He stands up to leave — I suggest he contacts his GP to rebook on another day when
we have the AstraZeneca stock. He goes: it’s his right, of course, but it was a waste of an appointment, which is frustrating.
Today is the third day in a row I’ve done a long, double shift. I haven’t seen my two children in days, but try not to dwell on it.
By 6.30pm, the queue has gone but we have five spare doses of the Pfizer jab. We manage to give four to those on the overflow list, but there’s one left: I’m asked if I’d like to have it.
I can’t help but feel guilt, but I accept it. While I’ve been lucky not to contract Covid, I’ve seen family members struggle and come close to death as a result of the virus — so just like everyone else, I want this to be over.
ARE WE BENDING THE RULES?
Another busy day — six weeks into the roll-out — and by 7pm, as we count the number of patients waiting, we realise we will have a few shots left over (mainly because of no-shows).
We hit the phones again. One patient manages to come in but there’s no one else on the overflow list who can. Three doses left. Before time runs out, we ask the staff on shift. One of the marshals needs her first jab. She is young and healthy but we feel it’s justified.
One of the GPs had his first dose three weeks ago. The guidelines recommend the second is given between three and 21 weeks later but we give it to him now to avoid wasting the dose. This is certainly a last resort as the priority is to give as many people as possible the first dose.
Another reason it’s crucial to use up our stock is because if we don’t hit our daily target, then the amount for our next delivery is reduced.
So there comes a time in the day when we’ll get anyone in to use up the last remaining doses — regardless of their health or age, or what the guidance says.
The last person in is a lucky 50-something, a friend of one of the marshals who lives locally. Some might say she skipped the queue but we can’t ever justify wasting a precious drop of the vaccine.
When our GP practice asked for people to help out with the vaccine roll-out, I jumped at it, and it’s proven to be the most satisfying and rewarding job I’ve had.
Most people are delighted to see us and grateful, and it really feels we’re helping the country move forward. And I’m in there making a difference, too, one jab at a time.
The heroic clinical trial guinea pig
Josh Miller, 35, a research paramedic, who lives in the West Midlands
Josh Miller, 35, a research paramedic, lives in the West Midlands. He says:
When a friend urged me to volunteer for the AstraZeneca/Oxford vaccine trial in April last year, my initial reaction was not entirely enthusiastic. I was worried it might be time-consuming — but after seeing so many people getting sick, I knew I should join up.
Because it was a trial, none of us was allowed to know if we would have the real Covid vaccine or the control vaccine (a standard meningitis one) — but after having my first jab in June I went back for a check-up every few months with my head held high, knowing I was doing something for others. It gave me a warm feeling. I had my second jab in August — again, with no side-effects — then in December, I was offered the Pfizer vaccine along with other paramedics and so immediately contacted my test team.
Within a few hours they got back to me to say I had been given two doses of the vaccine as part of the trial. After so long not knowing, it was strange to find out suddenly, but I was really delighted. I’ve played a part in vaccine history — and that’s a special feeling.