Postponing the Second Jab of the Covid-19 Vaccine Makes Sense for the Community

Jonathan Gornall

AFP photo via Indonesia Presidential Palace

We live in an age in which baseless conspiracies about every aspect of life thrive and spread with the speed of a super virus. Recently, confidence in the various Covid-19 vaccines now coming on stream has been shaken not so much by fringe social-media commentators, as by mainstream controversy over proposed departures from the recommended protocols for administering these new drugs. In other words, postponing the second jab of the vaccine.

For any population to develop herd immunity and break the chain of transmission requires up to 70 percent of people to be inoculated. The UK has decided to delay administering the second dose of the two vaccines approved for use so far in order to ensure more people receive their first dose sooner.

The decision is the product of two colliding realities. The first is that every country in the world is clamoring for their share of vaccines, which take time to manufacture and are currently in short supply. The second is that the rise of the new, super-spreader versions of the virus has made the need to inoculate our way to herd immunity even more urgent.

Already there is public unease that these drugs have been developed and approved far more quickly than appears prudent. The perception that, in their anxiety to inoculate as many people as possible, governments appear to be bypassing a key part of the approved protocols has only increased that unease. Public confidence, however, must be bolstered if we are to see an end to this pandemic.

Initially, the UK said each patient would receive two doses of either the AstraZeneca-Oxford or the Pfizer-BioNTech vaccine three or four weeks apart, as recommended by research. But on December 30 the Department of Health issued guidance that, in a bid to reach as many people as possible with a first dose, the second inoculation of either vaccine should be given up to 12 weeks after the first dose.

The decision has prompted criticism from Anthony Fauci, America’s leading infectious disease expert, and from within the UK itself. The British Medical Association, which represents the country’s doctors, said the decision was “grossly unfair” to vulnerable, at-risk patients who had already had their first jab and were now being made to wait for their second. Even the UK government’s Scientific Advisory Group for Emergencies said the proposal to delay second doses was “a finely balanced decision” justifiable “only as part of a comprehensive ambitious strategy to suppress infections.”

On January 5, the World Health Organization compounded public confusion by announcing that in “exceptional circumstances,” the second dose of the Pfizer-BioNTech vaccine could be given up to six weeks after the first – half the 12-week gap now approved in the UK. This was so that in countries facing difficulties in obtaining vaccine, supplies could “maximize the number of individuals benefiting from a first dose.”

The decision on whether or not to space out the first and second doses now confronts many countries racing to achieve herd immunity, and in this race, the Middle East is surging ahead.

Israel tops the vaccination league table, with 15 percent of its population of 9 million having received at least one vaccine dose. The UAE is next; as of the end of last week, 8 percent of its 10 million population had been given the vaccine, with the health ministry declaring it aims to reach 50 percent by the end of March. Bahrain is not far behind with 3.75 percent vaccinated.

Saudi Arabia began administering the Pfizer-BioNTech vaccine on December 17. As of January 7, 100,000 residents had received a first dose and a million had registered to get it.

Pfizer will reportedly supply the kingdom with one million doses of the vaccine by the end of February. Saudi Arabia’s population, however, is more than 33 million, which means that 23 million have to be inoculated before herd immunity can be achieved. The temptation to reach more people more quickly is evident.

So, should you be concerned if you’re asked to wait longer than recommended for your second dose?

No.

Take AstraZeneca’s vaccine. It was subjected to randomized, controlled trials involving more than 23,000 people in the UK, Brazil and South Africa. Overall, the largescale study found “significant vaccine efficacy of 70.4 percent after two doses and protection of 64.1 percent after at least one standard dose.” There was, in other words, a difference of just 6.3 percentage points in effectiveness between the first and second jabs.

It is possible – although extremely unlikely – that an individual who waits 12 instead of only three weeks for their second jab might contract Covid-19. But this risk is much less than the risk of contracting the disease without any protection. It is also outweighed enormously by the benefit to society as a whole of immediately extending the slightly lower level of protection to twice as many people.

It is an unavoidable reality that a far more detailed picture of the efficacy of the novel vaccines and any as-yet unknown side effects will emerge only after large numbers of people around the world have been inoculated. We are, in effect, guinea pigs, in the sense that those of us who receive one of the new vaccines are participants in one of the largest ongoing drug trials the world has ever seen – and we should be proud to be so.

In this way, we are not only reducing our own chances and those of our loved ones of contracting and possibly dying from this virus, but in accepting the small unknown risk that is inevitable with any drug deployed on such a vast scale we are also doing our bit in the great fight against a killer that has so far claimed close to two million lives.

Jonathan Gornall is a British journalist, formerly with The Times, who has lived and worked in the Middle East and is now based in the UK.