Selected Covid-19 vaccine Q&As. Extended interval: HCWs

Should we make exceptions for healthcare workers?

(For a list of my blogs relating to Covid-19 and a disclaimer, see here.)
(For links to the other questions and answers about Covid-19 vaccines, see here.)

One decision made for the first phase of the vaccination programme was to vaccinate both staff of care homes, as well as residents; and to vaccinate healthcare workers (HCWs) early on.

But should HCWs also get the second dose of vaccine earlier than 12 weeks – as an exception to the recommendation for the general population?

There has been a lot of pressure for this from some quarters.¹ Some of it comes from doctors and other healthcare workers who are worn out, exhausted – and terrified. They have seen what Covid-19 can do to young, healthy patients like themselves; and they want as much protection as soon as possible. They feel they have been – and still are – expected to work in high-risk environments with inadequate personal protective equipment (PPE), and they do not trust the government or Public Health England following their failure to address these issues adequately.

This lack of trust, and the fear that they will contract the disease and/­or pass it on to vulnerable family members may partly explain the clamour, from some, to have their second dose of vaccine at the earliest opportunity, feeling this will maximise their protection.

Arguments have been proposed for vaccinating HCWs at a shorter interval (the minimum “recommended” intervals in the product emergency use authorisations – three-weeks for the Pfizer-BioNtech product, and four-weeks for the Astra-Zeneca one). The arguments include:

·         Increased occupational risk of exposure. HCWs are at particularly high risk of exposure and infection.^2-4

·         Protect the NHS. The NHS is under such strain that even a small marginal decrease in staff absenteeism from sickness or self-isolation would make a huge difference.

·         Morale. Morale is low, and prioritising the second dose for HCWs would demonstrate support and concern, decrease staff anxiety, and thus improve morale.

·         Vaccine availability. Some HCWs have expressed concerns that there may be problems with vaccine supply when they are due their booster dose, so the dose will be delayed for longer than the intended 12 weeks.

·         Protect vulnerable patients. HCWs are in contact with vulnerable patients. While the first dose seems remarkably effective at preventing serious illness requiring hospital admission, it seems likely that the second dose will increase the likelihood of having the sort of immunity that will prevent you from being infected at all, and therefore reduce the likelihood of passing the infection on to a vulnerable patient.

I am not entirely convinced by these arguments, particularly when the additional delay is only a few weeks, and it is likely to enhance the quality of their immune response; but it might, on balance, be reasonable to offer HCWs vaccination at, say, six weeks, rather than 12 – I’ll continue to sit on the fence on this issue!

References

Note that I have included some twitter threads amongst the references – something that might enrage purists! But where I have done so, they not only make a point or develop an argument, but they mostly provide links to proper published papers or pre-prints. So I make no apology for this!

1. BMA. COVID-19: prioritising vaccination of healthcare workers. British Medical Association (BMA) web site 2021; Updated 19 Jan 2021; Accessed: 2021 (28 Jan): (https://www.bma.org.uk/advice-and-support/covid-19/vaccines/covid-19-prioritising-vaccination-of-healthcare-workers).

2. Mutambudzi M, Niedwiedz C, Macdonald EB, Leyland A, Mair F, Anderson J, et al. Occupation and risk of severe COVID-19: prospective cohort study of 120 075 UK Biobank participants. Occupational and environmental medicine 2020:oemed-2020-106731. (https://oem.bmj.com/content/oemed/early/2020/12/01/oemed-2020-106731.full.pdf or via https://oem.bmj.com/content/early/2020/12/01/oemed-2020-106731).

3. Nguyen LH, Drew DA, Graham MS, Joshi AD, Guo C-G, Ma W, et al. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. The Lancet Public Health 2020;5(9):e475-e483. (https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30164-X/fulltext).

4. Muiry R, Parsons V, Madan I. Risks posed by COVID-19 to healthcare workers. Occupational Medicine 2020. (https://academic.oup.com/occmed/advance-article/doi/10.1093/occmed/kqaa191/6008094).