Trends and clinical characteristics of COVID-19 vaccine recipients: A federated analysis of 57.9 million patients' primary care records in situ using OpenSAFELY

The OpenSAFELY Collaborative

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Background On 8 December 2020 NHS England administered the first COVID-19 vaccination. Aim To describe trends and variation in vaccine coverage in different clinical and demographic groups in the first 100 days of the vaccine rollout. Design and setting With the approval of NHS England, a cohort study was conducted of 57.9 million patient records in general practice in England, in situ and within the infrastructure of the electronic health record software vendors EMIS and TPP using OpenSAFELY. Method Vaccine coverage across various subgroups of Joint Committee on Vaccination and Immunisation (JCVI) priority cohorts is described. Results A total of 20 852 692 patients (36.0%) received a vaccine between 8 December 2020 and 17 March 2021. Of patients aged ≥80 years not in a care home (JCVI group 2) 94.7% received a vaccine, but with substantial variation by ethnicity (White 96.2%, Black 68.3%) and deprivation (least deprived 96.6%, most deprived 90.7%). Patients with pre-existing medical conditions were more likely to be vaccinated with two exceptions: severe mental illness (89.5%) and learning disability (91.4%). There were 275 205 vaccine recipients who were identified as care home residents (JCVI group 1; 91.2% coverage). By 17 March, 1 257 914 (6.0%) recipients had a second dose. Conclusion The NHS rapidly delivered mass vaccination. In this study a data-monitoring framework was deployed using publicly auditable methods and a secure in situ processing model, using linked but pseudonymised patient-level NHS data for 57.9 million patients. Targeted activity may be needed to address lower vaccination coverage observed among certain key groups.

Original languageEnglish
Pages (from-to)E51-E62
JournalBritish Journal of General Practice
Issue number714
Publication statusPublished - 31 Dec 2021
Externally publishedYes

Bibliographical note

Funding Information:
All authors have completed the International Committee of Medical Journal Editors uniform disclosure form at coi_disclosure.pdf and declare the following: over the past 5 years Ben Goldacre has received research funding from the Laura and John Arnold Foundation, the NIHR, the NIHR School of Primary Care Research, the NIHR Oxford Biomedical Research Centre, the Mohn Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK, the Health Foundation, and the World Health Organization; he also receives personal income from speaking and writing for lay audiences on the misuse of science. Krishnan Bhaskaran holds a Sir Henry Dale fellowship jointly funded by Wellcome and the Royal Society (reference: 107731/Z/15/Z). Helen I McDonald is funded by the NIHR Health Protection Research Unit in Immunisation, a partnership between Public Health England and London School of Hygiene and Tropical Medicine. Angel YS Wong holds a fellowship from the British Heart Foundation. Elizabeth J Williamson holds grants from the Medical Research Council. Rohini Mathur holds a Sir Henry Wellcome Fellowship funded by the Wellcome Trust (reference: 201375/Z/16/Z). Harriet Forbes holds a UKRI fellowship. Ian J Douglas has received unrestricted research grants and holds shares in GlaxoSmithKline. All other authors have declared no competing interests.

Funding Information:
This work was jointly funded by UK Research and Innovation (UKRI) (COV0076; MR/V015737/1), National Institute for Health Research (NIHR) and Asthma UK-British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme. EMIS and TPP provided technical expertise and infrastructure within their data environments pro bono in the context of a national emergency. The OpenSAFELY software platform is supported by a Wellcome Discretionary Award. Ben Goldacre’s work on clinical informatics is supported by the NIHR Oxford Biomedical Research Centre and the NIHR Applied Research Collaboration Oxford and Thames Valley. Funders had no role in the study design, collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. The views expressed are those of the authors and not necessarily those of the NIHR, NHS England, Public Health England, or the Department of Health and Social Care.

Publisher Copyright:
© The Authors


  • COVID-19
  • Ethnic groups
  • General practice
  • NHS England
  • SARS-CoV-2
  • Vaccination

ASJC Scopus subject areas

  • Family Practice


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