Decision to administer just one dose of the Covid-19 vaccine to people to increase the numbers of those vaccinated appears to be a rushed change of plan, after so much had been said and written about the need for two doses.

First published in January 2021.

Remember this exciting and vitally important moment in 2020, when the first person was vaccinated on 8 December, and the message from Professor Stephen Powis, National Medical Director of NHS England and NHS Improvement:

“What a great moment – Maggie, the first NHS patient to be vaccinated against COVID-19. A truly historic day here at the University Hospitals of Coventry and Warwickshire and the beginning of the end of this pandemic.”

The Department of Health and Social Care then explained that, “The Pfizer/BioNTech vaccine was the first vaccine to be authorised for use by the medicines regulator, the Medicines and Healthcare products Regulatory Agency (MHRA). Patients require 2 doses of the vaccine for the vaccine to be at its most effective. Thanks to the work of the government’s Vaccines Taskforce, 40 million doses of the Pfizer/BioNTech vaccine have been secured for the whole of the UK.”

This truly was a historic day, and the early dawn of our way through the Covid-19 pandemic; ultimately, we hope, safely to a new beginning for the world as ‘one’. A world that must take far more action against the poverty and exclusion that formed such a dark, potent mixing bowl for the transmission of the virus.

But, as, Dr Michael Head, Senior Research Fellow in Global Health, based in the Clinical Informatics Research Unit at the University of Southampton, recently wrote, Global vaccine roll-out will be incredibly complex, with a variety of factors inevitably contributing to the extent of its success.”

Was anyone really prepared, then, for the announcement that there was to be a shift of focus in this rollout in the UK? From providing two doses of the vaccine, within a pre-determined, and agreed, schedule, to administering just one dose to people in the early days, in order to increase the numbers of those vaccinated.

As reported by Reuters, the manufacturer Pfizer “sounded cautious on the prospect of shifting the schedule of its second dose, noting it had not been evaluated on different dosing schedules.

Pfizer commented that, There are no data to demonstrate that protection after the first dose is sustained after 21 days, adding that “the implementation of alternative schedules should be closely monitored.”

Pfizer have made it clear that while decisions on alternative dosing regimens reside with health authorities, it is critical to ensure each recipient is afforded the maximum possible protection, which means immunisation with two doses of the vaccine.”

Meanwhile today, the Metro reports that “The UK’s chief medical officers have defended the decision to delay second doses of coronavirus vaccines, saying they are ‘confident’ the first one offers ‘substantial’ protection. Following approval of the Oxford/AstraZeneca vaccine earlier this week, the Joint Committee on Vaccination and Immunisation (JCVI) outlined a new dosing regimen aimed at speeding up rollout which will see the first dose given to as many at-risk people as possible followed by a second jab within 12 weeks, rather than providing the required two doses in as short a time as possible.”

While the Financial Times has reported that, “The UK’s chief medical officers have warned that the availability of Covid-19 vaccines will continue to be a problem for “several months” as they defended the decision to lengthen the gap between doses to try and combat spiralling infection rates.”

This change of plan in the UK prompted Pfizer/BioNTech to issue their warning (above) over any ‘alternative’ schedules.

In addition, and significantly given the situation, there have been many comments made today by medical professionals and scientific experts, about the rationale for this change of plan by the government, not least the comments by several GPs about the anxiety that will be caused for those thousands of vulnerable people who had been promised two doses and encouraged to take the vaccine in the first place.

Dr Helen Salisbury, a GP and a BMJ columnist, tweeted yesterday:

The Doctors’ Association UK tweeted,

Prem Sikka, Emeritus Professor of Accounting, wrote that Pfizer/Biotech said that their vaccine was not designed to be used in two shots 12 weeks apart. In a statement, the firms said there was no evidence the first shot continued to work beyond three weeks. So why are the UK ministers saying different things?

In a statement the BMA said that, The decision to delay follow-up dose of Pfizer vaccine is grossly unfair to thousands of at-risk patients in England, as appointments are rescheduled. It will have a terrible emotional impact on many patients.”

So, how was this announced, and why so late in the day, why the change in plan? What is the plan? It is reported that the UK’s Chief Medical Officers backed the decision in a letter to the profession, saying: “In terms of protecting priority groups, a model where we can vaccinate twice the number of people in the next two to three months is obviously much more preferable in public health terms than one where we vaccinate half the number but with only slightly greater protection.”

It does all appear to be a rushed, change of plan, after so much has been said and written about the need for two doses, and after all the care, sensitivity, effort, and energy across the country, by GPs and their staff in starting this complex logistical process.

One final observation, exactly how many GPs and healthcare staff have been vaccinated already? Have staff in your local hospital even received their first dose?🔷

Dr Joe Pajak, Professional experience applied scientific research and development, then director of a national children’s charity, trustee of a disability charity, and governor of NHS foundation trust hospitals.

[This piece was first published in PMP Magazine on 1 January 2021. | The author writes in a personal capacity.]

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