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Plans to delay giving the second dose of a Covid vaccine to more than 500,000 people who have received the first jab have caused outcry among doctors who say cancelling appointments wastes time, causes confusion among patients and is potentially unethical.
On Wednesday the government announced a change to its Covid vaccination strategy, saying second doses of the newly approved Oxford/AstraZeneca vaccine and the previously approved Pfizer/BioNTech jab would now be given up to 12 weeks after the first dose.
The move applies to people scheduled to have their second dose of the Pfizer jab after 4 January, as well as those yet to receive either jab. The government said it hoped the approach would mean as many people as possible soon have some protection against the disease.
However, the announcement caused controversy, with Pfizer and BioNTech warning that two doses of their vaccine were required for maximum protection against Covid and that they did not have evidence that the first dose alone offered protection after three weeks.
Now doctors have said cancelling appointments for the second dose will take huge amounts of time and could lead to confusion.
Azeem Majeed, a professor of primary care and public health at Imperial College London and a practising GP, said he was shocked by the change in plans.
“We’ve got thousands or perhaps tens of thousands of people who have already booked their second jabs, and these are people who are all elderly, so they often have to make special arrangements for their care or have someone to bring them down. Someone is going to have to ring all these patients to cancel their appointments and rebook them, so it is going to create a lot of work for people as well,” he said.
“Clearly the people making these rules are not the ones having to enforce them. I understand the rationale that the government wants to increase the vaccine supply to make sure more people are immunised, but I think that could have been done for people starting from now, rather than cancelling the ones who have already been booked in, which is very disruptive.”
One doctor who spoke to the Guardian on condition on anonymity said they hoped to continue with the original schedule for the second dose rather than cancelling appointments, saying that to do otherwise would put their most vulnerable patients at risk and break promises to patients.
The British Medical Association said it was “unreasonable and totally unfair” to expect practices to cancel and rebook appointments for a second dose.
The chair of the BMA’s GP committee, Dr Richard Vautrey, said: “It is grossly and patently unfair to tens of thousands of our most at-risk patients to now try to reschedule their appointments. Local leaders are telling us that is unprofessional and impractical to amend the appointments for thousands of frail, elderly patients, particularly those booked and who have already made arrangements to have their second vaccination in the next two weeks.”
Vautrey called on the government to publish a scientifically validated justification for the new approach, adding that rebooking appointments would cause huge logistical problems. “For example, to make contact with even just 2,000 elderly or vulnerable patients will take a team of five staff at a practice about a week, and that’s simply untenable. The BMA believes the existing commitment made to these patients by the NHS and local clinicians should be respected. If GPs decide to honour these booked appointments in January, the BMA will support them.”
Dr Helen Salisbury, a GP and medical adviser to the health experience research group at the University of Oxford, tweeted that the health secretary Matt Hancock, should help to phone her elderly patients and explain to them why their second jab has been delayed. She said her primary care network needed to cancel and rebook 1,160 appointments.
“At 5 mins per phone call, that’s 193 hours work. Not to mention the grief & anger,” she wrote.
Salisbury asked the General Medical Council to give advice. “I have been instructed to break my promise to my elderly patients & use a vaccine outside its evidenced and approved schedule, probably placing them at risk. Please advise.”
Her comments unleashed a flurry of responses from other GPs, with some questioning whether it was ethical to delay a second dose when patients had given consent for the first dose on the premise that they would receive the second three weeks later.
However, others welcomed the change in approach. Dr Ed Turnham, a GP in Norwich, said the Medicines and Healthcare products Regulatory Agency should be congratulated for its “brave, pragmatic decision”.
He tweeted: “I think most of our elderly patients will be happy that this will reduce the delay in protecting their friends and relatives, and reduce the risk of hospitals being overwhelmed.”
Source: The Guardian
Keyword: Covid vaccine: UK doctors criticise rescheduling of second doses | Doctors