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.

But i suppose i genuinely think it will be as effective after 12w

Maybe you could tell Pfizer and the WHO that then so they could stop suggesting otherwise 😏

It will work in that it will give some protection even if 33% to say ecv teacher who has to go back after lockdown or a ecv parent. Both of whom are exposed with no masks.
Are hcp still catching in great numbers? As the most infected age group were in fact children.
I suppose i think you would have a point if
The virus were contained to mainly hospitals or care homes.

If I was an ECV teacher I wouldn't want a vaccine schedule that only gave me 33% protection. I would want - and deserve - the 90%+ that Pfizer rolled out.

I just don't see the point in not following the manufacturer's instructions.

The rationale has been explained though. Fwiw I think it's the right decision.Pfizer didn't do any trials on a larger gap so they have no choice but to say they don't recommend it.

Can you imagine the lawsuits if a drug company approved a particular dosing regime but had never actually tested that regime?!

@raviolidreaming

If I was an ECV teacher I wouldn't want a vaccine schedule that only gave me 33% protection. I would want - and deserve - the 90%+ that Pfizer rolled out.

It's a lot more that 33% effective after one dose though!

Let's say for arguments sake one dose gives you 60% protection (it's likely to be higher). You live on a planet with 20 people. Vax 20 people once gives the planets a while 60% protection. Vax 10 people twice gets you 90% for half the population, but zero for the other half - so planet-wide protection is 45%.

Titchy I was responding to the previous poster who said 33%.

I understand what you're saying, and I desperately hope this gamble is the right one - but I will probably continue to feel disappointed, frustrated, and concerned meanwhile!

The British Medical Association has now chimed in:

Senior doctors are calling on England's chief medical officer to cut the gap between the first and second doses of the Pfizer-BioNTech Covid-19 vaccine. Prof Chris Whitty said extending the maximum wait from three to 12 weeks was a "public health decision" to get the first jab to more people across the UK.

But the British Medical Association said that was "difficult to justify" and should be changed to six weeks.

The doctors' union said the UK's strategy "has become increasingly isolated internationally" and "is proving evermore difficult to justify".

"The absence of any international support for the UK's approach is a cause of deep concern and risks undermining public and the profession's trust in the vaccination programme," the letter said.

Circumlocutious

I'm glad you've seen this too. It was in the link I posted but I don't think previous posters read it.

Well it's always drummed into us that practice should be evidence based.... And having 12 weeks between Pfizer vaccines isn't. It sucks.

@Circumlocutious

The British Medical Association has now chimed in:

Senior doctors are calling on England's chief medical officer to cut the gap between the first and second doses of the Pfizer-BioNTech Covid-19 vaccine. Prof Chris Whitty said extending the maximum wait from three to 12 weeks was a "public health decision" to get the first jab to more people across the UK.

But the British Medical Association said that was "difficult to justify" and should be changed to six weeks.

The doctors' union said the UK's strategy "has become increasingly isolated internationally" and "is proving evermore difficult to justify".

"The absence of any international support for the UK's approach is a cause of deep concern and risks undermining public and the profession's trust in the vaccination programme," the letter said.

The BMA's position is always going to be based on what is best for the individual patient. Public Health isn't their remit or focus, quite correctly. The decision has been made based on what is best for the country as a whole.

We will find out in due course whether it was the correct decision or not.

33% for 1 though is more than the ecv teacher would get though if everyone were having 2. As we wouldn't get to any doses for them for months. We would still be on over 80s. Same with hcp... as many over 80s not done with 1 dose. It's been 3 w so we would be back to the first lot by now.
Another 6m without vax at school WITH no masks and no mitigation and they will mostly have had it anyway. I
I agree with pp on individual level a vax asap both doses is obviously best. But to protect the most people. Remember effectively we have all paid for the vax and many psople whole families will be expected to get on with it when everything is relaxed with no vax at all. We may be expected to catch covid every few months.

Although one downside is knowing the gov they will relax everything after only one dose for the vulnerable.

I’m ok with a delay in the second dose of the AstraZeneca vaccine as there is an evidence base for it and it looks like a delayed second dose could be MORE effective.

I VEHEMENTLY oppose delaying the second dose of the Pfizer Biontech vaccine. There is NO evidence to suggest it will be effective. This is brand new technology. Pfizer, the WHO and the BMA oppose it. We should follow the manufacturers guidelines and not play guinea pigs with the first set of people to receive these vaccines. No one else in the world is. The government’s approach to the Pfizer vaccine is morally reprehensible. They need to do a u-turn and fast.

I agree with pp on individual level a vax asap both doses is obviously best. But to protect the most people

But that's the worry though: if the Pfizer vaccine doesn't work with the delayed schedule then it isn't going to protect anyone because it isn't going to work.
The argument isn't who should be where on the timeline, it's whether this is going to work at all

So name a vax that doesnt work with a gap of over 3w between doses....
It is usually a minimum not max.

@HSHorror

So name a vax that doesnt work with a gap of over 3w between doses.... It is usually a minimum not max.

Name a MRNA based vaccine that’s EVER been given to the public outside of a trial before.

The technology in the AZ vaccine has been used before so we know it will be fine. Not so with the Pfizer. No one knows what happens with an alternative dosing regimen with an MRNA vaccine. They are brand new.

@ProudAuntie76

I’m ok with a delay in the second dose of the AstraZeneca vaccine as there is an evidence base for it and it looks like a delayed second dose could be MORE effective.

I VEHEMENTLY oppose delaying the second dose of the Pfizer Biontech vaccine. There is NO evidence to suggest it will be effective. This is brand new technology. Pfizer, the WHO and the BMA oppose it. We should follow the manufacturers guidelines and not play guinea pigs with the first set of people to receive these vaccines. No one else in the world is. The government’s approach to the Pfizer vaccine is morally reprehensible. They need to do a u-turn and fast.

This isn’t really true though is it. Have you read the JCVI reports?

I now have my appointment for my second Pfizer jab - 11 weeks after the first. Quite a difference from the 4 weeks in between that I originally accepted appointments for.

What I find strange is that care homes in our area (Cardiff and Vale UHB) are having 8 weeks between their 2 doses. What’s the rationale for that?

What isn’t true?

Have I read this?

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Obviously yes and all the Pfizer data within it is based on a second dose being given on day 21. There is no evidence as to what happens if the dose is given later, because it hasn’t been anywhere else.

I have more faith in the manufacturers themselves, the WHO and the BMA. And they suggest a maximum gap of 42 days but only in exceptional circumstances.

It sits fine with me. The best possible decision in the circumstances. Why would you think anything else?

Do you not “have faith” in the MHRA and the CSM?

The graph on p4 shows a clear effect of the first vaccine after day 12 ish, and the curve flatlines thereafter showing 90% efficacy. It seems very unlikely that the curve would bend upwards at day 21 and rejoins the placebo arm before week 12. It’s possible it will slope upwards, but anything >50% is good. 100 people protected at 51% is better than 50 people protected at 90%.

I can quite understand the ethical objection on previous consent grounds, but the public health benefits seem clear. It’s not ideal of course but it’s probably the least worst option for the population.

@Muchtoomuchtodo

I now have my appointment for my second Pfizer jab - 11 weeks after the first. Quite a difference from the 4 weeks in between that I originally accepted appointments for.

What I find strange is that care homes in our area (Cardiff and Vale UHB) are having 8 weeks between their 2 doses. What’s the rationale for that?

I think lots of places are planning for an 8-10 week between doses. In a care home it’s pretty likely a resident could be ill or in hospital so unable to have their second dose. 8 weeks gives a chance to come back and do anyone missed.

@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.

How will you decide who should not get their first dose so you can have your second though?

@WiseUpJanetWeiss

Do you not “have faith” in the MHRA and the CSM?

The graph on p4 shows a clear effect of the first vaccine after day 12 ish, and the curve flatlines thereafter showing 90% efficacy. It seems very unlikely that the curve would bend upwards at day 21 and rejoins the placebo arm before week 12. It’s possible it will slope upwards, but anything >50% is good. 100 people protected at 51% is better than 50 people protected at 90%.

I can quite understand the ethical objection on previous consent grounds, but the public health benefits seem clear. It’s not ideal of course but it’s probably the least worst option for the population.

No. I’m not happy basing policy on an unproven hypothesis. I wouldn’t have consented to take part in an informal trial.

3 gp’s I know have managed to give themselves both doses already of Pfizer, while everyone else, including my hospital frontline colleagues have been denied this.

I would be interested to know the reasons why these gp’s felt they needed the dose after 3 weeks but would not afford the same to their vulnerable patients. Unfortunately it feels like a case of I’m alright jack, and it’s not what you know it’s who you know.

I would be happier if I felt they had the confidence to wait the 10-12 weeks, especially as I know they are doing a lot of telephone appointments. I am back on the ward tomorrow, wondering how much protection my one dose and paper mask will offer me.

I have a bad feeling about it all.

As another poster, it’s reprehensible that the Government allowed people to be immunised under the belief they would have another in 3 weeks time, and then completely back tracked and changed the rules. It’s not acceptable or fair to those individuals. If it was me who’d been in that situation I would have been very angry.

I’m actually due to get my first vaccine next week (NHS) and I won’t lie, the fact the Government is now rolling out vaccines in an untested manner that isn’t backed by the WHO or the creators of the vaccine does not sit easy with me and I can’t say I have any faith in even bothering to get vaccinated now.

For the good of everyone I truly, truly hope this gamble will pay off, but I have a sinking feeling in my stomach that there will be repercussions from this.

Wasn’t it on the news today that there are requests that the 12 week gap between jabs be shortened?

The Government’s decisions have been an absolute confused mess from the start - as I think many people will agree due to all the posts on this forum over the last 12 months. I can’t say I’ve seen many people praising the Government for their clarity, honesty and good decision making anyway.

I’m not sure why people think the actions surrounding the Vaccine roll out are going to be any different.