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.

Can anyone explain, since it's a completely new dosing schedule that is now being done...

Is it just a case of it may not be as effective or could it cause any more serious repercussions? I'm not sure what exactly, but could it prove to be dangerous to spread it out this far, or would it just be that it's not potentially providing as much cover against Covid for the recipient.

Just trying to get my head round it.

I agree that it seems morally wrong to let people who consented to the original schedule to suddenly have their vaccines cancelled though.

I hope it's going to pay off..

There are some concerns that, thankfully are as of yet unproven, that this strategy could result in vaccine resistant strains emerging due to the longer gap. The theory is that in the 12 weeks the virus could learn to outmanoeuvre the weaker immune response from the single dose.

I imagine it’s that the gap between doses will render it less effective.

There’s a reason why Pfizer’s trials came to the conclusion that doses needed to be given 3 weeks apart....I’m pretty sure it wasn’t a number they just plucked out of thin air.... but obviously the Government know best.

But what do Pfeizer and WHO know anyway?

Silly us for thinking their opinions should matter far more than anyone else’s.

Have the FDA approved the Pfizer vaccine now?

@titchy

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.

You've misunderstood the BMA's remit. The BMA couldn't give a monkeys about individual patients. They're a union, there to protect their members. Their remit is to advance the rights and needs of doctors, who they represent.

Now, I grant that very often doing the right thing by doctors will also be good for patient care, but that's incidental.

They're arguing for a six week interval because that's what a cohort of their members want. Those members are scared doctors, working on covid wards, who have had the first dose and want the second now. Which I understand: I'm a clinician who has had the first dose and is gagging for the second. But it's not a public health or patient care decision. It's not a sensible weighing up of the evidence or the broader picture. It's advocating for the people they represent. That's what unions do.

It's directly analogous to the various teaching unions arguing for section 44 letters or for teachers to be prioritised for vaccines. It's not about the broader public health picture. It's not really about the kids (although it might be dressed up that way to make a better argument). It's teaching unions promoting the interests of teachers, because that is the role of a union.

If the BMA are saying that it's because they're worried about the broader public health picture, or they're concerned about the general population, then that's to make a stronger argument. It sounds better than "Our members should be prioritsed for a second dose sooner, because they're doctors". It's just like, historically, they've argued that doctors should be paid more because that gives better patient outcomes. That might even be true. But fundamentally the reason they're arguing for a shorter dosing period or more pay is because they're a union, fighting the corner for their members, and not because they're an independent body making an independent assessment of the evidence.

I'm not criticising the BMA at all for this. But it's worth understanding their remit before deciding how to weigh up their position.

The JCVI made this decision. NOT the government. The government are enacting the decision made by the JCVI.

I hate Boris and the Tories. But I'm fed up with the amount of misinformation going round about this pandemic.

JCVI membership:

Professor Andrew Pollard, Chair (University of Oxford)
Professor Lim Wei Shen, Chair COVID-19 immunisation (Nottingham University Hospitals)
Professor Anthony Harnden, Deputy Chair (University of Oxford)
Dr Kevin Brown (Public Health England)
Dr Rebecca Cordery (Public Health England)
Dr Maggie Wearmouth (East Sussex Healthcare NHS Trust)
Professor Matt Keeling (University of Warwick)
Alison Lawrence (lay member)
Professor Robert Read (Southampton General Hospital)
Professor Anthony Scott (London School of Hygiene & Tropical Medicine)
Professor Adam Finn (University of Bristol)
Dr Fiona van der Klis (National Institute for Public Health and the Environment, Netherlands)
Professor Maarten Postma (University of Groningen)
Professor Simon Kroll (Imperial College London)
Dr Martin Williams (University Hospitals Bristol)
Professor Jeremy Brown (University College London Hospitals)

COVID-19 sub-committee
Professor Lim Wei Shen (Chair) (Nottingham University Hospitals)
Professor Anthony Harnden, Deputy Chair (University of Oxford)
Dr Kevin Brown (Public Health England)
Dr Rebecca Cordery (Public Health England)
Dr Maggie Wearmouth (East Sussex Healthcare NHS Trust)
Professor Matt Keeling (University of Warwick)
Alison Lawrence (lay member)
Professor Robert Read (Southampton General Hospital)
Professor Anthony Scott (London School of Hygiene & Tropical Medicine)
Professor Adam Finn (University of Bristol)
Dr Fiona van der Klis (National Institute for Public Health and the Environment, Netherlands)
Professor Maarten Postma (University of Groningen)
Professor Simon Kroll (Imperial College London)
Dr Martin Williams (University Hospitals Bristol)
Professor Jeremy Brown (University College London Hospitals)
Professor Bryan Charleston (The Pirbright Institute)
Professor Lucy Yardley (University of Southampton)
Professor Robert Dingwall (Nottingham Trent University)
Professor Liz Miller (London School of Hygiene & Tropical Medicine)

@redsquirrelfan

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.

I think these are good points. Do we know why pzfizer chose a 3 week gap and not a 4 week gap or an 8 week gap or 6 months gap. It was a new trial for a new vaccine so it could presumably have been anything. Has that question been asked of Pfizer? Was it done for reasons of speeding up the trial ( understandable) or for clinical reasons that 3 weeks really is the best gap. Knowing that bit of information would help governments around the world make a decision on the gap.

And yes it’s not Boris deciding on the gap or even the government. It IS the experts

@Motorina

The experts advising the Govt are at odds with the experts in Pfizer, the experts advising the WHO and other experts advising almost all other governments, inc Pfizer themselves.

IF and at present it is an unknown, the 12 week plus plan shows that immunity drops off, then we would have wasted millions of doses, months and be back to sq 1.

There is also the danger that people with 1 dose will behave as if they have good immunity, when they haven't, leading to more spread etc etc.

@sashagabadon there's nothing in the phase 1 and 2 literature to say why they picked a three week interval. They genuinely seem to have plucked it out of thin air.

(Cynically, I wonder if a short interval was chosen because a longer interval would have delayed gathering results, which would have delayed phase three trials, and delayed time to market. But that's pure speculation on my part.)

[quote Motorina]@sashagabadon there's nothing in the phase 1 and 2 literature to say why they picked a three week interval. They genuinely seem to have plucked it out of thin air.

(Cynically, I wonder if a short interval was chosen because a longer interval would have delayed gathering results, which would have delayed phase three trials, and delayed time to market. But that's pure speculation on my part.)[/quote]
This is also what I suspect. 3 weeks were chosen as the minimum possible gap between jabs for speed purposes rather than an optimum gap for clinical reasons as how could they know what that was given the speed of it all. But I don’t know for sure and have no expertise. Ideally we’d also know if a second jab was necessary at all. But there is not a trial if people with just one dose again for speed reasons I would think.

I'm not a HCP but watched a doctor from Liverpool on BBC breakfast to his morning whose take on this was interesting. I've been of the mind that I would prefer it to be given with the 3 week interval the manufacturers have tested response to it for.

The doctor said that the vaccine doesn't stop you contracting the virus but only stops the virus from being life-threatening so, paraphrasing here, would you prefer your siblings and family to be protected to that extent with one dose or the vulnerable groups to have two doses with the others unprotected by vaccines?

If it is such a good idea to wait for 12 weeks not give it at 3 weeks, why are no other countries in the world doing this too?

@Watermelon999
You've hit the nail on the head there.

@Watermelon999

If it is such a good idea to wait for 12 weeks not give it at 3 weeks, why are no other countries in the world doing this too?

To be fair we don’t really know yet what other countries will or won’t do as very few countries have got to that point yet. Some countries are looking at extending the gap though as supplies are constrained everywhere. I guess everyone is watching Israel to see if one dose there helps them significantly or not

Yes instead of feeling relieved to have the vaccine, instead it feels like I’m inadvertently in some sort of drug trials experiment which I wouldn’t normally choose to sign up to because I am generally very risk averse.

And again, we are helpless to do anything about it now we’ve had it, yet some of those who are doing the vaccinating that I know are giving themselves the 2nd dose while making others wait, which makes me much more anxious about the whole thing.

I think because I’m a natural pessimist it doesn’t sit well with me at all.

@Calmandmeasured1 yes, that's it in a nutshell. Ideally everyone would be vaccinated at the three week interval. But we don't have enough vaccine to do that.

The dilemma is this: imagine you have two equally vulnerable 80 year olds infront of you. One had had dose one three weeks ago, so has some protection. The other has had nothing and has no protection at all. You have a syringe with precisely one dose in it. Would you give it to granny A, who has already had a dose, or granny B, who has had nothing?

It's that decision on a population level.

People saying they would not have consented are puzzling me.

Are they saying that they’d rather have no protection than less than they originally hoped?
Or are they saying they’d have waited for the AZ version which doesn’t seem problematic on one dose?

Denmark has also chosen to delay the second dose but, rightly imo, given the second dose in line with the patients consent given before the first dose. I think it’s the right decision because more vulnerable people will get protection during these crucial winter months. I also suspect the 3 week wait was pulled out the air to make it as short a wait as possible to get the results ASAP.

I will hold judgement until the data from Israel is scrutinised further.

If vaccine supplies run low.. do we not then run the risk of this happening with the 12 week delayed doses and deciding to not give them at all? As in, decide to cancel the 12 week ones to give first doses to the younger but CEV individuals that are further down the list.

Or if it reached that point would they give out the AZ Oxford as the second dose to the ones who had a pfizer first shot?

The JCVI made this decision. NOT the government. The government are enacting the decision made by the JCVI

I suspect most of us know this. The concern remains though: Pfizer, the WHO, and other countries in the world not adopting our vaccine schedule presumably have scientists who don't agree with delaying the second dose.

Out of interest have most people already vaccinated had the Pfizer or the AZ vaccination?

Mine was Pfizer.