First Dose Strategy

Important: All vaccination sites to move to 1st dose strategy for vaccine

At a webinar yesterday evening with Simon Stevens, a national directive has been given instructing all vaccination sites to move to the 1st dose strategy for delivering the vaccine. All sites now need to have moved to the 1st dose strategy with the 2nd dose towards the end of the 12 week period. This needs to happen asap, and ideally from Monday 11 January. This is not open to local interpretation and supersedes any previous guidance.

We would like to thank all PCNs that have already moved to this strategy. We recognise that cancelling appointments is challenging and that some patients may be concerned. However, this will save lives and we need to move quickly.

Why do we need to act locally?

Data is now becoming available from Pinnacle and it shows that across the Staffordshire and Stoke-on-Trent area, 1,855 2nd doses were given on Friday and 2,455 on Saturday. This data is now available at PCN site level and we are being challenged by NHS E/I on why these numbers remain high. If you have not rearranged appointments yet, please do so asap. If you are struggling to do this or there is a real risk of wasting vaccine, please let us know.

Why are senior figures recommending this strategy?

The webinar included Simon Stevens and senior figures in the UK Coronavirus vaccination programme, including Emily Lawson, Nikki Kanani, Chris Whitty, Jonathon Van Tam, Wei Lim and Steve Powys. They discussed the change in policy and the compelling argument to delay the 2nd dose to 12 weeks.

This change in policy is the unanimous opinion of the 4 CMOs, and JCVI and is supported by the UK professional bodies. Vaccine supply is going to remain an issue for at least the next five weeks, so if we are to have the greatest impact on Public Health and save as many lives as possible, with the available vaccine, then giving more people one dose is our best option.

Put another way, every time we give a 2nd dose, we deny someone else their first dose. The current vaccination cohorts are at very much higher risk as this paper from the Covid-19 Actuarial Response Group shows

https://c8930375-0dbb-4319-ae2f-025f70d4b441.filesusr.com/ugd/ab45f7_a40832c6069842e6af33fcf2b06611bf.pdf

A single dose of any of the vaccines gives a high level of protection especially after the 10-14 day response time. The AZ trial showed only 2 admissions post vaccination, 1 after 2 days and another at 10. Beyond this the vaccines appear to stop hospital admissions with serious disease. So far, 250K 2nd doses have been given which might equate to 1,000 lives saved.

Whilst the UK is the first country to adopt this policy, Quebec followed on Friday and many other countries are considering this strategy. In some respects, our access to the AZ trial data has given us more information on which to make this decision.

Is this policy the same for staff?

On the webinar the question of whether frontline staff should continue to have their 2nd doses at 21 or 28 days was raised. The response from Chris Whitty was unequivocal. The actuarial data above shows that the risk for most frontline staff is far lower than the current priority cohorts. As such, it is important that we are seen to adopt the same policy across all of the JCVI cohorts including frontline staff.