Officials have defended England’s vaccine regimen after details of a contingency plan to potentially mix the two approved jabs in small numbers of cases emerged.
Public Health England’s Covid “green book” recommends that “it is reasonable to offer one dose of the locally available product to complete the schedule” if the same vaccine used for the first dose is not available. But it adds: “There is no evidence on the interchangeability of the Covid-19 vaccines although studies are under way.”
Criticism erupted following the publication of a New York Times report which quoted virologist Prof John Moore, from Cornell University in the US, who said “there are no data on this idea whatsoever” and that British officials “seem to have abandoned science completely now and are just trying to guess their way out of a mess”.
The American infectious disease expert Dr Anthony Fauci said on Friday he did he not agree with the UK’s approach of delaying the second dose of the Pfizer/BioNTech vaccine. He told CNN that the US would not be following in the UK’s footsteps and would follow Pfizer and BioNTech’s guidance to administer the second dose of its vaccine three weeks after the first.
The head of immunisations at Public Health England, Dr Mary Ramsey, said mixing was not recommended and would only happen on extremely rare occasions.
Quick guide When and how will I be able to get a Covid vaccine in the UK?
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Now that the UK has authorised the first Covid vaccine, who will get it first?
The government’s Joint Committee on Vaccination and Immunisation (JCVI) says its priority is to prevent Covid-related deaths and protect health and social care staff and systems.
Elderly care home residents and their carers are first on the JCVI’s list because their risk of exposure to the virus is higher and because the risk of death closely correlates with older age. They are followed in priority by anyone else over 80 and frontline health and social care workers.
Even so, for pragmatic reasons NHS staff are likely to be the first group to receive the Pfizer/BioNTech jab. This is because the vaccine needs to be stored at ultra-cold temperatures, which can be achieved more easily by using hospital facilities
Are there enough doses to reach all the priority groups?
Together, care home residents, their carers and the over-80s make up nearly 6 million people, and frontline NHS staff a further 736,685. Matt Hancock, the health secretary, has said he expects 10m doses of the Pfizer/BioNTech vaccine to be available this year, so if this is the only vaccine authorised, everyone else would have to wait until further doses become available next year.
Where will I go for the vaccine?
Covid-19 vaccines are expected to be delivered at three types of venue: NHS trust “vaccine hubs” at hospital sites; mass vaccination centres, which are in the process of being set up at places such as football stadiums, conference buildings and racecourses – these are expected to vaccinate up to 5,000 people a day; and at GP surgeries and pharmacies. GPs can also visit care home residents and housebound patients at home without them needing to travel.
How far apart will the two doses be administered, and will I protected after the first?
While there is some evidence to indicate high levels of short-term protection from a single dose of vaccine, a two-dose schedule is what has been approved by the MHRA.
The second dose will need to be delivered at least 21 days after the first, and both will be injected into the deltoid muscle – the thick triangular muscle we use to raise each arm.
For the Pfizer vaccine, its efficacy rate was calculated seven days after the second shot. It is likely that people will have some protection before this, but this is how long it will take for full protection to kick in. We will learn more about the extent of protection and how long it lasts as data from ongoing clinical trials comes in.
Can I pay to get the vaccine privately?
Unlikely. England’s deputy chief medical officer, Jonathan Van-Tam, has said he believes Covid-19 vaccines should be delivered according to clinical priority rather than allowing people to jump the queue if they can afford it.
Will I be able to choose which vaccine I have?
Also unlikely, at least in the short to medium term. Assuming more than one vaccine is approved, the priority will be distributing any available doses to the people who need it as quickly as possible.
Linda Geddes
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She said: “If your first dose is the Pfizer vaccine you should not be given the AstraZeneca vaccine for your second dose and vice versa. There may be extremely rare occasions where the same vaccine is not available, or where it is not known what vaccine the patient received.
“Every effort should be made to give them the same vaccine, but where this is not possible it is better to give a second dose of another vaccine than not at all.”
On BBC Radio 4’s Today programme, Prof Anthony Harnden, the deputy chair of the Joint Committee on Vaccination and Immunisation, said: “Our current advice is that you use the same vaccine for both doses. However, we have studies that are ongoing at the moment to look at mixing vaccines and when we see the data for those and are secure about the data for those, then we may be recommending mixed dose strategy,”
He also insisted delaying the second anti-Covid dose and frontloading the first dose rollout was the correct strategy, stating: “I don’t think this is a supply issue, as much as trying to get as many vaccines into as many people as possible. And, I accept that it may cause mistrust if we don’t communicate this properly.”
The “green book” states: “If the course is interrupted or delayed, it should be resumed using the same vaccine but the first dose should not be repeated. There is no evidence on the interchangeability of the Covid-19 vaccines although studies are under way. Therefore, every effort should be made to determine which vaccine the individual received and to complete with the same vaccine.
“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.
“In these circumstances, as both the vaccines are based on the spike protein, it is likely the second dose will help to boost the response to the first dose. For this reason, until additional information becomes available, further doses would not then be required.”
The guidance, published on Thursday, contradicts guidelines in the US, the New York Times reported. According to the Centers for Disease Control and Prevention, the authorised Covid vaccines “are not interchangeable”, and “the safety and efficacy of a mixed-product series have not been evaluated. Both doses of the series should be completed with the same product.”
Pfizer spokesman Steven Danehy told the paper: “While decisions on alternative dosing regimens reside with health authorities, Pfizer believes it is critical health authorities conduct surveillance efforts on any alternative schedules implemented and to ensure each recipient is afforded the maximum possible protection, which means immunisation with two doses of the vaccine.”
The UK is preparing to send out the new Oxford University and AstraZeneca vaccine with 530,000 doses available for rollout from Monday, amid reports that 2m doses are due to be supplied each week by the middle of January.
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