Delayed 2nd vaccine - how does that sit with you as a health professional

[gildalilly]

Regarding the delaying of administering the 2nd dose of the vaccines. If you're a health professional who has to take the hippocratic oath or has similar professional guidelines, how does this delay sit with your professional guidelines?

I'm asking because if you have agreed 'first do no harm' isn't there a really difficult moral dilemma here for you? Isn't this just another unwanted pressure on you?

I have read online that practices have been specifically outlawed from giving 2nd doses within the dosing guidelines and you have to follow the government's untested rules. Is this true?

I feel so bad for health professionals being put in this awkward situation.

I think it’s probably reasonable to delay the second dose. There are limited supplies of vaccine, and I think it makes sense to vaccinate all vulnerable people partially, than only to vaccinate half of them in the same timeframe. That’s the choice we have to make. But I haven’t read the evidence in detail.
In terms of doing “no harm”, isn’t it more harmful not to vaccinate half of the vulnerable people, and leave them fully susceptible while we give the second vaccine to those who have already had the first?

Sits totally fine with me. The four principles of biomedical ethics are:

Respect for autonomy: respecting the decision-making capacities of autonomous persons; enabling individuals to make reasoned informed choices.

Beneficence: this considers the balancing of benefits of treatment against the risks and costs; the healthcare professional should act in a way that benefits the patient

Non maleficence: avoiding the causation of harm; the healthcare professional should not harm the patient. All treatment involves some harm, even if minimal, but the harm should not be disproportionate to the benefits of treatment.

Justice: distributing benefits, risks and costs fairly; the notion that patients in similar positions should be treated in a similar manner.

I am quite happy that delaying the second dose to allow more wide distribution of dose one is in accordance with the principle of justice. The benefit of doing so on a public health level, and to those who receive a jab who would otherwise not, outweighs the limited harm done to individuals who have had their second dose delayed. I can see that those who had the first jab before the decision to delay the second was made have had their autonomy to chose not to go ahead on that basis impaired, but that does not hold true for the cohorts who had their first jab in the knowledge the second would be 12 weeks off.

I have outlined (extensively!) on other threads why I think the decision to delay dose 2 is reasonable in terms of the evidence base. I don't intend to repeat that. I am also comfortable in biomedical ethics terms, for the reason outlined above.

There's such a strong lobby of people on MN criticising the government's decision on delaying the 2nd dose in order to get more people partial immunity.
Who is behind this? It doesn't ring true that it's individuals?

Respect for autonomy:respecting the decision-making capacities of autonomous persons; enabling individuals to make reasoned informed choices

The timings were changed after I had my first dose, as was the case for many of us. So we weren't able to make an informed choice as what we consented to wasn't what we got. Many of us feel we're in a clinical trial that we didn't sign up for.

I would add that most professional codes have something in them along the lines of, "learn about and follow the rules and regulations which govern your clinical practice".

There is a professional expectation that you will follow accepted guidance, even if you disagree with it personally. This it to protect patients, who have a right to expect that the clinician they end up seeing follows normal rules and practices. This is particularly true on the NHS, where patients do not always have a choice about who treats them.

Most of this stuff is guidance. There will always be exceptions, and it is appropriate to breach guidance if there is good reason and the patient is aware and consents. But flying in the face of professional guidance simply because you disagree with it is considered a professional failing, because it leaves patients vulnerable to maverick practitioners. You need to know - for example - that if you pitch up at A+E whichever clinician you see follows normal practice on antibiotic prescribing, even if they personally wouldn't touch antibiotics and treat themselves with sugar-pills and crystals.

In this case, it would be considered wrong for a clinician to blithely carry on giving doses at a 3 week interval, in breach of the national guidance to the contrary, no matter how strongly they felt that guidance was wrong. It might not be wrong for them to make an exception and give the second dose at three weeks for a particular patient, in exceptional circumstances, where deviating from the guidance is clearly justified.

@raviolidreaming

Respect for autonomy:respecting the decision-making capacities of autonomous persons; enabling individuals to make reasoned informed choices

The timings were changed after I had my first dose, as was the case for many of us. So we weren't able to make an informed choice as what we consented to wasn't what we got. Many of us feel we're in a clinical trial that we didn't sign up for.

Yes, I think that's a very reasonable and valid point.

@raviolidreaming I’m in the same position, and while I don’t disagree with the current strategy to get one dose into as many people as possible, I do wish that I’d known that the the schedule was going to be changed before I consented and had my first dose. I’m not sure that I would have gone ahead so quickly to be honest.

I’m a health care professional and I’m fine with it. I’m happy that more vulnerable people below me will get their first dose quicker. I was initially sceptical but after doing more reading I accept the rational. We were all excited at work to get our first vaccine weeks earlier than originally planned. This is because more slots were available due to the clinic only currently offering first doses.

I expect I would feel differently if I was more front like though. I see most of my patients (though certainly not all) via video call.

Thanks to all those who have replied. I've read that the delay of the second vaccine could result in a vaccine-resistant strain of covid which is why I asked. Clearly there isn't a huge likelihood of this as most people seem to see the delay of the 2nd dose as a positive thing and as medical professionals you'll know better than I will!

I also didn't realise that there was an expectation to follow the rules written in to any professional agreements. Now that you've pointed that out it makes sense that there needs to be, as it's not acceptable for people to go rogue and follow their own beliefs for obvious reasons.

This thread isn't going to be representative OP but if you look at the RCN, BMA websites you'll see other perspectives.

Most of our first patients could not give informed consent and have had second dose appointments for this week onwards cancelled. Some have been really distressed by not being given the protection the second dose would. To me this feels like a moral injury.

@DianaT1969

There's such a strong lobby of people on MN criticising the government's decision on delaying the 2nd dose in order to get more people partial immunity. Who is behind this? It doesn't ring true that it's individuals?

It’s not that unusual. WHO itself said that the second shot of the Pfizer vaccine could be delayed up to a maximum of 6 weeks. The UK’s strategy may work out, but it’s still an very much an experiment: a vaccination schedule that doesn’t have a randomized clinical trial in support of it.

@Jobsharenightmare thanks I'll have a look at these two.

www.bbc.co.uk/news/uk-55777084

I find it all increasingly concerning.

I agree @raviolidreaming it seems that the government's policy of ignoring the experts carries on.

You do realise that most HCPs are also not getting the second dose according to the original schedule? It’s suboptimal all round but not sure what you think individuals to do about it.

@Greybeardy yes I know that everyone's in the same boat. My question was how it say ethically and whether or not it out people in an awkward situation ethically. I've been told that's not the case which is good.

Doctor. Not happy I’m waiting 11 weeks between doses. Huge slap in the face. Had covid once, was so ill. Do not want it again. Not convinced by evidence for delaying 2nd dose. Happy to work frontline but want adequate protection.

Imo it's the right call for several reasons including for the very elderly they have a high chance of dying in the next year already, we could give them 2 doses in the next month and it be effectively wasted. When we are looking at such high numbers of elderly. Also.it means the vax gets down to the ecv group many of whom are still working and the cv group. These people working with kids are at higher risk of contracting it than elderly shielding. And will lose more years etc. (Obviously i have elderly parents too. They are getting a vax and having to wait for no 2. They are retired and are getting food deliveries. their only risks are dentists and medical appts. So in some ways the working age should be prioritised. My parents can wait as anyway it may not be safe to go to the shops and pub for them even after 2 doses as in reality we dont know how well the vaxxes will work.

@raviolidreaming

Respect for autonomy:respecting the decision-making capacities of autonomous persons; enabling individuals to make reasoned informed choices

The timings were changed after I had my first dose, as was the case for many of us. So we weren't able to make an informed choice as what we consented to wasn't what we got. Many of us feel we're in a clinical trial that we didn't sign up for.

Exactly.

[quote Muchtoomuchtodo]@raviolidreaming I’m in the same position, and while I don’t disagree with the current strategy to get one dose into as many people as possible, I do wish that I’d known that the the schedule was going to be changed before I consented and had my first dose. I’m not sure that I would have gone ahead so quickly to be honest.[/quote]
Same.

I was not afforded the choice, but told after I had consented to treatment - that nope, it won't be going ahead.

@Medstudent12 there's no way in the world that front-line medical staff should wait under any circumstances. They should have been first in the queue IMO

@HSHorror I just don't see the point in not following the manufacturer's instructions. So many medical professional bodies and scientists are warning against diverging from the tested plan. I'd have more faith if the government had a track record where they'd made good decisions but they've made cock up after cock up so I'm not feeling confident.

@Medstudent12

Doctor. Not happy I’m waiting 11 weeks between doses. Huge slap in the face. Had covid once, was so ill. Do not want it again. Not convinced by evidence for delaying 2nd dose. Happy to work frontline but want adequate protection.

Fully agree.

The people who know how the vaccine works are the MHRA and Pfizer.

Ultimately if they are happy with a 12 week delay that works for me. It also occurs to me that the trials had short intervals because they were carried out quickly - clearly a 12 week gap would make the trial take much longer than a 3 week gap.

It makes sense to me for more people to have some protection than a much smaller group to have the ideal earlier. As it is, the younger generations are going to have to wait a long time even for a first dose as they're going to have go back and do all the second jabs before they start on the first lot for lower priority groups.

That said, I do see why those who had the first vaccine early consented on the basis of a 3 week gap are annoyed now. On the other hand many of you must be coming up for a second dose much earlier than the majority. Be grateful for that.

Obviously a lot of hcp and cafe staff will be under 50 so wouldnt even be being vaccinated in this round. Instead it seems they have gone ahead including office staff and people wfh.
Everyone with kids is likely to catch covid. We are vaccinating hcp so they are not all off sick and possibly to protect patients. So hopefully one dose will do enough to stop serious illness.
Tbh it sounds a bit like, 'i want my second dose even though im (probably) young because ive been at risk of catching it'

But i assume 15% of people have had it now.
Maybe gov should only have vaxxed the at risk by age/condition medical staff first. Then maybe they could have had the 2??

But i suppose i genuinely think it will be as effective after 12w. after all every single other vax works with different spacing. At the end i mean. The bigger issue is obviously not full protection for well more like 14w.
As i say if youve had one thats one more than almost all shielded people. people who have had to send kids into school under threat of fines etc.

Even with lockdown and schools shut it is still currently in dc school.

The people who know how the vaccine works are the MHRA and Pfizer.
Ultimately if they are happy with a 12 week delay that works for me

Pfizer aren't happy with a 12 week delay. Nor are the WHO.

On the other hand many of you must be coming up for a second dose much earlier than the majority. Be grateful for that

It is difficult to be entirely grateful when you are working front line and don't know how effective the vaccine will now be.

itmeans the vax gets down to the ecv group many of whom are still working and the cv group

• and if the delayed regime still works, then I will concede that it was the right decision. Time will tell.