The situation in the U.K. is dire. So far, 57,725 people were diagnosed with Covid-19 in one day, a record number since the beginning of the pandemic. There are hundreds of new victims every day; December 30 saw 981 deaths.
“I do cry my way to work at the moment because of just how bad things are to come,” Suzanne Barke, an intensive care unit nurse said.
“Hospitals are running out of oxygen. … NHS staff are at a breaking point. This is not a drill. Please believe us,” Dr. Samantha Batt-Rawdem, a critical care doctor and president of the Doctor’s Association U.K. tweeted.
The situation is even more concerning considering the fact that the numbers should be drastically lower at this point. The U.K. entered a full second lockdown during November for the purpose of getting back control over the spread of the virus before the holidays. Then came the new Covid-19 variant, and instead of dropping, the numbers kept rising.
The Pfizer vaccine rolled out on December 8. There were logistical problems, and in the three weeks that followed, a million people in the U.K. received the first vaccine dose. It’s not enough; the vaccination rate is not catching up with the spread of the virus.
This is the frame to be taken into account when discussing the two interesting and controversial decisions recently made by the U.K. government.
Decision 1: A longer time between doses
All three of the available western vaccines: Pfizer, Moderna, and AstraZeneca are based on a two-dose regime. In Pfizer’s case, the recommended interval between the first and second vaccine dose is 21 days. In AstraZeneca’s experiment, the second dose was given “at least a month” after the first dose.
This raises a question that is already under discussion. Considering the vaccine stock is limited, which is the better course of action? Completing a two-dose process, making sure every person receiving the vaccine is protected at the level shown during the trials? Or using the full stock of available vaccines to vaccinate as many people as possible while hoping that a one-dose regime would still be effective for a longer period of time?
The U.K. recently chose the latter and decided to extend the period of time between doses. Instead of a 21-day/one-month interval, the British people receiving the first dose would have to wait for between four and 12 weeks until receiving the second dose. A government press release stated:
Prioritising the first doses of vaccine for as many people as possible on the priority list will protect the greatest number of at risk people overall in the shortest possible time and will have the greatest impact on reducing mortality, severe disease and hospitalisations.
The U.K. chief medical officers said that it is their understanding that “the great majority” of protection comes from the first dose while the second dose allows for a marginal boost that is more helpful for the long term. They explained:
For every 1,000 people boosted with a second dose of Covid-19 vaccine in January, who will as a result gain marginally on protection from severe disease, 1,000 new people can’t have substantial initial protection, which is in most cases likely to raise them from 0% protected to at least 70% protected.
Criticism was soon to follow.
Following the change in guidelines, doctors had to cancel appointments already made for people about to receive the second dose. “It’s grossly unfair,” commented Dr. Richard Vautrey from the British Medical Association. “We’ve been left high and dry,” said 82-year-old Stella Joseph who’s waiting for her second dose.
The main question surrounds the data. It is not yet clear how much, and whether at all, the longer interval route is effective.
“The evidence for the beneficial effect of a single dose for the AstraZeneca vaccine is somewhat less clear at least from publicly available data,” says professor Paul Hunter from The Norwich School of Medicine.
According to the Pfizer trial, the vaccine was only 52% effective after one dose. Postponing the second dose might leave millions of people vulnerable to the virus. Pfizer itself criticized the decision. “There is no data to demonstrate that protection after the first dose is sustained after 21 days,” the company said. The longer interval wasn’t even tested in the company’s experiments.
The U.S. also considered the British approach, however, on January 1, 2021, Dr. Anthony Fauci ruled it out.
Decision 2: Mixing vaccines
While the vaccination campaign continues, the U.K. is fearing a shortage of vaccines. “Currently the main barrier is vaccine availability,” U.K.’s chief medical officers wrote. “Vaccine shortage is a reality that cannot be wished away.”
This raises a second question and a second, even more controversial, decision. What should happen if there aren’t enough vaccines for a second dose? The U.K. decided that in certain circumstances, mixing different vaccines is “reasonable.” Meaning a person could, theoretically, receive the first dose of Pfizer’s vaccine and the second dose of AstraZeneca’s vaccine or vice versa. As the U.K. government’s Green Book for vaccinations states:
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.
While the decision states that this approach should only be taken as a last resort, in rare cases, and preferably only with high-risk individuals — again, criticism came quickly.
“There are no data on this idea whatsoever,” John Moore from Cornell University told the New York Times. “[Officials in the U.K.] seem to have abandoned science completely now and are just trying to guess their way out of a mess,” he added.
“This was not tested anywhere, it looks like a complete act of desperation,” professor Ran Balicer, a public health expert from Clalit Health in Israel tells me. There were many other similar concerns.
Following the criticism, health officials in the U.K. released a clarification stating that “mixing coronavirus vaccines is not recommended” and would only occur in extremely rare cases. The new, controversial guideline still stands.
More to come
It is safe to assume that with the progression of vaccination campaigns in the U.K. and elsewhere around the world, more questions and tough decisions will arise. The Covid-19 pandemic has formed an unprecedented short timeline, and so answers are needed in real time and without all the data to back them up.
“There are dozens of decisions that need to be made about HOW a vaccine that is safe and effective on an individual-level Should be used to control a disease at the population-level,” wrote Dr. Nicole Basta, an associate professor of epidemiology at McGill University in Montréal, Canada. “In normal times we would launch studies … these studies take time. Decisions will need to be made before results are available.”
The U.K. was already blamed for conducting a dangerous experiment at the start of the pandemic, acting in what seems like pushing for herd immunity. This approach was later blamed for costing the lives of thousands.
Today, many experts are closely examining the U.K.’s recent two decisions regarding the Covid-19 vaccines and hoping that these “experiments” won’t end the same way.
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