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THE Elijah Mosialos write about strategy vaccination against the coronavirus followed in Great Britain and by the questions that have arisen from the possible mixing of doses of different vaccines.
Specifically, it states:
“In Britain we are in a real race on the road with coronavirus after discovering the rate of spread of the new, possibly more contagious variant of coronavirus. Despite strict measures, hospitals remain under pressure and are reported daily Tens of thousands of new infections Schools in London and other areas hardest hit by the virus will be closed for at least the next two weeks.
At the same time, the vaccination committee adjusted the guidelines to vaccinate as many people as possible.
The country has approved two vaccines (Pfizer and AstraZeneca) and about a million people have already been vaccinated. Under the new guidelines, “every effort should be made” to complete the dosing of each with the same vaccine used for the first time. But, if a second dose of a vaccine is not available, it can be replaced with another dose of vaccine from another company.
The new guidelines go against directives in the US, where the US Centers for Disease Control and Prevention (CDC) say there are approved vaccines. COVID-19 “They are not interchangeable” and that “the safety and efficacy of the mixture have not been evaluated” concluding that everyone should receive two doses of the same vaccine.
However, this practice will not be based on existing data. Also from Pfizer, a spokesperson said that every effort should be made to meet dosages and deadlines, to ensure maximum possible protection for each recipient.
So what applies here? British experts are wrong to recommend mass vaccination even with a combination of doses?
First of all, let us remind you that
Both vaccines are safe and effective.
– Both vaccines target the protein spike of the coronavirus. Therefore, it is possible that the second dose, even with a different carrier, could enhance the immune response to the first dose.
– from reinfection cases we know that patients developed higher rates of antibodies to the second exposure to the virus.
I have said many times that managing a pandemic is risk management. And to calculate the potential benefits and risks of such an approach, we need absolute transparency.
Therefore, it was announced that the two vaccines will be administered at 4 to 12 week intervals. That is, in essence, the priority is to get at least one dose of the vaccine, given limited resources.
Where is this based?
Here are some technical details about the Oxford clinical trial. What does the published data show?
The clinical trial was originally scheduled in a single dose, but a booster dose was added when scientists realized this would likely increase efficacy. Therefore, some volunteers took the second dose months after the start of the trial, and the interval was different according to the age group, and there was the problem of different doses.
The reported efficacy data indicates an efficacy of ~ 60% for the group that received 2 standard doses and ~ 90% for the group that received the first half and then the standard dose of the vaccine. What is less clear is whether these differences are due to the lowest first dose, the youngest participants, or the larger intervals between doses.
The efficacy of the vaccine between the ages of 18 to 55 years was 59% for the standard 2-dose regimen, compared with 90% for those who received half and then the standard dose. Differences in the intervals do not appear to affect efficiency in this analysis.
Is this due to the dose or the time difference between the two doses? We do not know yet.
Nor can we assess the recommended approach, for those over 55, because there are no published data yet. Of course, there are reports that unpublished data support longer intervals between doses. I also believe that the British Regulatory Authority (MHRA) has evaluated all of these items before approving the current dosing protocol.
The arguments in favor of the government’s approach have a certain urgency. However, I consider it important that the unpublished data that supports the decision is announced. Not only for reasons of transparency but also to earn the trust of the people to be vaccinated, which is the most basic point in the vaccination effort.
The problem that arises in the UK can also arise in other countries. At the moment, almost 2% of citizens have been vaccinated, giving priority to the vulnerable. We currently have specific capacity to produce and dispose of vaccines, and this can be improved. But we cannot predict changes in the virus and whether they will cause changes in its transmission to the community. The variant of the coronavirus that has appeared has changed the balance and shows us that there should be no complacency. No time to lose. ”
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