Some family doctors in Britain said on Thursday that they would defy the government’s instructions to postpone patients’ appointments for a second dose of coronavirus vaccine, a signal of unease in the medical community over Britain’s new plan to delay second shots as a way of giving more people the partial protection of a single dose.
British doctors, who have been instructed to begin rescheduling second-dose appointments that had been set for next week, said they were loath to ask older, vulnerable patients to wait an extra two months for their booster shots of the Pfizer-BioNTech vaccine. They said those patients had been counting on having the full protection of two doses, had already arranged for caregivers to help them get to their doctors’ offices, and could ill afford to rely on a new and untested vaccination strategy.
Beyond that, doctors said, it was logistically impossible to make contact with thousands of older patients in a matter of days, and then fill those slots with first-time recipients.
The British Medical Association, a trade union for doctors, said on Thursday that it would support doctors who decided to keep second-dose appointments that have been booked for January.
“It is grossly and patently unfair to tens of thousands of our most at-risk patients to now try to reschedule their appointments,” Dr. Richard Vautrey, the chairman of the trade union’s family doctor committee, said in a statement. “The government must see that it’s only right that existing bookings for the oldest and most vulnerable members of our society are honored, and it must also as soon as possible publish a scientifically validated justification for its new approach.”
A spokeswoman for Britain’s National Health Service said in a statement that the service was giving family doctors “extra financial and logistical support” in order to “to help ensure thousands more receive the vaccine quickly.”
With distribution of a coronavirus vaccine beginning in the U.S., here are answers to some questions you may be wondering about:
- If I live in the U.S., when can I get the vaccine? While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.
- When can I return to normal life after being vaccinated? Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.
- If I’ve been vaccinated, do I still need to wear a mask? Yes, but not forever. Here’s why. The coronavirus vaccines are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill. But what’s not clear is whether it’s possible for the virus to bloom in the nose — and be sneezed or breathed out to infect others — even as antibodies elsewhere in the body have mobilized to prevent the vaccinated person from getting sick. The vaccine clinical trials were designed to determine whether vaccinated people are protected from illness — not to find out whether they could still spread the coronavirus. Based on studies of flu vaccine and even patients infected with Covid-19, researchers have reason to be hopeful that vaccinated people won’t spread the virus, but more research is needed. In the meantime, everyone — even vaccinated people — will need to think of themselves as possible silent spreaders and keep wearing a mask. Read more here.
- Will it hurt? What are the side effects? The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection into your arm won’t feel different than any other vaccine, but the rate of short-lived side effects does appear higher than a flu shot. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. The side effects, which can resemble the symptoms of Covid-19, last about a day and appear more likely after the second dose. Early reports from vaccine trials suggest some people might need to take a day off from work because they feel lousy after receiving the second dose. In the Pfizer study, about half developed fatigue. Other side effects occurred in at least 25 to 33 percent of patients, sometimes more, including headaches, chills and muscle pain. While these experiences aren’t pleasant, they are a good sign that your own immune system is mounting a potent response to the vaccine that will provide long-lasting immunity.
- Will mRNA vaccines change my genes? No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.
“The N.H.S. has to follow” the new guidance, the statement said, “so as to increase the number of vulnerable people protected against Covid over the next three months, potentially saving thousands of lives.”
Delaying second vaccine doses could double the number of people who receive a shot soon, and eventually lighten the toll of the virus in Britain, where hospitals are facing a deluge of cases of a new and more contagious coronavirus variant. While any one person may be better off getting the second dose promptly, some scientists said, society as a whole benefits if more people are given the partial protection of a single dose for the time being.
Other scientists, however, believe that Britain overshot the available evidence, potentially leaving older people and health care workers without the full protection of two vaccine doses amid dreadful wintertime surges. Britain made the decision without the public meetings or voluminous briefings that have preceded American regulatory decisions. No trials have explicitly tested the long-term efficacy of a single shot.
And what limited evidence exists about the protection afforded by a single dose clashed with scientists’ fears that antibody responses would wane over time, potentially falling below a protective threshold.
Some family doctors in Britain said that they were uneasy about a lack of evidence showing that patients would be protected for many weeks from Covid-19 after a single shot of the Pfizer-BioNTech vaccine.
“I have been instructed to break my promise to my elderly patients,” Dr. Helen Salisbury, a family doctor in Oxford, said on Twitter on Thursday morning, “and use a vaccine outside its evidenced and approved schedule, probably placing them at risk.”