Wednesday 24 March 2021

Grumbles from the Pulpit: More on Mixing Vaccines



Just read the following and wonder where is the evidence of this "endorsement" and what precisely did it say? I would like to see the documentary evidence by email or letter, with any caveats, as there appear to be plenty in the UK and elsewhere.

I'm not - please be clear - saying mixing should not take place, as the UK permits it "on extremely rare occasions". I'm just concerned that what we are being told is an "endorsement" is in fact misleading. Jersey can make a decision, but if it has any endorsement, it must be a special dispensation by the JCVI, since that is not that body's current policy.

Historically, combining doses from different vaccines is not unprecedented. For example, there have been clinical trials testing the mixing of different influenza (flu) vaccines. There are many potential benefits to being able to combine COVID-19 vaccine candidates, which is why scientists are eager for more data to evaluate this.

But studies in the UK are still under way, and not expected to be complete until the summer - although so far no adverse indications have been given, but we haven't had any reports on efficacy either.

I would also encourage anyone who can get a vaccine to get a vaccine - it is our major weapon in the fight against coronavirus.

Bailiwick Express: 8th March 2021

Mixing covid vaccines should be allowed when the same manufacturer as an individual’s first dose is unavailable, Jersey’s senior medics have decided.

The measure will mostly apply to individuals who are vaccinated at home and who received the Pfizer vaccine for their first dose, and not those who receive their vaccines in Fort Regent.

Deputy Medical Officer for Health Dr Ivan Muscat, Chief Pharmacist Paul McCabe and Associate Medical Director Dr Adrian Noon decided the measure was safe for islanders. It follows an endorsement of the approach by the UK’s Joint Committee on Vaccination and Immunisation.

Gov.Je Information:

This delivery model will be used in low numbers in the community and will not be the model of delivery at the Vaccination Centre at Fort Regent where the transport of vaccine is not necessary.

BBC News: BMJ: 2 January 2021


The editor of the British Medical Journal has asked the New York Times to correct an article that says UK guidelines allow two Covid-19 vaccines to be mixed.Ms Godlee said the Joint Committee on Vaccination and Immunisation (JCVI) does not make any recommendation to mix and match - in other words, having a shot of one vaccine and then a different one 12 weeks later.

Dr Mary Ramsay, Public Health England's head of immunisations, said: "We do not recommend mixing the Covid-19 vaccines - if your first dose is the Pfizer vaccine you should not be given the AstraZeneca vaccine for your second dose and vice versa."

Dr Ramsay added that on the "extremely rare occasions" where the same vaccine is unavailable or it is unknown which jab the patient received, it is "better to give a second dose of another vaccine than not at all".

CDC: 5 March 2021

The safety and efficacy of a mixed-product series have not been evaluated. Both doses of the series should be completed with the same product.

Health Desk: 10 March 2021 (UK report)

Researchers are still learning about the outcomes of mixing a first dose of one vaccine with a second dose of another. In the clinical trials that have led to emergency authorization of COVID-19 vaccines, combining doses from different vaccines has not yet been tested. This means that scientists do not yet know if combining doses from different COVID-19 vaccine candidates will be as effective or safe.

To help provide more data, a clinical trial was announced on February 8, 2021 to begin testing the combination of one dose from the AstraZeneca vaccine candidate with one dose from the Pfizer-BioNTech vaccine candidate. This clinical trial, dubbed Com-Cov, is being led by the University of Oxford and is considered the first in the world to test the combination of different COVID-19 vaccine candidates. Enrollment of 820 participants over 50 years of age is starting, and scientists hope this clinical trial can provide more data and insights by the summer of 2021.

BBC: 18 March 2021

Vaccine Mixing: Nadhim Zahawi said the government's taskforce had given about £7m to fund the study, but that findings would not be available until the summer and therefore "at the moment, we're not changing anything at all"

Gov.UK: March 12 2021 - note the JCVI recommendation which is current while Jersey is saying the JCVI endorses mix and match.

Frequently asked questions answered by Deputy Chief Medical Officer, Professor Jonathan Van-Tam

It is current UK policy that you will get the same type of vaccine for your first and second doses. The NHS keeps a very careful track of the type of vaccine you got the first time in the National Immunisation Management System (NIMS). When people are called back for their second dose the NIMS tells staff what vaccine to give. The NHS and PHE are managing stock levels very carefully so that the right vaccines are available locally for second doses.

JVT adds: “Please don’t worry about getting the right vaccine on your second visit. The NHS has very tight control of this and the JCVI does not currently advise mixing and matching. However, it is true that we are currently performing mix and match research studies. You are not in one of these studies unless you have volunteered and given written consent. But these studies are important and may give us greater flexibility in the long run.

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