It is excellent news that the Medicines and Healthcare
products Regulatory Agency (MHRA)
has today authorised the AstraZeneca (Oxford) vaccine for
deployment across the UK.
The MHRA
authorisation includes conditions that the AstraZeneca
(Oxford) vaccine should be administered in 2 doses, with
the second dose given between 4 and 12 weeks after the
first. The MHRA
has also clarified that for the Pfizer/BioNTech vaccine,
the interval between doses must be at least 3 weeks. For
both vaccines, data provided to MHRA
demonstrate that while efficacy is optimised when a second
dose is administered, both offer considerable protection
after a single dose, at least in the short term. For both
vaccines the second dose completes the course and is likely
to be important for longer term protection.
The Joint Committee on Vaccination and Immunisation
(JCVI)
has subsequently recommended that as many people on the
JCVI
priority list as possible should sequentially be offered a
first vaccine dose as the initial priority. They have
advised that the second dose of the Pfizer/BioNTech vaccine
may be given between 3 to 12 weeks following the first
dose, and that the second dose of the AstraZeneca (Oxford)
vaccine may be given between 4 to 12 weeks following the
first dose. The clinical risk priority order for deployment
of the vaccines remains unchanged and applies to both
vaccines. Both are very effective vaccines.
The 4 UK Chief Medical Officers agree with the JCVI
that at this stage of the pandemic prioritising the
first doses of vaccine for as many people as possible on
the priority list will protect the greatest number of
at risk people overall in the shortest possible time and
will have the greatest impact on reducing mortality, severe
disease and hospitalisations and in protecting the NHS and
equivalent health services. Operationally this will mean
that second doses of both vaccines will be administered
towards the end of the recommended vaccine dosing schedule
of 12 weeks. This will maximise the number of people
getting vaccine and therefore receiving protection in the
next 12 weeks.
Based on JCVI’s
expert advice, it is our joint clinical advice that
delivery plans should prioritise delivering first vaccine
doses to as many people on the JCVIPhase
1 priority list in the shortest possible timeframe. This
will allow the administration of second doses to be
completed over the longer timeframes in line with
conditions set out by the independent regulator, the
MHRA
and advice from the JCVI.
This will maximise the impact of the vaccine programme in
its primary aims of reducing mortality and hospitalisations
and protecting the NHS and equivalent health services.
The JCVI
has also amended its previous highly precautionary advice
on COVID-19 vaccines and pregnancy or breastfeeding.
Vaccination with either vaccine in pregnancy should be
considered where the risk of exposure SARS-CoV2 infection
is high and cannot be avoided, or where the woman has
underlying conditions that place her at very high risk of
serious complications of COVID-19, and the risks and
benefits of vaccination should be discussed. Those who are
trying to become pregnant do not need to avoid pregnancy
after vaccination, and breastfeeding women may be offered
vaccination with either vaccine following consideration of
the woman’s clinical need for immunisation against
COVID-19. The UK Chief Medical Officers agree with this
advice.
