Covid vaccine: Independent Sage defends ‘justifiable’ decision to delay rollout of second doses

UK scientists have defended the government’s decision to delay the rollout of a second vaccine dose, arguing that the strategy is “justifiable” amid the recent surge in Covid-19 cases and hospitalisations.

Independent Sage, which is made up of leading scientific experts, said it was vital to “pursue coverage of as high a proportion of the population as possible, as quickly as possible” – but acknowledged it was a “finely balanced decision” to make.

Upon announcing approval for the Oxford vaccine last week, the government said doses would be administered up to three months apart, rather than over a four-week period, thereby allowing more people to be inoculated over a shorter time frame.

The policy also applies to the vaccine developed by Pfizer and BioNTech, which was licensed for use across the four nations last month and has already been administered to more than 500,000 people.

Independent Sage said there was “sound theoretical and empirical public health reasons” to support the decision to delay a second dose of the Oxford vaccine, including trial evidence which showed this prolonged interval boosts its effectiveness in preventing Covid disease.

However, the team of scientists – set up to shadow the government’s Scientific Advisory Group for Emergencies (Sage) – said “considerable concerns” have been rightly raised in implementing the same strategy for the Pfizer-BioNTech vaccine.

Independent Sage said there was no evidence from the Pfizer trials which supports the theory that a delayed second dose will be as effective. It also warned there were ethical issues to addressed.

“A large number of elderly people, many likely to have cognitive impairment, gave consent to be vaccinated on the basis that they were receiving the first dose of a two dose regime within the 3 week timeframe,” the group said.

It added that “any change to a vaccine schedule, unless, or in some cases even if convincingly communicated, risks undermining confidence in the vaccination strategy.”

But in light of the UK’s growing second wave, driven by the new coronavirus variant first detected in Kent, Independent Sage said the government was right to push ahead with plans to inoculate as many people as possible using the first wave of vaccine supplies.

The latest data show a 33 per cent rise in the number of confirmed coronavirus patients in hospital in England between Christmas Day and 2 January, while the number of daily new infections continues to reach record heights.

Frontline NHS staff have warned that some patients have been forced to wait hours in the back of ambulances for available beds, with 11 hospitals across the southwest region failing to meet nurse-to-patient staffing ratios in intensive care.

“The pandemic is now out of control, and the NHS is struggling, with some hospitals having to stop non-Covid activities,” Independent Sage said. “The NHS is no longer being protected.

“For these reasons, there is a strong argument for maximising the coverage of the population with at least one dose of vaccine, even though this requires a change to the dosage schedule.

“The urgency of concerted and effective action to suppress the new variant cannot be overstated.”

Professor Jonathan Van-Tam, the UK’s deputy chief medical officer, has similarly thrown his support behind the strategy, saying the four nations are caught in “a race against time” to bring the virus under control.

“Simply put, every time we vaccinate someone a second time, we are not vaccinating someone else for the first time,” he told the Daily Mail. “It means we are missing an opportunity to greatly reduce the chances of the most vulnerable people getting severely ill from Covid-19.”

According to research from the London School of Hygiene and Tropical Medicine (LSHTM), the UK must vaccinate at least two million people a week in order to prevent a third wave.

Without strict coronavirus prevention measures and a “substantial vaccine rollout”, the pandemic’s impact on Britain could be worse in 2021 than in 2020, the study added.

Stephen Evans, a professor of pharmacoepidemiology at LSHTM, said it will “never be possible” to use the vaccines in the “exact conditions reflecting the trials”.

“We have a crisis situation in the UK with a new variant spreading rapidly, and as has become clear to everyone during 2020, delays cost lives,” he said.

“It is clearly on stronger ground to use the vaccine in exactly the same way as it was used in the trials, but it is simply not true to say that there is evidence that using the vaccines in a different way will have dramatically reduced efficacy.

“We have some evidence that the efficacy is quite good, and there are no reasons to believe it will show a sudden decline between three and twelve weeks.

“We must take into account that in the current UK context there will be many more cases of disease and therefore more deaths by vaccinating fewer people.”