How to get a second Pfizer vaccine in NW England

[Labradoodle1989]

I would appreciate advice on a vaccine related predicament. From my research, the UK / JCVI seems to be out of step with other countries on this but I’d appreciate guidance from anyone who knows more than me about the reasoning behind this (I don’t want to sound like I’m criticising them, I just don’t understand the current guidance for people like me).

I will give some background first. I had my first dose of the vaccine when invited in April. It was the AstraZeneca / Oxford. I am early 30s. Shortly afterwards, following the developing awareness of the very small blood clot risk, the guidance in the UK changed to say that under 40s should be offered an alternative brand as a first jab. However, the guidance was (and still remains) for people who like me are under 40 who have had the first AZ jab to still have the second AZ rather than having the option to switch to another brand like Pfizer or Moderna for the second jab. The only exception to this is apparently if someone suffered a blood clot or other event putting them in hospital from the first AZ dose (which was not the case for me). I’ve asked my GP, and at the vaccine centre in my town, if I can have a Pfizer jab for my second dose instead but they both said no because they are not allowed to deviate from JCVI guidance which says that the only vaccine I can now have is AstraZeneca as that’s what I had for the first dose - unless I was hospitalised with side effects which I wasn’t.

I really do not want another AstraZeneca dose. firstly I felt very unwell after the first one and had to take a week unpaid off work and do not want that to happen again (I know risk is lower after second dose). secondly I had some period changes after the first one (first time this has happened in my life) which I do not want to happen again as me and my DP are currently TTC and I worry it could have some impact. Also, if by any chance I am just pregnant then I understand that Pfizer is recommended over AstraZeneca when in early pregnancy. thirdly I would rather not take the (admittedly very tiny) risk of blood clots (which I know are only 4 per million for second doses, I’ve read the full government data so I know the risk is really tiny, but I know someone who suffered from this so it feels more real to me and I’m still not convinced it’s a risk worth taking when there is safer alternative vaccine for my age group available). Fourthly I have a minor medical condition making me slightly more prone to clotting and strokes - nothing serious but enough that GPs will not prescribe me the pill and I’ve never taken the pill in my life for this reason and I take other precautions when on flights etc.

It now seems from the data that the Pfizer is slightly more effective against the Delta variant, and Pfizer will be used for booster jabs for the over 50s from September (even if people had AstraZeneca first) so clearly the JCVI are not fundamentally opposed to the principle of using Pfizer when someone had already had AstraZeneca. I know that current studies on the efficacy of mixing vaccines are limited (though to date the small studies appear to show that such mixing may provide a sufficient immune response without safety concerns) so I understand why the JCVI / doctors / vaccine may be reluctant to allow mixing AstraZeneca first dose then Pfizer second dose without extensive studies. I guess their view is that There is not enough information available for them to be sure it’s ok to mix.

But what is confusing me is why the UK is taking a different approach to basically every other country. In Norway, denmark, Germany, Spain, Korea, canada, and lots of other countries, anyone my age with a first AZ dose had the option to take Pfizer as their second dose. Especially when there are extra reasons, like the ones I’ve explained above, why someone doesn’t want AZ second dose. Does anyone know why the JCVI \ UK is taking a different approach, please? Surely it’s safer to just get people like me jabbed, whatever the brand of jab?

I feel like I am in difficult position. I really really want to be double vaccinated as soon as possible. It looks like it will be a requirement soon for my work too. But I also really really don’t want the second AZ for the reasons above when it seems like Pfizer would be a better option. The GP and vaccine centre in my town both say there is nothing they can do and that if I don’t consent to AZ (which I don’t at the moment) then I just have to wait and see if JCVI will change their guidance to match other countries. I’ve been hoping they will change it now for nearly 4 months, but no word on whether the mixing will soon be possible. Is anyone else in this position?

Thanks for reading, and sorry for the long post.

Ps. Am in the north west, and willing to travel, in case anyone knows of a different vaccine centre that would allow Pfizer second dose in this situation. Thank you!

I don't think it will be long before it changes but to be honest you are better off getting the AZ one now, otherwise you are leaving yourself vulnerable (which could be a disaster in pregnancy). Having said that I do understand your reasons.

Many people also report period changes with Pfizer....

Unless your GP or a hospital consultant is able to assist then no, I suspect you will not be able to get a second dose of different vaccine to the first.

They simply aren't allowed to, unless there are extremely good clinical reasons. Your previous clot issues are irrelevant, btw, it's a completely different type of clot.

Also what other countries are/aren't doing is irrelevant to you.

When and if the rules change here you can have a different vaccine . Until then you are not a special case . Make a choice and get properly vaccinated or wait and hope that the rules will change and that you have the option to choose.

I've mostly heard of period changes with Pfizer tbh. But can you not just go to a drop in clinic? I dont know tbh just guessing

@ShinyGreenElephant GP/booked/pop-up doesn't matter - no clinician will give a vaccine to a patient that they are not authorised too.

Thanks for all your replies, that’s helpful. I know I’m not a special case and need to just go with the rules unless they change.

Rose, I agree that what other countries are doing is irrelevant to me. I guess I’m just curious why it’s different , and thought someone on hear might know (and might persuade me that the UKs approach is actually better). and I feel like I’d feel happier deciding what to do if I knew the logic behind the UK’s reasons for taking a different approach than other places. (Most of my relatives are in a different country and some are doctors so I hear a lot about what’s different and I guess I wanted to make sense of it all and do the right thing.) maybe I am over thinking this all.

Good point that the types of clot are different. I mentioned that issue so people didn’t say ‘you are at less risk taking the pill!’ but I agree it’s not really relevant.

@Rosehip10 I thought there were drop in clinics giving them out no questions asked eg to the homeless / unregistered immigrants etc? I defo read that but maybe its bollocks

[quote ShinyGreenElephant]@Rosehip10 I thought there were drop in clinics giving them out no questions asked eg to the homeless / unregistered immigrants etc? I defo read that but maybe its bollocks[/quote]
Drop in clinics will vaccinate anyone over 18 irrespective of residency status etc but they still have to follow the protocols that have been set by the JCVI, such as , no AZ in the under 40s, 8 week gap between doses, not mixing vaccines.

OP in your circumstances I would trust what the professionals are telling you and get your second AZ , the longer you wait to have the second dose could potentially mean the vaccine is less effective overall

I have had mixed Vaccs - I explained the situation to my GP, why I wanted to mix etc. He agreed it would be the best thing for me personally, and organised it with the attached vaccine hub. GP that gave it said it wasn’t the first one she’s given, including to her daughter in law.

This is in E.Lancs if that’s any help.

Unfortunately you won’t be able to mix. You could try your luck at drop in centres but it’s unlikely to work.

@whataballbag OP has discussed it with her GP and they have said still recommended to have a second AZ. I doubt any vaccinator would administer a different dose to what's been authorised without any pre authorisation from a GP. If I was a vaccinator I certainly wouldn't put my job/profession on the line by knowingly giving a patient the wrong vaccine to what's been prescribed or authorised

Just to say I'm pretty sure the Pfizer jab screwed up my period so it's not just AZ.

Worth speaking to GP again though. The first one I spoke to wouldn’t have any of it. The second one was happy to arrange it though

My periods are messed up op and I had Pfizer.

Guidance on mixing vaccines is likely to change soon, I believe, especially when the booster shots come in.

The Green Book (Information for public health professionals on immunisation from the Goverment) section on vaccination was updated on 30 July to already include some leeway at sites where only one vaccine is available - ie if you attended a Pfizer only site after having had AstraZeneca and were deemed unlikely to return again there is the following guidance on Previous Incomplete Vaccination:

"For individuals who started the schedule and who attend for vaccination at a site where the same vaccine is not available, or if the first product received is unknown, it is reasonable to offer one dose of the locally available product to complete the schedule. This option is preferred if the individual is likely to be at immediate high risk or is considered unlikely to attend again. Further doses would not then be required."

I had terrible side effects for six weeks after my first AstraZeneca and although it has been getting better since then I have decided not to have a second and risk going through those six weeks again. I will wait until mixing is approved and am prepared to to put up with any side effects from Pfizer, if any.

This option is preferred if the individual is likely to be at immediate high risk or is considered unlikely to attend again. Further doses would not then be required.
This is interesting, I was told that someone attended our site & refused to leave unless given Pfizer (AZ first). They decided they were unlikely to attend again & so did it. I didn't mention it above as I thought it might be anecdotal.

I don`t know about all those countries but I can tell you that in Norway and Danmark proppe were offered Pfizer as their second jab because AZ was taken completely out of use.

The issues/ concerns etc relating to AZ (clotting etc) were all seen after first dose

That’s why younger people who have had first doses without isues are told to carry on with second

A study published in the Lancet at the end of last month stated that the AZ vaccine is no more dangerous than the Pfizer jab.

It's not correct to say the blood clot with low platelets condition was only seen with the first dose of AstraZeneca:

"Up to 28 July 2021, the MHRA had received Yellow Card reports of 411 cases of major thromboembolic events (blood clots) with concurrent thrombocytopenia (low platelet counts) in the UK following vaccination with COVID-19 Vaccine AstraZeneca. Forty three of the 411 reports have been reported after a second dose. Of the 411 reports, 211 occurred in women, and 198 occurred in men aged from 18 to 93 years. The overall case fatality rate was 18% with 73 deaths, six of which occurred after the second dose."

www.gov.uk/government/publications/coronavirus-covid-19-vaccine-adverse-reactions/coronavirus-vaccine-summary-of-yellow-card-reporting

For the same condition with Pfizer:

"Up to 28 July 2021, the MHRA had received Yellow Card reports of 15 cases of major thromboembolic events (blood clots) with concurrent thrombocytopenia (low platelet counts) in the UK following use of the COVID-19 Pfizer/BioNTech vaccine. These events occurred in 6 women, and 9 men aged from 31 to 91 years, and the overall case fatality rate was 7% with one death reported."

Personally, I don't want a repeat of the side effects I suffered. Of course it's possible there would be none at all with a second dose of the same vaccine and no one can guarantee it wouldn't happen again with a different vaccine, but I would like a choice.

The evidence is that with AZ you feel unwell first jab (if you're going to) but Pfizer with the second jab. If that matters to you. It wouldn't concern me, as the vaccine is dead and you're unlikely to feel unwell after the 48 hours in which it is still in your body.