With COVID-19 vaccination campaigns largely underway across Europe and the supply of vaccines expected to drastically increase in the second quarter, health systems across Europe are now looking at working as quickly as they can to get available doses into arms.
. Although the quantity of vaccines remains the main bottleneck, having enough workforce in place to administer the vaccines is also crucial for a speedy rollout. This policy snapshot examines the different approaches to vaccine delivery. Has the vaccination workforce been expanded to allow for health care professionals beyond physicians and nurses to give jabs? We also briefly discuss whether rollouts are relying on traditional vaccination infrastructure and whether there is a role for the private sector. We also share where there have been any notable changes so far.
The information presented and analysed below comes from the COVID-19 Health System and Response Monitor (HSRM) and interviews with country experts in the network (up to 11 March 2021), ministry of health websites and news articles.
Countries have expanded who can administer COVID jabs beyond traditional vaccinators
The overwhelming majority of countries are relying on personnel that normally perform vaccinations in their countries to also administer the COVID-19 jabs, primarily physicians and nurses (Table 1). However, some countries have explicitly expanded the workforce for their campaigns to include paramedics (Austria, Israel, Ukraine), medical students (Austria and Belgium), pharmacists (Portugal, Switzerland, UK), doctors’ assistants (Germany, Netherlands) and even dentists (Ireland). Additionally, there is evidence that countries are also utilizing members of the public by training volunteer, “peer” and “non health care” vaccinators to administer jabs (Belgium, Ireland, UK). Some countries (Czechia, Denmark, Romania, Russian Federation) that are allowing non-physicians to administer vaccines are still requiring that the jab be done with a physician’s permission or under their supervision. Even in cases where countries have narrowed who can administer the jab, they are also encouraging and training volunteers (both with and without medical experience) to assist in all other operations of the vaccination process, including check-ins, taking vitals, helping vaccinators complete paperwork and staying with people in the recovery area following their jab.
Table 1. Medical personnel administering COVID-19 vaccinations (as of 11 March 2021)
Some countries are involving the military
Also of note are instances where members of the armed forces have stepped in to assist in the vaccination efforts. In Germany (where 20,000 soldiers have already been deployed over the past year to assist health authorities with contact tracing and testing capacities), an additional 2,500 are being sent to vaccination centres across the country in anticipation of increasing supply which will necessitate longer opening hours and more staff. This would be in stark contrast to the early days of the rollout, where some centres in the German capital had to close due to lack of supply and low registrations. Likewise, the Israel Defense Forces (IDF) has sent at least 700 reserve medics to vaccination centres across Israel to assist with jabs and logistics and military doctors have been deployed across the Russian Federation.
The settings where vaccines are administered are also changing
Aside from workforce expansions, the settings where jabs are being performed are varied and are still very much in flux. Large vaccination centres and mobile teams in care homes and medical facilities for priority and vulnerable groups have been the dominant spaces in the early months of vaccination campaigns. This has potential to shift as vaccine supply across Europe ramps up in spring and summer and more vaccines become available (e.g., Oxford-AstraZeneca, Johnson & Johnson) that do not require very cold storage. The UK has been integrating pharmacies into its COVID-19 vaccination network since mid-January 2021, while France has given the OK for their pharmacists to administer Oxford-AstraZeneca doses. Germany has planned to start allowing GP offices to administer the vaccines in April 2021, while Italy’s Lombardy region agreed with the Confederation of Italian Industry to carry out mass vaccinations in private companies. Authorities in Tel Aviv, Israel, even worked with a local pub and offered free drinks to anyone who came to get vaccinated.
Many countries have allowed for a range of vaccinators and flexibility in where jabs are given
The strategies described above show that groups of countries share similarities when it comes to who administers the COVID-19 vaccine (traditional vaccinators, other medical workers, medical students and the military or even members of the general public). There is also an evolving flexibility in the locations used for vaccinations, which is likely to become even more broad as countries progress through their priority groups and start reaching out to the general populations. As this situation is very fluid, it will be important to re-examine the different approaches to COVID-19 vaccinations and monitor for further developments.
As vaccine supply increases, how will countries re-adjust?
Once additional vaccines are approved and supply increases further, there are key questions that will need answering as to how countries, regions and localities approach COVID-19 vaccinations:
- Will the countries that have been relying on traditional vaccination infrastructure thus far start to face workforce shortages as supply increases and vaccinations are rolled out to wider population groups? Will vaccination centres extend their hours of operation to administer as many vaccines per day as possible?
- Beyond pharmacies and GP practices, what other locations will be integrated into the vaccination efforts? Do larger companies and other private actors have a role to play here?
- Are there going to be further situations where non-physician vaccinators are able to administer certain vaccines?
Additional Credits: Yulia Litvinova
Appendix 1. Breakdown of medical personnel administering COVID-19 vaccinations (as of 11 March 2021)
|Physicians||Nurses & Midwives||Other Medical Workers (EMTs, Pharmacists, etc.)||Volunteers||Other|
|Austria||✓||✓||✓ (EMTs)||✓ (Medical Students)|
|Belgium||✓||✓||✓||✓ (Medical Students)|
|Czechia||✓||✓||Nurses only under doc supervision|
|Denmark||✓||✓ (“Another Health Care Professional”)|
|France||✓||✓||✓ (Pharmacists: AZ only)|
|Germany||✓||✓||✓ (Those with proper training)|
|Ireland||✓||✓||✓ (Dentists)||✓ (Specialist & Peer vaccinators)|
|Israel||✓||✓||✓ (EMTs and Pharmacists)||✓ (Reservist Medics)|
|Latvia||✓||✓||✓ (“Additional Personnel”)|
|Netherlands||✓||✓||✓ (“Doctor’s Assistants”; in presence of a doc)|
|Russian Federation||✓||✓||✓ Military docs|
|Ukraine||✓||✓||✓ (EMTs)||✓ (“Junior specialist with medical education”)|
|UK||✓||✓||✓ (Pharmacists, “registered health care professionals”)||✓ (“Non health care vaccinators”)|
Note: EMT = emergency medical technician, AZ = Oxford-AstraZeneca vaccine