Daily Telegraph.....
Chris Whitty moves to head off GPs' rebellion over vaccine doses
CMO tells medics that the 'public will understand and thank us' for administering as many first doses as possibleByVictoria Ward
The chief medical officer on Thursday night attempted to head off a growing rebellion by GPs over delaying the second dose of the Pfizer vaccine as he insisted the new strategy was the “right decision.”
In a letter co-signed by his counterparts in Scotland, Wales and Northern Ireland, Prof Chris Whitty told medics that the “public will understand and thank us” for administering as many first doses as possible, rather than giving people a second jab within the recommended three or four weeks.
It came as GPs across the country vowed to defy the Government’s new strategy, branding it a “huge gamble.” Doctor's leaders said the decision to cancel appointments for elderly patients due to have their second Pfizer coronavirus vaccination next week was "grossly unfair", and encouraged GPs to press ahead with the planned jabs in defiance of the Government’s new strategy.
In a letter to ministers, the Doctors Association said there was no evidence that delaying the second dose of the Pfizer vaccine would be effective, suggesting the move “undermined the vaccine programme as a whole.”
In a joint letter sent to medics, all four of the UK’s chief medical officers said: “We recognise that the request to reschedule second appointments is operationally very difficult, especially at short notice, and will distress patients who were looking forward to being fully immunised.
“Halving the number vaccinated over the next two-three months because of giving two vaccines in quick succession rather than with a delay of 12 weeks does not provide optimal public health impact.”
They added: “"We have to follow public health principles and act at speed if we are to beat this pandemic which is running rampant in our communities and we believe the public will understand and thank us for this decisive action.”
The letter added that for every 1,000 people boosted with a second dose of the vaccine in January, 1,000 new people were unable to have substantial initial protection.
The Government's advisory Joint Committee on Vaccinations and Immunisation (JCVI) meanwhile insisted that an extended time period between doses would not prove detrimental.
In a lengthy statement explaining the decision, it said the short term efficacy from the first dose of the Pfizer vaccine was around 90 per cent, 20 per cent higher than that of the Oxford vaccine.
“Given the high level of protection afforded by the first dose, models suggest that initially vaccinating a greater number of people with a single dose will prevent more deaths and hospitalisations than vaccinating a smaller number of people with two doses,” it said.
Meanwhile, it emerged that a million doses of the newly approved Oxford vaccine will be ready by Monday amid concern over the NHS’s ability to carry out a mass vaccination programme at speed.
The MHRA and the Government's advisory Joint Committee on Vaccinations and Immunisation (JCVI) announced the last minute change of approach for the Pfizer vaccine in order to reach as many people as quickly as possible, extending the time between doses from three to 12 weeks.
The decision brings it in line with the Oxford vaccine regime, meaning that more than 500,000 elderly people who have already been vaccinated will have their second dose delayed. Pfizer said there was “no data” suggesting that a first dose of its vaccine would offer immunity after three weeks.
The Doctors Association UK (DAUK) yesterday (THURS) wrote to both the NHS and Matt Hancock highlighting “major concerns” about the decision to change the regimen, which they said could leave people without immunity.
The Black Country and West Birmingham CCGs are among several understood to have vowed to continue with the original three-week regime, defying the new edict.
Dr Martin Stevens, GP partner at Umbrella Medical in Walsall, told the Telegraph: ““Our patients consented to a vaccine schedule of two doses and doing anything other than that would be doing them a disservice.
“The Walsall CCG told us they would support us in making a pragmatic decision that was in the best interests of our patients and that is what this is about. It is sensible and it keeps up staff morale.”
Lizzie Toberty, a GP spokeswoman for DAUK, warned the intervention “undermined the vaccine programme as a whole.”
She told the Telegraph: “The idea that the Government can come in and change the schedule without an evidence base is extremely concerning.
“It is population protection versus individual protection. Their logic seems to be that if we confer some protection on as many people as possible, perhaps that is better than fully protecting certain cohorts. But the over 80s need the fullest protection. This is an untested strategy. It’s a huge gamble.”
Dt Toberty warned that patients who had not consented to receiving the Pfizer vaccine 12 weeks apart might now legitimately request the Oxford vaccine, rendering the last eight weeks “wasted.”
Dr Katrina Farrell, a haematologist, revealed on Twitter that she had received a letter cancelling her appointment for her second jab.
“This means that the vaccine is not being delivered as licensed,” she said. “I did not consent to receive an off-label drug with no evidence of benefit with a single dose.
“This means that tens of thousands of Scottish & UK health & social care workers have rolled their sleeve up for a vaccine unlicensed at this dose schedule. For which they did not consent. This is a scandall.”
Aside from a lack of evidence about immunity, Dr Toberty said the logistical challenge of contacting thousands of elderly patients to change their appointments would be time consuming, impractical and cause anxiety for many.
Dr Richard Vautrey, chair of the British Medical Association’s (BMA) GP committee, said it was “grossly and patently unfair to tens of thousands of our most at-risk patients” to try and reschedule their appointments.
Pfizer said in a statement: “Data from the phase 3 study demonstrated that, although partial protection from the vaccine appears to begin as early as 12 days after the first dose, two doses of the vaccine are required to provide the maximum protection against the disease, a vaccine efficacy of 95 per cent.
“There are no data to demonstrate that protection after the first dose is sustained after 21 days.”
However, Prof Adam Finn, a member of the JCVI, insisted that extending the period between doses was “just pragmatic” and that there was “no plausible likelihood” it would leave people unprotected.
He told BBC Radio 4’s Today programme: “It would be absurd to suggest that the protection from the first dose simply evaporates after the first dose and people are left vulnerable. It’s clear that the immune response is very strong.”
An NHS spokesperson said: “The MHRA, JCVI and UK Chief Medical Officers have updated the second dose timing guidance which the NHS has to follow, so as to increase the number of vulnerable people protected against covid over the next three months, potentially saving thousands of lives.
“The NHS immediately informed GPs on the day the revised instruction was given, with extra financial and logistical support now being provided to help ensure thousands more receive the vaccine quickly.”
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