The vaccines programme was named Programme of the Year in the 2021 Civil Service Awards. This unprecedented endeavour brought together teams from the Department of Health and Social Care, the Vaccine Taskforce, NHS England, the UK Health Security Agency, the Medicines and Healthcare Products Regulatory Agency, and NHS Digital. So far, it has deployed over 100 million doses of Covid-19 vaccines.
Antonia Williams, director of Covid vaccine deployment at DHSC, and Leila Tavakoli, deputy director: Covid-19 vaccines strategy, sat down with CSW to share their experiences working on the programme.
Congratulations on the award – have you enjoyed telling people about it?
AW: I think everyone feels really proud to be a part of this, and it’s lovely to have that recognised through the awards. So many people have been working so hard [over the course of the pandemic] to prepare and be ready to deploy a vaccine.
What’s it been like working on the programme over the last couple of years?
AW: It has been very intense. I have sometimes felt like it’s like a very long hurdle race: the minute we get over one challenge and achieve something, the next appears. It’s been quite unrelenting in that respect, but it’s also felt like the privilege of a lifetime. I’ve never done a job like this and I don’t think I will again. But it’s serious, hard work – people have given up their lives for years for it.
"There’s been such a clear and nationally significant mission at the heart of it, so we’ve had a very clear objective and the whole weight of government, the public service and the public has got behind this single mission"
How have the extraordinary circumstances – the time pressures and scale of the challenge – changed the way you’ve operated, compared to a standard government programme?
AW: There’s been such a clear and nationally significant mission at the heart of it, so we’ve had a very clear objective and the whole weight of government, the public service and the public has got behind this single mission. I think a huge part of the programme’s success is having the support of every government department and the sectors they represent – which have not only been willing to help, but have proactively stepped forward offering resources, people and expertise. Whether it’s the Department for Education, helping with the rollout in schools; MHCLG, helping bring together local authority chief execs and finding our local sites; the Treasury expediting funding processes – there’s just been that real sense of goodwill and willingness for it to succeed.
What lessons do you think government can learn to improve its delivery in future?
AW: A couple of things come to mind. There’s been a real model of bringing together expertise from a range of different backgrounds. Across the vaccines programme, we’ve had clinical experts, commercial experts, operational, policy, legal, data and tech experts, all working as a single team. Because we’ve had support right from the prime minister down, we’ve managed to cut across those silos.
I think there’s a lot to take into other programmes about the use of data, particularly in tackling the challenges around health inequalities and targeting areas of lower uptake. We’ve been very focused on reaching as many people as we possibly can, encouraging everyone to come forward for the vaccine. There’s a lot to learn for other health programmes, as well as wider public sector programmes, on the multidisciplinary approach and the use of tech and data.
"I think there’s a lot to take into other programmes about the use of data, particularly in tackling the challenges around health inequalities and targeting areas of lower uptake"
LT: I think this probably happened across quite a few parts of the Covid response, not just vaccines, but we can also learn from the way that teams have challenged themselves to improve their processes in the moment. For example, the MHRA carried out their stages of work concurrently, rather than in sequence, which sped up that whole process of authorisation while still maintaining all the safety standards. I think that approach of testing a longstanding approach to something and seeing how we can improve it was really important and worked really well.
Are there particular lessons for government to learn around innovation and harnessing science and technology?
AW: Yes, that’s been a huge plank of the whole programme – having a much more venture-capital approach to risk and bringing that expertise in house. But also, the government took a much more proactive approach to identifying research questions that will give us the information and data we need, and then working with industry and the academic communities to get the right trials set up.
So we felt that on the policy side, we have been at the forefront, globally. Lots of other countries have been waiting for UK trials to conclude, for example, looking at the effectiveness of the booster vaccine and the mix and match of vaccines. Again, that was a result of collaboration, with government providing money but also helping to frame the policy and clinical questions, bringing academics and industry together. [Outgoing deputy chief medical officer] Jonathan Van Tam was the main driving force behind that.
Government programmes can suffer when people work in silos – what worked well when bringing different organisations together on this programme?
AW: That’s the question: how do you bottle it and maintain it? We’ve had really strong leadership from some critical people – in particular the likes of Emily Lawson, who has led the deployment programme across the board. We’ve had really strong leaders that people have mobilised behind, but also leaders who have been mission and people-focused, which really inspired people.
"We’ve had really strong leaders that people have mobilised behind, but also leaders who have been mission and people-focused, which really inspired people"
We also had ministers very much with their sleeves rolled up, wanting to get things done. The prime minister had weekly meetings, the secretary of state had daily meetings, so any issue that emerged with another government department or a funding issue was immediately escalated right to the top.
The fact that this was one of government’s top priorities, with the civil service and public sector support behind it and ministers putting their time and energy into those priorities – that’s made a big difference. The fact that it’s been a life-saving programme has also helped with getting people energised!
What were some of the hurdles that you had to overcome?
AW: The thing that jumps out is the speed at which we knew we had to go. During the preparatory work, we knew we had to be ready the second there was a safe vaccine. And the second we knew there was going to be a safe vaccine, we had to get it in arms days later, as fast as physically possible. Every hour counted in terms of saving a life.
Doing all that whilst ensuring it was safe and maintaining quality and operational excellence was the big overall challenge. That mattered for the long-term confidence in the programme. We knew that every announcement, every person’s experience, all added up to the reputation that could help reassure the significant number of people who were – and are – nervous about it.
There were lots of other hurdles along the way. There were times when there was nervousness around the supply chain, or if we could get enough workforce out there to give us the scale of operation. Then when we had the vaccine and the staff to do it, the hurdle shifted to: are there enough people coming forward?
The other big concern has been whenever safety questions arose. For example, when the Joint Committee on Vaccination and Immunisation provided advice around offering AstraZeneca preferentially to the over-40s, rather than the under-40s, that was very challenging for our comms colleagues, in terms of getting the messaging and language right. Those were particularly intense periods.
"We have been working on this for a long time, so one challenge has been sustaining enthusiasm and motivation across the whole workforce"
LT: We have been working on this for a long time, so one challenge has been sustaining enthusiasm and motivation across the whole workforce, including people on the ground. That’s where really strong leaders come in, I think.
How have you supported your team while you’ve been working under this enormous pressure over such a long period of time?
AW: There are multiple teams across the system, and I was leading the DHSC team of about 50 individuals. It has been a real challenge. I’m taking a break now, which I needed after 14 months. We tried to staff up and have spare capacity to be able to make sure people are getting breaks. We thought quite hard in the team about how people can cover for each other and rotas to make sure people are getting proper time out. That has happened across the different programmes – it’s been very supportive.
LT: In our team we have focused a lot on keeping an eye on each other. We have regular meetings, checking in, because we’ve been quite virtual. All of that helps, I think, in terms of keeping morale up.
AW: We’ve also made an effort to share positive stories. Everybody’s got one about a family member who managed to get vaccinated or persuaded. I think the team has felt a part of something really important, which has helped to keep people motivated. But it’s a big challenge, which is much wider than vaccines. People have worked so hard, and there are still many challenges ahead, so we need to keep supporting each other.