The Covid vaccination drive in England has opened to everyone over the age of 21 today as ministers try to get every adult jabbed by the country's new 'freedom day' on July 19.
Around one million people aged 21 and 22 will begin to be invited to come forward for their vaccine from this morning, leaving only 18 to 20-year-olds yet to get the call.
NHS England said it expects to have opened up the scheme to all adults by the end of this week. But a shortage of vaccines could threaten a further Freedom Day delay as supplies of Pfizer and Moderna jabs are said to be 'tight'.
There has been an increased demand for the American vaccines as young people are taking alternatives to AstraZeneca due to its small risk of blood clots.
In light of the rapidly spreading Indian variant, the Government has brought forward its target for vaccinating all adults from July 31 to July 19. But despite needing to go faster, the Covid jab rollout has slowed to under half its peak speed.
Just 368,555 vaccine doses were deployed across the UK on Monday, well under half the 844,285 it managed on a single day in March.
The pace has slowed because of the decision by Government advisers to recommend alternatives to the Oxford/AstraZeneca jab for the under-40s and limited supply of the two alternatives – Pfizer and Moderna.
Ministers have conceded that the supply of the Pfizer jab is particularly 'tight' while the Moderna vaccine – which has only just become available – is thought to be similarly limited.
NHS England boss Sir Simon Stevens has said that the health service would 'finish the job' of the vaccination programme to the 'greatest extent possible' over the next four weeks, and he expects all remaining adults to be offered their first vaccine by the end of the week.
But he told the NHS Confederation's annual conference 'supply continues to be constrained'.
Government advisers recommended an alternative to the Oxford/AstraZeneca jab for under-40s after it was linked to fatal blood clots. But this has hugely increased demand for the Pfizer and Moderna vaccines.
Downing Street's vaccine minister Nadhim Zahawi last week admitted stocks of Pfizer — the main jab being administered to young people — would be 'tight' this month.
But in a glimmer of good news, Covid cases appear to be flat or falling in the first areas to be hit by the new Indian 'Delta' variant, official figures show.
The infection rate in Blackburn with Darwen, which took over from Bolton as the country's hotspot at the end of May, is now falling after appearing to peak on June 4 when there had been an average 143 cases per day over the previous week.
It remains the worst-affected place in the country but if the trend keeps up the change of fortunes could suggest that, as was seen in Bolton, simple surges in testing and vaccinations and tougher advice on travelling in or out of the area and social distancing could be enough to keep a lid on local outbreaks.
Ministers urged another 3.6million people in Birmingham, Liverpool, Warrington and parts of Cheshire to try to avoid travelling and be more careful about virus control measures in a bid to slow outbreaks there.
Boris Johnson yesterday announced a four-week delay to plans to end social distancing rules on June 21 as planned, saying not enough is known about the Indian variant and how difficult it will be to control.
The other areas that were first to be hard hit by the strain when it emerged in April – Bedford and Burnley – also appear to have arrested the spread of Covid by scaling up local efforts to stamp it out and test and isolate everyone.
Those four areas, Bedford, Blackburn, Bolton and Burnley, were the first to see cases surge, the first to get extra help from the Government to control the virus, and now appear to be the first to see infections levelling off.
But infections are still rising fast in many areas that have been added to the official hotspots where advice has been upgraded, with cases going up in twice as many areas as they are flat or falling.
Department of Health positive test figures show that there has been a plateau in the numbers of people testing positive for coronavirus in those hard-hit areas, offering proof that the Indian variant can be controlled.
In Bolton the infection rate had risen to 453 cases per 100,000 people on May 21, with an average of 186 people testing positive each day, but this has since plummeted to 309 per 100,000 and an average 127 daily cases.
There are hopes that the trend there, where the council offered free regular testing to all adults and stepped up its efforts on contact tracing and vaccinations, will translate to other areas that see outbreaks of the variant.
It may be beginning to happen in Blackburn, which took over as the hotspot at the end of May with the rate of cases per 100,000 people hitting 667 by June 7, but since dropping to 599. Average daily cases appear to have peaked at 143 on June 4 and since fallen to 128.
In Bedford a similar trend is playing out, with an infection rate high of 208 per 100,000 on May 23 now having fallen to 154 per 100,000, and average daily cases peaking at 52 on May 20 and now down to 38 per day in the past week.
Burnley also appears to have seen a levelling off in cases, although the trend is less certain and only recent. The seven-day infection rate was 370 per 100,000 on June 8 and fell to 367 by two days later, with average daily cases having levelled off at around 47 per day since June 5.
There are 34 areas now on the list of places to face tougher guidance, which offers a 'package of support' from the Government to include surge testing, enhanced contact tracing and financial support to Covid cases and their contacts who have been asked to self-isolate.
Recent data from these 34 areas show that infections appear flat in 10 places, are falling in two (South Ribble as well as Blackburn) but are rising in 22 places.
Most of them are recent additions to the enhanced support list and ministers will be hoping the extra measures help to turn the tide on infections in those places, too.
Boris Johnson's delay to the original June 21 'Freedom Day' by four weeks came amid fears a third wave of Covid could overwhelm the NHS.