Leading vaccine experts have backed the government’s decision to delay the second dose for up to three months, after doctors warned that the strategy was proving “ever-more difficult to justify”.
The British Medical Association (BMA), which represents doctors, has suggested that the UK has become “increasingly isolated internationally” by deciding that the second dose of the Pfizer vaccine can be delayed, and called for a maximum delay of six weeks. However, several prominent scientists backed the government’s plan to maximise the number of people receiving their first dose.
Dr Mike Osborn, president of the Royal College of Pathologists, said the college supports the government plan to delay second doses. “The data and information we have been provided with supports the way the vaccine is being used, which is particularly designed to vaccinate as many people as possible to protect the population as much as possible,” he said. “When you take the risks and the benefits associated with the information, that seems to be the best way forward – with the caveat that this is a very rapidly evolving situation.”
The latest figures show on Saturday there were 33,552 new confirmed cases, 37,899 people in hospital with the disease and 1,348 deaths recorded.
Professor David Salisbury, the former director of immunisation at the Department of Health, said the BMA’s intervention risked “undermining the confidence that doctors and the public can have in the recommendations that have been made after very careful consideration”. He added: “This wasn’t just a knee-jerk recommendation. It was carefully considered by the Joint Committee on Vaccination and Immunisation (JCVI). They gave their advice to the four chief medical officers.”
Peter English, a former chairman of the BMA’s public health medicine committee, also backed the current approach. “If we do see immunity tailing off before 12 weeks, we can rapidly change the policy and give the second dose earlier,” he said. “I think that is extremely unlikely but it could be done if it was necessary. We are not burning any bridges by taking this current approach.”
Eleanor Riley, professor of Immunology at Edinburgh University, said: “It is always uncomfortable to be an outlier in terms of international practice and I expect doctors are receiving questions and expressions of concern from their patients. However, there is no evidence that the immune response induced by either the Pfizer or the AstraZeneca vaccine declines markedly over 12 weeks after the first vaccination.”
However, there are now calls for the evidence behind the strategy to be published and for urgent trials to be conducted into the effects of delaying the second dose. According to the JCVI, unpublished data suggests the Oxford/AstraZeneca vaccine is still effective when the doses are administered 12 weeks apart. Pfizer has said it had only tested its vaccine’s efficacy when the two doses were given up to 21 days apart. The World Health Organization has said second doses of the Pfizer vaccine should only be delayed “in exceptional circumstances” and recommended a gap of four weeks.
Jeremy Farrar, a leading figure on the government’s Scientific Advisory Group for Emergencies (Sage), called for an investment in studies.
Stephen Dorrell, the former Tory health secretary, said more of the evidence behind the strategy needed to be revealed. “It’s a perfect example of where the advice has to be published, as well as the evidence on which it is based,” he said. “I think the BMA is actually on this occasion posing a perfectly legitimate question. The medical community is entitled to see the evidence on which this decision was based.”
Chris Whitty, the chief medical officer, has said delaying the second dose was a “public health decision” based on the best advice and balance of risks.
Further support for the practice of delaying second vaccine doses also emerged from Israel last week. Earlier reports there had indicated that Pfizer vaccine first doses had provided poor virus protection in one preliminary study.
However, these results were emphatically countered by a new study carried at the Rambam Health Care Campus in Haifa where 91% of 1,800 doctors given their first vaccine jab were found to have a major presence of antibodies. A further 2% showed a moderate presence of antibodies.
All this comes as NHS leaders warn against any suggestion that lockdown measures could begin to be lifted from the start of March. They say any such move remains too dangerous while the degree to which vaccinated people can still spread Covid is unknown. Writing for the Observer online, Chris Hopson, the chief executive of NHS Providers, said: “We still can’t guarantee what the supply of vaccines will be and how quickly we will therefore be able to vaccinate the population. We still don’t fully understand the impact of vaccination on transmission and need more data before deciding how quickly we can loosen restrictions without triggering infection and resulting death and harm in those who haven’t been vaccinated.”
The deputy chief medical officer, Jonathan Van-Tam, also warned that vaccination on its own does not mean people can return to life as normal. “Regardless of whether someone has had their vaccination or not, it is vital that everyone follows the national restrictions and public health advice, as protection takes up to three weeks to kick in and we don’t yet know the impact of vaccines on transmission. The vaccine is rightly something to celebrate – let’s stay patient, stay at home and support the NHS as it continues to roll out the vaccine.”
Meanwhile, other senior figures are pushing for further measures to be put in place to combat the virus. Commons health select committee chair Jeremy Hunt told the Observer that people should be required to wear higher-grade masks on public transport and in shops. “Current lockdown measures are just not working fast enough,” he said.
Germany and Austria have toughened rules around masks in the last few days.
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