Vaccinating Against Hope


Vaccinating Against Hope

Just as tempers and relationships start to fray, in practice and out, finally some positive news – a SARS-CoV-2 vaccine is here. Stock markets soared, people cheered in the street – well, people in England cheered locked in their homes, in Scotland they went to the pub to have a latte and in Wales they went shopping.

But while the celebrations continued in the media and politicians patted themselves on the back for doing such a good job, those of us in primary care had the whiff of hope quickly blown away.

General practice is the perfect place to deliver the vaccinations. Sounds sensible. But the devil is always in the details.

Practices in England need to deliver this through PCNs, seven days a week from 8 til 8 including bank holidays, keeping the vaccine below minus 70 degrees until required, and then observing patients for 15minutes after their jab while socially distancing.

Most PCNs can’t even decide who gets the pharmacist on a Wednesday, no-one from reception wants to do the early shift on Christmas Day (I don’t blame them, neither do I) and our waiting room now only has space for 5 people and getting even those in and out will involve strategy like a chess grandmaster. Luckily minus 70 degrees Celsius is roughly the temperature of when hell freezes over so a least that’s one problem to scratch off the list.

And all of this based on a press release from the manufacturer. And that’s what’s been lost somewhere in all this excitement and false promises. This is an interim analysis of a phase 3 trial that has yet to be published and have any of the results scrutinized.

We’re told the vaccine has an efficacy rate >90% seven days after the second dose, 28 days after the initial dose. But we don’t know what that really means. Does it prevent transmission or merely reduce symptoms? This is an important distinction.

Out of their study of 43k participants, only 94 have developed COVID-19. One presumes (it has to be an assumption because we can’t see the data) this was heavily skewed to the placebo side but most of us might be somewhat uncomfortable delivering the 40 million doses the government has just bought into people’s bodies based on those numbers. They say the safety data is good, we have to hope that’s true.

So while the world rejoices I would be much more hopeful if this announcement was coming after the independent scientific community had studied the data, not a politician hell-bent on a positive news story. I would be much more hopeful if NHS England had considered how the very elderly, the very cohort recommended to be initially targeted, are going to get themselves a vaccine through a national appointment system for a Sunday evening at 6:30 when they struggle to even phone our practice. I would be much more hopeful if they had asked general practice how best to do something we’ve been doing for decades and as NHS England state in their own document are “a global leader in achieving high levels of vaccine coverage”. For one, we already know who all those frail elderly are.

But park all that for a moment. It’s hard but put it to one side. There is now a genuine reason for optimism in the near future. There is a potential end in sight. Enjoy it today, tomorrow we can address the challenges. And if there’s one thing I am hopeful about, it’s that general practice will figure it out.

Dr Neal Tucker
11th November 2020

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