Second vaccine appointment cancelled

[vanished]

I work in healthcare. I was due to have my second Pfizer vaccine next week, but I've just been informed that it's been cancelled.
Now, I understand the bigger picture, it means more supplies. Therefore more people can get their first dose, but...
does this compromise the "winning formula" of the Pfizer? Ie two doses 21-28 days apart? Potentially rendering all the first dose Pfizer recipients useless if they don't receive it for a longer period...
plus, I have volunteered to be a vaccinator. One of the provisos of the role is that you need to have received both doses. This will either mean I cannot help out now until March, or they change the rules. Personally as high risk, I would be a little more hesitant volunteering...
Of course the great public health demand is more important, I'm just a bit concerned that this new approach to Pfizer is concerning...

@Pipandmum

It has been clearly explained. The efficacy is not compromised if there is as much as a 12 week interval, and you do have increased immunity from the first vaccination after a couple weeks. The idea is to get as many vaccinated with one shot and as supplies come in get the second vaccine done. People far more knowledgeable about immunology and the relevant vaccines have talked about this system.

"The safety and efficacy of the vaccine has not been evaluated on different dosing schedules as the majority of trial participants received the second dose within the window specified in the study design," Pfizer and BioNTech said.

I'm due the 2nd dose next Thursday I imagine I'll get an email saying I won't be getting it now?

I think they could concentrate on getting the first dose into people in the community.
I would rather that frontline NHS and care home staff are as protected as they possibly can be, as they are the ones who are much more likely to be spending most of their day with people with the virus/people ECV.

Pfizer themselves are against this increase in time between vaccinations as it isn’t as well tested.

Not everyone at Pfizer;

USA TODAY spoke with Dr. Scott Gottlieb, former commissioner of the Food and Drug Administration. Gottlieb, 48, serves on the board of Pfizer ...

Q: For the Pfizer and Moderna vaccines, each person is supposed to get two doses, three or four weeks apart. Between the two companies, 40 million doses are expected to be available in the U.S. this month. Is it better to give 20 million people two doses, one in December and one in January, or get all 40 million out there and then catch up to the second dose as supply increases?

A: I feel very strongly that we should get as many shots in arms as possible, right away. The reality is that one dose is partially protective. I just fundamentally disagree with (saving half the supply for January) ...

eu.usatoday.com/story/opinion/2020/12/07/covid-vaccine-get-many-shots-arms-possible-right-away-opinion/6483439002/

@Pipandmum

It has been clearly explained. The efficacy is not compromised if there is as much as a 12 week interval, and you do have increased immunity from the first vaccination after a couple weeks. The idea is to get as many vaccinated with one shot and as supplies come in get the second vaccine done. People far more knowledgeable about immunology and the relevant vaccines have talked about this system.

They don't actually know that. There's no trial data that says one dose protects for any more than three weeks as trial participants had their doses 21 days apart.

I was due to get my second dose on Tuesday and I am very disappointed and concerned by this. I think it's a potential public health scandal waiting to happen, but I've thought that about most things since March. Feel like I'm in a whistleblowing documentary.

A very simple explanation is that the first dose gives a high level of protection and the second provides a sustained level of protection

According to the government. The fact is that all the trials and their results have been based on very specific conditions, and the government have now "found some science" that is entirely unproven to institute a long gap between doses. To be clear - I am in favour of the vaccine, I was a vaccine volunteer, and I have no time at all for ant-vaxxers. But the government have just played right into their hands, because there is absolutely no science to support their claims. There can't be because the vaccines were never trialled in this way. So they are, effectively, trialling whether it works or not on the British population, and some of the most vulnerable of those. That is an incredibly dangerous thing to do, to say nothing of immoral and unethical. People on whom things are tested should be informed and given the right to refuse. The vaccine developers have set down a regime for administration, and until actual evidence from a properly formulated trial exists, that regime should be stuck to. This is a matter of whether the government are right or wrong about the period between doses - there is no right to play with peoples lives like this. They are not guinea pigs.

@viques

The 21 day gap was never going to happen! There are barely enough HCPs available to deal with the limited stock of vaccine presently available, how would they cope with the situation when the first tranche of vaccinated people started turning up for their second injection when they are also trying to give subsequent tranches their first. The workload would have doubled in 21 days. I think the 12 week gap is clinging to hope that within those 12 weeks enough HCP/Army Personnel/ well meaning volunteers who fancy it ( please not!) , will somehow appear to cope with the demand.

It’s another government logistics nightmare cock up brewing.

I’ve just spent hours on my day off filling in volunteer forms and approaching referees to help with marshalling. 😐

I may be ‘well meaning’ but I have decades of practical volunteering experience. I won’t be injecting anyone but I am used to working outdoors with all kinds of people, some very vulnerable and some very fit and helping them as best I can.

For arguments sake, if they did stick to the manufactures guidelines, wouldn't they have to double capacity?
EG, weeks 1-3, fine. Everyone is having first dose.
Then once second dose was due, they'd either have to stop new appointments for the next three weeks to do the second ones and then restart the cycle, or double the space and staff needed.

@Moondust001

A very simple explanation is that the first dose gives a high level of protection and the second provides a sustained level of protection

According to the government. The fact is that all the trials and their results have been based on very specific conditions, and the government have now "found some science" that is entirely unproven to institute a long gap between doses. To be clear - I am in favour of the vaccine, I was a vaccine volunteer, and I have no time at all for ant-vaxxers. But the government have just played right into their hands, because there is absolutely no science to support their claims. There can't be because the vaccines were never trialled in this way. So they are, effectively, trialling whether it works or not on the British population, and some of the most vulnerable of those. That is an incredibly dangerous thing to do, to say nothing of immoral and unethical. People on whom things are tested should be informed and given the right to refuse. The vaccine developers have set down a regime for administration, and until actual evidence from a properly formulated trial exists, that regime should be stuck to. This is a matter of whether the government are right or wrong about the period between doses - there is no right to play with peoples lives like this. They are not guinea pigs.

This is an absolutely brilliant summary. Also appreciated the point of consent that was raised earlier in the thread. We've been given dose 1 of an MHRA-approved regime and are now being forced into basically partaking in a trial without our consent. I'm so angry.

[quote Clavinova]Pfizer themselves are against this increase in time between vaccinations as it isn’t as well tested.

Not everyone at Pfizer;

USA TODAY spoke with Dr. Scott Gottlieb, former commissioner of the Food and Drug Administration. Gottlieb, 48, serves on the board of Pfizer ...

Q: For the Pfizer and Moderna vaccines, each person is supposed to get two doses, three or four weeks apart. Between the two companies, 40 million doses are expected to be available in the U.S. this month. Is it better to give 20 million people two doses, one in December and one in January, or get all 40 million out there and then catch up to the second dose as supply increases?

A: I feel very strongly that we should get as many shots in arms as possible, right away. The reality is that one dose is partially protective. I just fundamentally disagree with (saving half the supply for January) ...

eu.usatoday.com/story/opinion/2020/12/07/covid-vaccine-get-many-shots-arms-possible-right-away-opinion/6483439002/[/quote]
That isn't what he said at all! What he said was that he did not believe that there would be production /logistical problems in delivering enough doses in 2021, so he personally was opposed to hanging on to half of the existing (December) production in order to give the second dose at the end of January because he was confident there would be further supplies coming off the production line. Effectively he was "betting" - and probably a safe bet from his position - that there would be enough vaccine supplies to give everyone their second doses within the trialled timeframe.

I have think it's good that they get as many people as possible to at least partially vaccinated. A clever message move.

It's a tradeoff of risks.

They're betting that giving people a single dose (with the risk of incomplete protection) is less bad than leaving some people unvaccinated.

If there were enough vaccine to go around, this wouldn't be considered for a moment. There isn't.

I'm NHS frontline, doing AGPs on covid +ve patients, and clinically vulnerable. The latest communication from the trust is 'We'll contact you when you can book an appointment'. No time frame. Same for my colleagues. Who are dropping like flies with this thing, inspite of using all the right PPE.

In normal circumstances administrating any drug outwith the research would never be considered. Nor would one ITU nurse caring for 4 patients. Nor would posting on twitter for med students to go in and help in ITU. Nor would closing schools and telling people to stay home on New Year's Eve. It is all outrageous and unprecedented, but the gamble is that giving twice as many people one dose will save more lives than giving half as many two.

I understand why they're making the decision. I hope hindsight proves it was a wise one.

The first person I heard suggesting this approach was the medically unqualified Tony Blair on Radio 4. Immediately I wondered what's in it for him. He spoke as though it was a fact that this would be a better approach. A scientist interviewed immediately afterwards completely disagreed with him. I have no idea who decided his opinion was relevant.

The Guardian:
www.theguardian.com/society/2020/dec/31/covid-vaccine-uk-doctors-criticise-rescheduling-of-second-doses

Its absolutely stupid my dads 80 he had his first one today and the next is in march! .. nearly 9 weeks away like whats the point of the 2 jabs if its not going to offer proper protection

Moondust001
That isn't what he said at all!

But he was asked;
Is it better to give 20 million people two doses, one in December and one in January, or get all 40 million out there and then catch up to the second dose as supply increases?

He is also quoted in The Financial Times;

Should we take a chance and divert early booster shots to the unprotected?

Could veering off-script in the rollout of Covid119 vaccines also be in the public interest? ...

The idea was floated recently by Scott Gottlieb, the former head of the US Food and Drug Administration who now sits on the board of Pfizer ....

There is another point in Mr Gottlieb's favour: there is no firm evidence that boosters must be timed precisely to be efficacious. While second doses dramatically enhance protection, dosing intervals are not set by any immutable commandments of dosing schedules. ...

Routine boosters for other diseases are also put off for multiple reasons - holidays, clinic closures, delayed deliveries, forgetfulness - without efficacy being a worry.

www.ft.com/content/bae89c74-a154-4f31-8e6e-9957074c3cce

The first person I heard suggesting this approach was the medically unqualified Tony Blair on Radio 4. Immediately I wondered what's in it for him. He spoke as though it was a fact that this would be a better approach. A scientist interviewed immediately afterwards completely disagreed with him.

As per usual with Covid-19 the scientists are divided;

The change of strategy, most prominently championed by former Prime Minister Tony Blair, was widely welcomed by experts.

“I have no doubt this decision will save many lives,” said Paul Hunter, professor in medicine at the University of East Anglia. Hunter pointed to available evidence from the trials of both vaccines indicating that a single dose is beneficial.

The decision is a “sensible” one, echoed Stephen Evans, professor of pharmacoepidemiology at London School of Hygiene and Tropical Medicine, explaining that while the evidence on the efficacy of one dose is more limited, “the crisis in the U.K. requires more than the usual regulatory approach.”

The move, which follows advice from the Joint Committee on Vaccination and Immunisation (JCVI), is based on data from clinical trials that show recipients of the vaccine seem to acquire a strong degree of immunity after a single dose.

www.politico.eu/article/uk-decision-to-prioritize-first-coronavirus-vaccine-shots-will-save-lives-say-experts/

@Coffeeislife04

Its absolutely stupid my dads 80 he had his first one today and the next is in march! .. nearly 9 weeks away like whats the point of the 2 jabs if its not going to offer proper protection

Which is better on a population level? Your father and another vulnerable patient having good protection, or your father having excellent protection whilst that other person has none?

The ideal would be for both to have excellent protection, but we don’t have the doses for that.

I understand your frustration. I also understand the decision.

So they're now using the phizer jab in an unlicensed way that the people/staff they have already given it to didn't consent to? This should go well.

This. Regardless of the potential public health justification, this is not at all science based and definitely not ethical.

It's ridiculous. The govt is trying to shoehorn the same procedure that will work for the Oxford vaccine onto the Pfizer vaccine. There must be a lot of elderly people who are very upset and probably confused as to why this is happening.

It's wrong on so many levels.

@LemonTT A very simple explanation is that the first dose gives a high level of protection and the second provides a sustained level of protection that’s not true Pfizer have said they have no data to support the new vaccine schedule being effective.

@TurkeyTrot

if the second dose is later than 21 days, it doesn't make the first dose 'useless' as you will have mounted an immune response against it. The % chance of having 'full' immunity increases after the second dose - the 21 days thing was defining the minimum gap in between the prime and the booster for it to work.

I think it's important for healthcare workers to get both doses to maximise the benefits, but another week or two or three should be fine from an immunology point of view (frustrating though, I know)

Is that true - I've seen somewhere that Pfizer are saying it's not as effective? I think it's great if they can do this as it would give at least some protection to the vulnerable (and more of them) but it is a bit confusing.

@Motorina Which is better on a population level? Your father and another vulnerable patient having good protection, or your father having excellent protection whilst that other person has none? the other person won’t be CEV though.

My next dose is booked in for the 11th. So far, it's still going ahead. If I get an email cancelling it, I shall be emailing the people providing it, asking what scientific evidence they have seen to suggest a delayed 2nd dose is effective, and other points raised here re consent etc.

@oneglassandpuzzled

I congratulate you on volunteering as a marshal, I am sure you will do an efficient and effective job (unlike the inefficient people who left vulnerable pensioners waiting outside in the cold for several hours in Harlow the other day) . I appreciate that your role is essential and will free up HCP for clinical duties.

My , only half lighthearted, worry is that the govt/Hancock will be so desperate that he will let almost anyone wield a syringe to cope with the backlog. This is after all the man who encouraged his next door neighbour -with no previous manufacturing experience - to produce phials for vaccine distribution , and moreover approved and paid for them for NHS use before they had been licensed as safe.