Advice For Doctors On Astrazeneca And Pfizer Biontech Vaccines In Scotland

10th January 2021

A letter from the chief medical officer to doctors.

ADVICE FROM JOINT COMMITTEE ON

VACCINATION AND IMMUNISATION (JCVI) ON THE

ASTRAZENECA AND PFIZER BIONTECH VACCINE.

1. I am writing to provide you with information about the

advice received from the Joint Committee on

Vaccination and Immunisation (JCVI) on the

AstraZeneca and Pfizer BioNTech vaccines.

2. The JCVI, an independent clinical group of experts

that provides all Governments in the UK with advice

on vaccinations, recommended a maximum interval

between the first and second doses of 12 weeks for

both the Pfizer BioNTech and AstraZeneca COVID19 vaccines.

3. This is in recognition of the very high levels of

protection offered from the first dose, and that the

increased transmission rate of the new strain of

coronavirus poses a significant risk of increased

case numbers and subsequent deaths.

4. In the published phase III efficacy paper for the

Pfizer BioNTech vaccine the vaccine efficacy after

dose 1 and before dose 2 was given as 52.4%.

However, this figure includes COVID-19 infections

occurring shortly after the first dose, when the

majority of failures occurred, within an interval where

the vaccine could not yet be expected to have its

intended effect. When vaccine efficacy is measured

from a point when vaccine and placebo arms begin

to diverge, at a period of 15-21 days, the vaccine

efficacy is shown as 89%. Analysis of Astra Zeneca

vaccine suggests vaccine efficacy after first dose is

73% at day 22, demonstrating similar high levels of

vaccine efficacy.

5. It is important to note that these figures for vaccine

efficacy are NOT directly comparable, due to

differences in trial design and population, but when

looking at research outcomes such as hospitalisation

both vaccines demonstrate similar levels of high

efficacy and protection.

6. In a statement released on the 31 December 2020

the JCVI concluded: "The Committee advises initially

prioritising delivery of the first vaccine dose as this is

highly likely to have a greater public health impact in

the short term and reduce the number of preventable

deaths from COVID-19."

7. This reflects the need to reach as many people in the

shortest possible timeframe, within the available

vaccine supplies, against a background of immediate

disease activity and high population susceptibility.

The JCVI advice is also supported by the four UK

Nations' Chief Medical Officers (CMOs) and further

details are outlined my subsequent letter which can

be found on the Scottish Government website, which

also covers the timing of second doses.

8. As we roll out the vaccine in Scotland, initially, there

will be a limited supply available and, as such, it is

crucial we make the best use of what we do receive.

This amendment to the dosing schedule will also

mean that we are able to protect a greater number of

people more quickly than would otherwise be the

case. Taking the approach recommended by the

JCVI will therefore allow as many first doses as

possible to be provided as quickly as possible,

providing substantive levels of individual protection

while reaching more of those most at risk. This will

prevent deaths and hospital admissions.

9. In response to this, any appointments for second

vaccinations which were scheduled after the 4

January 2021 are currently being rescheduled.

However, everyone will still receive their second

dose, which is expected to be as, or more effective,

when delivered at an interval of 12 weeks.

10.It is also our intention that people receive the same

vaccine for their first and second dose based on the

current advice from the Medicines and Healthcare

products Regulatory Agency (MHRA) and the JCVI.

11.The Scottish Government will continue to follow the

JCVI's prioritisation list, which recommends that

vaccinations should be prioritised in this order:

1) Residents in care homes for older adults and their

carers

2) All those 80 years of age and over and frontline

health and social care workers

3) All those 75 years of age and over

4) All those 70 years of age and over and clinically

extremely vulnerable individuals

5) All those 65 years of age and over

6) All individuals aged 16 years to 64 years with

underlying health conditions which put them at

higher risk of serious disease and mortality

7) All those 60 years of age and over

8) All those 55 years of age and over

9) All those 50 years of age and over

12.It is estimated that taken together, these groups

represent around 99% of preventable mortality from

COVID-19.

13.The JCVI's recommendations are designed to

protect as many people as possible and that is why

we are proceeding at pace on this basis. Both

vaccines remain safe and effective and it is therefore

important for those who are eligible to get a vaccine.

14.With two vaccines deployed widely, this should

reduce severe illness, hospitalisations and mortality.

15.The World Health Organization’s European director

has recently supported the response of countries

including the UK seeking to counter initial low

vaccine supplies by extending the gap between first

and second doses. He said it was important to strike

a balance between making the most of limited

supplies and protecting as many people as possible

and that it was an imperative for Governments to

protect as many people as possible while reducing

the burden of any subsequent wave on the health

systems. The Scottish Academy, the British Society

of Immunology and the Royal Pharmaceutical

Society have also issued statements of support.

16.I hope that the above assists you with

communications with your constituents, I have

outlined a shorter version below that you may wish to

use in communications for ease of reference.

‘The Joint Committee on Vaccination and Immunisation

(JCVI), an independent clinical group of experts that

provides all Governments in the UK with advice on

vaccinations, recommended a maximum interval

between the first and second doses of 12 weeks for both

the Pfizer BioNTech and AstraZeneca COVID-19

vaccines. This is in recognition of the very high levels of

protection offered from the first dose, and that the

increased transmission rate of the new strain of

coronavirus poses a significant risk of increased case

numbers and subsequent deaths.’

Your sincerely

Dr Gregor Smith

Chief Medical Officer