And so it begins again. Just as the summit of the Covid vaccine mountain looks to be within reach, another 35 million or so boosters (and a similar number of flu jabs) have been added to the NHS to-do list. If you are one of the 38,345,841 people who have been “double-jabbed” and thought it was all over — at least for a while — then here is what you need to know.
Media reports suggest that boosters will begin at the start of September. As yet, GPs have not received any official information as to who will be given what, or when. However, we’ve been placed on standby and, in my part of Gloucestershire, already have a new GP-led vaccine hub “mothballed” for the big day (our existing one at a local hospital continues for now). It can’t come soon enough for me and my colleagues who were given two jabs of Pfizer just four weeks apart at the beginning of the campaign last year.
While we felt lucky to be offered protection first, there is growing unease that it may be waning. We now know that the sweet spot for Pfizer in terms of long-term protection is eight weeks between jabs (probably even longer for AZ) and that immunity may start to drop after six months. I had my first jab in December and my second in early January, so I fare poorly on both counts, as do some of our most vulnerable patients immunised in the early stages. I want a booster, and so should you, but if you were vaccinated later in the year, with a longer interval, you are likely to be well protected for some time yet.
Pending official confirmation, I don’t know which boosters we will be giving and to whom. Trials are under way, looking at the benefits of mixing different vaccines (eg a Pfizer booster for people who have had AZ and vice versa). Rumours abound that this type of mix is going to get the nod, but the default position is that you can expect an extra dose of whatever you were given before and, since all the vaccines offer good protection against Delta, we may not see any changes in formulation. Yet.
There is always a risk that other troublesome variants will arise (the virus is constantly mutating), but from an evolutionary point of view, Delta is strong and likely to remain dominant for some time. However, manufacturers are looking at tweaking the make-up of boosters to better match emerging variants.
Advertisement
It is too early to tell how well tolerated a third dose will be, but so far we have seen more reactions with the second doses of Pfizer and first doses of AZ. We haven’t used enough Moderna in our area to comment, but it is likely to mirror Pfizer with the first dose generally better tolerated than the second. This bodes well for the majority who may get an AZ booster, but only time will tell.
For now, however, the emphasis remains on getting as many people as possible double-jabbed, and we still have some way to go, particularly with older teenagers and young adults. There is also growing concern about pregnant women and the Delta variant. In the past quarter there have been nearly 200 pregnant women with Covid admitted to hospitals in England, and a significant minority of them have been very ill (see below). The Delta variant does seem to cause more problems in pregnancy than the Alpha and original strain that were dominant during the earlier part of the pandemic. And vaccine uptake among pregnant women remains worryingly low.
I hardly dare mention flu, but the predictions are that this is going to be an awful season due to low herd immunity caused by social distancing over the past 18 months. We are planning on giving more flu jabs this year than before (about 35 million) and while these could potentially be given alongside Covid boosters, logistic difficulties — not least delivery schedules — mean it is unlikely most people will get a jab in each arm.
A word of caution. The UK’s vaccination programme has been a great success and is the envy of much of the world, but the move to start boosters is controversial given such poor progress elsewhere, including many developed countries. While boosters are good for the UK population, this is a global problem and we must be careful not to rest on our laurels having mopped up our part of the beach, while ignoring the tide that is still rising.
As soon as we receive official guidance on the booster campaign I will update you. You will find regular updates on my Twitter feed @drmarkporter.
Covid and pregnancy
Advertisement
● Pregnant women in the UK have been offered the Pfizer or Moderna vaccines since April, but uptake remains poor
● The latest data from Public Health England shows that just over 50,000 pregnant women have had their first dose and 21,000 have had both. It is estimated that there are at least 600,000 women who are eligible
● The Delta variant is causing more problems during pregnancy than earlier variants
● In the past three months 171 pregnant women with Covid have been admitted to hospitals in England — nearly all were unvaccinated, a handful had received one dose and none had received both.
● One in three developed pneumonia and one in seven required intensive care
Advertisement
● One in five went into labour prematurely (compared with one in 13 across all pregnant women)
● 130,000 pregnant women have had the Covid vaccines in America and no serious safety concerns have been raised.
