Vaccine rollout in the UK

[gosling]

Maybe a quick computer program, taking all >50s on the GP's list and calculating appointments p.a.?

Instead of a time-consuming careful trawl through records for actual health vulnerabilities, simply assume if someone has visited the GP ten times a year then they must have something. Stick 'em higher up the list. If someone has zero visits, shove 'em down.

Why waste scarce resources on doing it in more detail, when all it means is shuffling people up and down the list by a few weeks?

That would be a sensible approach, and totally out of character for how our surgery is usually run

[snoozeofreason]

It's probably been suggested before on this thread, but surely the best approach would be to randomise. Given the rate of vaccination it wouldn't be hard to accumulate data. If there are strong theoretical reasons to think that a 12 week delay is going to work, but insufficient empirical evidence, then why not arrange that, of the 300,000 or so people who receive a first vaccination each day, 290,000 are told to come back in 12 weeks, and 10,000 in three weeks. It wouldn't significantly slow the rate at which first vaccinations occur, but within a week you'd have 70,000 controls against which to judge the effectiveness of the new strategy.

Weirdly, I think you'd need ethical approval do this, whereas just deciding as policy to leave it 12 weeks and not particularly collect any data about it is fine.

The impression I have here is that second doses are anyway being offered at any time between 3 and 12 weeks anyway, and also that the UK can't possibly be vaccinating all these people with the Pfizer vaccine (it's probably getting about half a million doses per week of that one, since that's what e.g. Germany and Italy seem to be getting, and that's enough for about one day of the UK's vaccinations let alone one week; and right now Pfizer isn't even able to produce that much).

Observational data will be available, because some people will still get their second jab 3 weeks after the first - care home residents and staff in NI for example - but I imagine it will be difficult to separate the effects of the 3 week interval from all the other factors that might differentiate those groups from the general population.

[bob sterman]

Maybe a quick computer program, taking all >50s on the GP's list and calculating appointments p.a.?

Instead of a time-consuming careful trawl through records for actual health vulnerabilities, simply assume if someone has visited the GP ten times a year then they must have something. Stick 'em higher up the list. If someone has zero visits, shove 'em down.

Why waste scarce resources on doing it in more detail, when all it means is shuffling people up and down the list by a few weeks?

Even more simple - every time an >50 turns up for an appointment of some sort - jab them!

Although I expect word would get out, and then a lot of people would be making appointments for bunions, warts, calluses etc.

[shpalman]

Maybe a quick computer program, taking all >50s on the GP's list and calculating appointments p.a.?

Instead of a time-consuming careful trawl through records for actual health vulnerabilities, simply assume if someone has visited the GP ten times a year then they must have something. Stick 'em higher up the list. If someone has zero visits, shove 'em down.

Why waste scarce resources on doing it in more detail, when all it means is shuffling people up and down the list by a few weeks?

Even more simple - every time an >50 turns up for an appointment of some sort - jab them!

Although I expect word would get out, and then a lot of people would be making appointments for bunions, warts, calluses etc.

If they're able to so easily get appointments for such non-urgent things then their GPs aren't working hard enough giving jabs.

[shpalman]

The scientists I interact with seem split down the middle on the general principle of the 12-week delay.

These doctors want the 12-week delay split down the middle: https://www.bbc.com/news/uk-55777084

These 'experts' say delaying the second dose is ok.

Personally, I appreciated that it was important to just get going as soon as possible without worrying if enough vaccine would eventually be delivered to give everyone second doses, but now I think that at least for the Pfizer one don't dick about with whatever regime got approved. At best it will end up being less effective than it otherwise would have been, at worst it will breed a vaccine-resistant variant. (Approval originally got rushed through based on a very strict protocol regarding splitting up boxes etc. and I remember something about it requiring each batch to be approved, has this changed?)

The rush to get everyone vaccinated still won't be fast enough as compared to what would happen if you didn't lock down hard to end the current wave, so the lockdown is still necessary, and vaccinating the vulnerable won't help control the spread once the next lockdown ends.

The Oxford/AstraZeneca one has a different issue, that apparently they have unpublished data which the rest of us haven't seen which says it's ok to delay the second dose, which suggests that of all the possible regimes tested in Phase II they chose to design their Phase III around the shittest one.

“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.”

I would still be interested to know how much of each vaccine the UK has in stock, and how much is getting delivered each week.

[shpalman]

The scientists I interact with seem split down the middle on the general principle of the 12-week delay.

These doctors want the 12-week delay split down the middle: https://www.bbc.com/news/uk-55777084

These 'experts' say delaying the second dose is ok.

Personally, I appreciated that it was important to just get going as soon as possible without worrying if enough vaccine would eventually be delivered to give everyone second doses, but now I think that at least for the Pfizer one don't dick about with whatever regime got approved. At best it will end up being less effective than it otherwise would have been, at worst it will breed a vaccine-resistant variant...

https://www.independent.co.uk/news/heal ... 91438.html

In papers released on Friday, SAGE scientists there was an “increased risk of virus replication under partial immunity after one dose than after two doses, so in the short term, delaying the second dose would be expected to somewhat increase the probability of emergence of vaccine resistance – but probably from a low base.

“Is such an increase material? It is not currently possible to quantify the probability of emergence of vaccine resistance as a result of the delayed second dose, but it is likely to be small. The UK currently has more than 1,000 Covid-19-related deaths each day and has limited supplies of vaccine.

“In the current UK circumstances the unquantifiable but likely small probability of the delayed second dose generating a vaccine escape mutant must be weighed against the measurable benefits of doubling the speed with which the most vulnerable can be given vaccine-induced protection.”

So, it's a possibility, but maybe not quite as dramatic at the headline makes it sound.

Still, any variant which does manage to escape a vaccine which is being heavily relied on in Europe will screw everything over.

If only there were some scientists who could actually weigh the small probability of the delayed second dose generating a vaccine escape mutant against the measurable benefits of doubling the speed with which the most vulnerable can be given vaccine-induced protection!

[shpalman]

The scientists I interact with seem split down the middle on the general principle of the 12-week delay.

These doctors want the 12-week delay split down the middle: https://www.bbc.com/news/uk-55777084

It's probably been suggested before on this thread, but surely the best approach would be to randomise. Given the rate of vaccination it wouldn't be hard to accumulate data. If there are strong theoretical reasons to think that a 12 week delay is going to work, but insufficient empirical evidence, then why not arrange that, of the 300,000 or so people who receive a first vaccination each day, 290,000 are told to come back in 12 weeks, and 10,000 in three weeks. It wouldn't significantly slow the rate at which first vaccinations occur, but within a week you'd have 70,000 controls against which to judge the effectiveness of the new strategy.

we can haz robust monitoring plz

The chief executive of the British Society for Immunology said there needed to be greater clarity about how the potential effect of a 12-week dosing gap was being assessed, particularly in terms of the body’s immune response.

“If we are changing the dosing schedule [compared with] what was done on the trials then we need to have a robust programme monitoring the immune response,” said the chief executive of the British Society for Immunology.

[Martin Y]

... surely the best approach would be to randomise.

Considering who's in charge that might just happen anyway.

[raven]

Maybe a quick computer program, taking all >50s on the GP's list and calculating appointments p.a.?

Instead of a time-consuming careful trawl through records for actual health vulnerabilities, simply assume if someone has visited the GP ten times a year then they must have something. Stick 'em higher up the list. If someone has zero visits, shove 'em down.

Why waste scarce resources on doing it in more detail, when all it means is shuffling people up and down the list by a few weeks?

Even more simple - every time an >50 turns up for an appointment of some sort - jab them!

n=1 and all, but that's how a friend got their flu shot at our GPs. Middle of an appointment with the nurse for something else, second nurse walks in, here's your flu shot, jabbed and done.

(Friend has multiple risk factors; GPs seem on the ball about targetting those who need it most.)

[Woodchopper]

Better news on first shot from Israel:

Israel sees 60% drop in hospitalizations for age 60-plus 3 weeks after 1st shot
Full effects of Pfizer’s shots only kick in around a month after inoculation, but data from Israel shows there is a stark drop in infections even before that point

https://www.timesofisrael.com/israel-se ... ccination/

[tom p]

That's why I highlighted your "may be quite crowded and is poorly ventilated". Do you have any evidence of this being the case? Because this is a pretty easyish thing to fix.

Tom - thanks for the comprehensive analysis.

Evidence was first hand experience of taking an elderly relative into the post-vaccination observation room. Windows might have been open slightly but it was crowded and impossible to maintain spacing > 2m.

I think they had 4 vaccinators - so could put 4 into the room at a time for their 15 minute wait. Plus these were elderly folk - and some had a carer or relative with them.

As I was not being vaccinated - my personal risk-benefit calculation had me go and wait in the car park until relative had completed 15 minutes.

That's f.cking shabby of them. No excuse for that. I hope (expect) most places aren't that stupidly thoughtless

[lpm]

Better news on first shot from Israel:

Israel sees 60% drop in hospitalizations for age 60-plus 3 weeks after 1st shot
Full effects of Pfizer’s shots only kick in around a month after inoculation, but data from Israel shows there is a stark drop in infections even before that point

https://www.timesofisrael.com/israel-se ... ccination/

The UK did a bit at the end of December, but the program only really began on 4 Jan - 3 weeks ago. Hence it's at this point that the 12-week gap policy vs 3-week gap policy begins to kick in.

Numbers were about 50k a day in last week Dec, up to 150k a day week of 4 Jan, now up to 400k a day. This is the point when UK partial immunity might start to feed into case numbers for the elderly/care home population, probably a few more days before anything could be expected to change hospitalisation stats.

The government is having a major win with 500k doses a day, well over the official target of 2 million per week for England and 2.5 million per week for UK. It's on the verge of the biggest triumph it will see in this 2019-24 election cycle.

The only criticism it's getting is about the 12-week gap policy. Suffering a fair bit of pain from that. So the obvious move is to cash in on its over-achievement on jabs per day by bringing forward second doses (particularly for Pfizer, seems to be getting less criticism for Oxford-AZ).

It can still deliver its headline targets for total first doses by 15 Feb (Cohorts 1-4) and 31 March (Cohorts 5-9) while using the excess vaccination speed to deliver second doses. Fairly straightforward to allocate all Pfizer doses to 2nd jabs, bringing the 12-week gap down to 6 or 8 weeks.

Just imagine how good Johnson would look in mid February if:

(1) the Cohort 1-4 first dose target has been met
(2) the 2m/2.5m jabs target per week has been met
(3) a reasonable number of Cohorts 1-4 have had 2nd dose or have appointments or the gap has been brought in from 12-weeks
(4) the top of the heat map for over 80s has improved significantly better than cases overall
(5) hospitalisations for the vaccinated population have started to fall
(6) overall cases are coming down nicely and the pressure on the NHS has started to ease.

Johnson is on track for all of this. Soon his multiple f.ck ups that have increased the death toll by tens of thousands will be forgotten. He's about to be the nation's saviour and the tabloids are going to love him.

[headshot]

Where have they said cohorts 5-9 by the end of March?

Frau HS is cohort 6 and everything she’s read says her first does will be sometime in Apr-Jun.

[lpm]

If they complete first doses for Cohorts 1-4 by 15 Feb, and don't do second doses for 12 weeks, who does Frau HS think will be getting jabbed between 15 Feb and 31 March?

The official target for first doses for all 5-9 is "spring" - but maintaining the target rate of vaccinations of 2m/2.5m per week would imply around 31 March.

Cohorts 5-9 is 7 weeks worth of jabs if 100% take up the offer of a vaccine. Call it 6 weeks worth to allow for vaccine refusers. That's 31 March. Bit earlier given the current over achievement.

[headshot]

Assuming they keep up the pace, that makes sense.

Still, spring ends of 20th June...so there’s that.

[grimpeur]

Even more simple - every time an >50 turns up for an appointment of some sort - jab them!

Which is exactly what Guy's and St Thomas' have been doing since the start of the vaccine rollout.

The grimpette had her first jab before Christmas and was really hacked off to have the second one cancelled, one of her colleagues had the second one and then tested positive a couple of days later (with no symptoms though).

[lpm]

What % of the population has at least one GP appointment or other health appointment in a year?

The jabbing anyone who comes through the door approach would obviously get a lot of the elderly and vulnerable population. But for the 50-70 year old group I bet it would be significantly biased towards women. For the 18-50 it definitely would.

[Martin Y]

That's a fair point. Until I hit my 50s I could easily go many years without seeing a GP.

[shpalman]

EU threatens to block Covid vaccine exports amid AstraZeneca shortfall

[Millennie Al]

Johnson is on track for all of this. Soon his multiple f.ck ups that have increased the death toll by tens of thousands will be forgotten. He's about to be the nation's saviour and the tabloids are going to love him.

But then his nerve will fail and he'll relax the measures and we'll have another big wave. He's wobbling already: https://www.telegraph.co.uk/politics/20 ... -lockdown/

[shpalman]

Local newspaper finds a couple of NHS workers who caught covid after getting the first dose of the vaccine because it takes time and two doses to get the full effect and even then the efficacy is not perfect

A nurse, who wishes to remain anonymous, claims she caught the virus three days after [her] first jab.

A GP receptionist says she caught the virus almost three weeks after receiving her first injection. "... at the time I naively thought I was safe."

[FredM]

Had a text message today (26/01) inviting me to book a jab at my local surgery on 16/01. Now booked in for the 30th. Things appear to be moving more quickly here (i.e. East of England), after a slow start.

[Bird on a Fire]

Local newspaper finds a couple of NHS workers who caught covid after getting the first dose of the vaccine because it takes time and two doses to get the full effect and even then the efficacy is not perfect

A nurse, who wishes to remain anonymous, claims she caught the virus three days after [her] first jab.

A GP receptionist says she caught the virus almost three weeks after receiving her first injection. "... at the time I naively thought I was safe."

Not very reassuring that even NHS employees don't seem to understand how the vaccine works. I hope they don't say anything to patients that encourages them to "naively think they're safe".

[Martin Y]

My mum (87) got her first one today. Since my brother's already had his that's their bubble halfway done and it's quite a relief as she's very frail.

[jcm]

Not very reassuring that even NHS employees don't seem to understand how the vaccine works. I hope they don't say anything to patients that encourages them to "naively think they're safe".

Well my 85 and 87 year old in laws were told at their GP practice while getting the first dose of the AZ vaccine last week that it would work within 2 weeks and they'd be 70% protected.
Luckily they seem to be listening to us and won't be relying on that - but who knows who else has been told that and will believe it.
And this is in Galloway, which is just coming out of a horrendous spike in infections, so there's plenty of virus around to catch if they stopped shielding next week!