Vaccines, From A Gp’s Perspective!

It’s important to me that this blog is as current as it can be, in these incredibly fast moving times. As always there is a lot being talked about vaccines, much not true. I wanted to bring to you the most up to date accurate picture. Many thanks as always to my friend Dr Simon Hodes for sharing his personal views and experiences from the last couple of weeks.

“After clean water, vaccines have been the most effective global health intervention for saving lives.

To most doctors, the idea of ‘herd immunity’ without a vaccine is a total misnomer. The thought of just letting Covid-19 rip through society hoping for the best sounded more like a cull to me, and hearing politicians speak about it as a credible policy, sat very uncomfortably.

It seems the UK government has changed its rhetoric now, as have those who argued for herd immunity through infection – most notably in the ‘Great Barrington Declaration’. This ‘declaration’ failed to acknowledge that Covid-19 is highly unpredictable, that it’s hard to segregate those at risk from their households, and that there is now a huge and growing number of patients suffering with Long Covid causing lasting health problems.

So there was great excitement when 2 vaccines were licenced within a short space of time. The UK became the first country in the world to approve the Pfizer BioNTech vaccine on 2.12.2020, shortly followed by our own Oxford AstraZeneca one on 30th December. Many GPs were anxious that the Covid Vaccination Programme (CVP) would be handed to private providers (like Test & Trace) but thankfully the NHS was chosen. Whilst many GP groups (PCNs) have felt able to offer this extra service, many others clearly don’t have the facilities or staff required.

It’s hard to explain the amount of work needed to provide the CVP safely, in addition to our core work. It’s like taking on another full time job. We have constant email updates with large attachments, numerous guidelines to read, learning modules to complete, extra staff to organise, even longer busier days and frantic changes to our waiting areas and clinics to ensure a safe flow of patients – all whilst wearing PPE and maintaining social distancing. Although we are used to mass vaccinations (flu) every year, this is on a totally different scale. Why?

1) the sheer number of patients – expected to be around 40 million nationally

2) boosters are required – so 80 million appointments are needed

3) the Pfizer BioNTech vaccine has very complicated cold chain requirements. We have to use up all the vaccines within 3.5 days of arrival at the practice

4) we have been told to observe all patients for 15 minutes following their jabs in case of reaction. That’s a major logistical challenge which will hugely slow down the pace at which we can vaccinate. (It also seems

rather unnecessary given that the chances of a vaccine allergy are cited at less than 1 in a million. Let’s be clear – you’ve got more chance of being struck by lightning (1:700,000 annual risk).

5) annual flu vaccines come fridge ready in syringes. The covid vaccines come in vials of multiple doses and need to be drawn up individually

Vaccinating the nation is now the key priority to help end the pandemic, and indeed was one of the central messages in Boris Johnson’s address to the nation 4.1.2021 when declaring another lockdown. Primary Care deals with 90% of all NHS contacts, and GP teams are once again centre stage in the fight against the Covid-19 pandemic.

Following the priority order advised by the JCVI we are initially vaccinating those living in care homes and their carers, and those aged over 80. They are a largely elderly frail cohort, many of whom need help or pre-arranged transport to attend appointments. This age group in particular do not tend to be high users of SMS services or email, and hence were largely booked by individual phone calls. The time and effort to book 975 patients at short notice cannot be understated. Many GP teams did this over weekends and evenings, with reception and administrative teams working overtime, and the General Practitioners taking on lists of patients to call. When I made these calls to my own patients they were all so grateful and willing to attend.

After all the frantic planning, reorganising and lining up 975 frail elderly patients, we started to hear reports of some GPs having delays to their deliveries. I had a sleepless night before ours was due as the disruption caused to patients – and practices – by late deliveries is massive. Thankfully our first batch arrived on time on 15.12.2020 (as did our boosters 3 weeks later on 2.1.2021).

The sense of excitement was palpable. Most of the team literally ran down the stairs to witness the delivery. It felt like medical history in the making. Having been named as the signatory, I had to receive the delivery, and was scared that I’d slip with the box and ruin the batch. It felt like unwrapping a special birthday present, as we carefully peeled it open.

The mRNA vaccines are ground-breaking technology and after following the news so closely to actually see them in real life was remarkable. As we carefully opened up the package and peered inside you could have mistaken us all for being in a scene from Indiana Jones!

A few hours later our first patients arrived. We were learning how to gently invert the vials to make them up (as seen on training videos) but doing that in real life was very different. Obviously we are well versed at it now.

Many of the patients attending for their vaccines have not left their homes for over 9 months. It was extremely emotional seeing them in person again, and to see their grateful smiling faces. The chatter and excitement in the waiting areas was clear. We know how hard Covid has been for society, and GPs have taken a ‘digital first’ approach as advised by the Government. As such we screen all calls first, try to offer solutions by phone or video call, and only see those patients that we cannot safely help remotely. This has greatly reduced footfall through the practice.

The hubbub of the vaccine clinics was such a stark contrast to the months of empty waiting rooms. Seeing patients in person again gave staff such a huge morale boost. At the end of the first day we were all exhausted, but relieved and jubilant. As we tidied and prepared for another long day ahead there was a spontaneous round of applause – something I can’t ever recall after a shift in my entire career. It was incredibly moving.

The photos attached I think speak for themselves.

Now we have to hope for a regular supply of vaccines so that we can continue at scale. The boosters need to come on time and they need to be the correct type so that no ‘mix and match’ vaccines are required. We are reassured this is not the plan, but it will of course depend on supply chains. We have already seen a major change of policy by delaying the Pfizer BioNTech boosters to 12 weeks rather than 3. My thoughts on this can be found in this separate article. I’m sure there will be many more twists and turns along the way.

Like most GP sites, we have a safe effective system now in place. We are local, trusted, hold full electronic records, robust disease registers and recall systems, do this every year for seasonal flu and we are ready and waiting to vaccinate at pace. Whatever you hear or read from some media outlets, I truly believe that there is no need to overcomplicate the process. There are around 1250 PCNs (GP groups) nationwide, so just 1600 vaccines a week each = 2 million a week (the Boris target), which is easily achievable.

Just give the trusted NHS experts the resources. Allow us to manage the recalls and we will do the rest.”

Simon Hodes @DrSimonHodes has worked as a GP partner in the same Watford practice since 2001, and is also a GP trainer, appraiser and LMC rep. The views expressed above are his own.