Gib poised to receive first vaccine batch, finalises delivery strategy

by Priya Gulraj and Brian Reyes

The first batch of 5,000 Pfizer/BioNTech Covid-19 vaccines is set to arrive on the Rock on January 9 and could be delivered under a “single dose strategy” to increase the number of people who can be vaccinated initially.

In considering that strategy, the Gibraltar Government is taking its lead from the UK, where experts advising the UK Government, including the Joint Committee on Vaccination and Immunisation (JCVI), said the focus should be on giving as many at-risk people as possible the first dose of the vaccine, rather than providing the required two doses in as short a time as possible to smaller groups.

The strategy envisages a longer time period between first and second dose, making it possible to reach a larger number of people with the initial batch.

The second dose of the Pfizer/BioNTech vaccines would be within 12 weeks of the first, rather than three weeks as originally envisaged by the manufacturers and tested in clinical trials.

The UK’s chief medical advisers have said the first Covid-19 vaccine dose offers “substantial” protection.

“Short term vaccine efficacy from the first dose of the Pfizer-BioNTech vaccine is calculated at around 90%, short term vaccine efficacy from the first dose of the AstraZeneca vaccine is calculated at around 70%,” the JCVI said in a statement.

“Given the high level of protection afforded by the first dose, models suggest that initially vaccinating a greater number of people with a single dose will prevent more deaths and hospitalisations than vaccinating a smaller number of people with two doses.”

“The second dose is still important to provide longer lasting protection and is expected to be as or more effective when delivered at an interval of 12 weeks from the first dose.”

Many experts agree that the delayed-dose strategy is the best of rapidly ensuring as many people as possible have a good degree of immunisation.

Stephen Evans, professor of pharmacoepidemiology at the London School of Hygiene and Tropical Medicine, said: “It is quite understandable that those vaccinated with their first dose might be anxious that they are not as protected as they might be when their second dose is delayed.”

“They should understand that the first dose has an effect that will give many people complete protection over a reasonable period, certainly three months and probably a lot longer.”

“The second dose will increase the numbers with complete protection and will not give extra benefit in the short term to those who already have essentially complete protection.”

“Getting the second dose later is very likely to extend the duration of protection and possibly also increase the numbers who will become fully protected compared with getting the second dose at 21 days.”

“This is clearly not ideal, but realising that we are all in this pandemic together and individually doing things that benefit us all is the best way forward.”

But the strategy has not been without its critics amid concern that changing the schedule for the second dose could impact on the vaccine’s efficacy in providing immune resistance to the virus.

On Tuesday, Pzifer/BioNTech said there was no data to support moves to delay the second dose of the jab.

“The safety and efficacy of the vaccine has not been evaluated on different dosing schedules as the majority of trial participants received the second dose within the window specified in the study design,” the companies said in a joint statement, referring to prime and a booster shot given three weeks apart.

“There is no data to demonstrate that protection after the first dose is sustained after 21 days.”

The British Society for Immunology said that while it would prefer the original dosing schedules tested in clinical trials be followed, it accepted the rationale for the change.

The society called on the UK Government to implement a robust programme of immune monitoring to assess how altering the dosing schedule impacts efficacy of both vaccines that have been approved for use in the UK and by extension Gibraltar, with rapid modification of dosing schedules as appropriate.

The Gibraltar Government said it would follow the advice and guidance of UK health authorities in administering the vaccine once it arrives on the Rock this Saturday, with a final decision on dosage strategy yet to be confirmed.

“The Government will act only in keeping with the advice from the UK Medicines & Healthcare products Regulatory Agency in respect of dosage and dosage intervals,” a spokesman for No.6 Convent Place told the Chronicle.

“Anything we do will be designed to be safe, secure and in keeping with the practice in the UK under the NHS or approved for deployment by them.”
At a press conference earlier this week, Chief Minister Fabian Picardo said delaying the second dose of the vaccine would allow health officials in Gibraltar to vaccinate 5,000 people as opposed to 2,500.

This is important because against the backdrop of huge worldwide demand, it is not yet clear how soon Gibraltar would receive subsequent batches of the Pfizer/BioNTech vaccine or the second vaccine approved by the UK and developed by Oxford-AstraZeneca.

One sixth of Gibraltar’s population, including those who are vulnerable and elderly, as well as frontline workers, would receive the vaccine under this one-dose strategy, Mr Picardo said.

“In the context of our population, this is a huge potential step forward,” Mr Picardo said.

“Our size often puts our figures out of kilter.”

“We are testing more than anywhere else in the world almost on a per capita basis.”

“That means our figures are higher per capita for detected infections than anywhere else in the world.”

“But if weighted against testing per capita, our figures can be seen in a different light.”

“Now, also, our vaccination rates will be higher.”

The Chief Minister said he had asked Public Health Gibraltar and the GHA to provide him with a vaccination strategy to reflect the one-dose approach after it was first proposed by the UK’s Chief Medical Advisor, Professor Chris Whitty.

“If we are able to give our vulnerable and our elderly in January 90% immunity to this virus… then I think we are moving in the right direction,” Mr Picardo said.

“There is a lot of science here and if we are able to move to a one-dose [delayed second dose] vaccine, because the United Kingdom is considering this, we are taking this vaccine from the United Kingdom and agreeing to use the vaccine in a way that they set out that we should.”

“We need to agree with the United Kingdom that the vaccine they give us is the vaccine we are permitted to deploy in a one-dose strategy.”

“If we go down that road by the time the vaccine arrives it will be because we have agreed that the advice of the MHRA in the UK is that we can pursue that both in relation to the Pfizer vaccine and the AstraZeneca vaccine.”

The Chief Minister said too that Gibraltar would have to see how quickly further batches of the vaccine could be procured for the Rock, particularly given the high worldwide demand.

“There has to be fair distribution and the right way to do this is not to say that we must get our hands on the first 32,000 doses that we can, and we are alright Jack,” Mr Picardo said.

“That is not the right approach.”

Unlike PPE and swab test kits, Mr Picardo said the vaccines can only be acquired through the Governments, not through a commercial market.

For Gibraltar and other Overseas Territories, vaccines have to be acquired through the UK Government, he said.

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