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

Background: On December 8th 2020 NHS England administered the first COVID-19 vaccination. Aim: Describe trends and variation in vaccine coverage by clinical and demographic groups. Design and Setting: With the approval of NHS England, we conducted a cohort study of 57.9 million patient records in general practice in England, in-situ and within the infrastructure of the Electronic Health Record (EHR) software vendors EMIS and TPP using OpenSAFELY. Method: We describe vaccine coverage across various subgroups of Joint Committee on Vaccination and Immunisation (JCVI) priority cohorts. Results: 20,852,692 patients (36%) received a vaccine between December 8th and March 17th 2021. Of patients aged ≥80 not in a care home (JCVI group 2) 94.7% received a vaccine, but with substantial variation by ethnicity (White 96.2% vaccinated, 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% vaccinated) and learning disability (91.4%). 275,205 vaccine recipients were identified as care home residents (priority group 1; 91.2% coverage). 1,257,914 (6.0%) recipients have had a second dose. Detailed characteristics of all cohorts are reported. Conclusion: The NHS in England has rapidly delivered mass vaccination. We deployed a data monitoring framework using publicly auditable methods and a secure, in-situ processing model, using linked but pseudonymised patient-level NHS data on 57.9 million patients. Targeted activity may be needed to address lower vaccination coverage observed among certain key groups.