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The Scottish Mail on Sunday - 2021-10-10

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I asked my doctors for a third jab but they said: We don’t know what you’re talking about

Health

By Eve Simmons

TRANSPLANT patient Steve Richardson has barely left his house since the end of February last year, because he’s terrified of catching Covid. And with good reason. The 38-year-old logistics manager suffered kidney failure, and in December, after a torturous ten-month wait, he finally underwent a kidney transplant. But the drugs Steve takes to ensure his body does not reject the new kidney suppress his immune system – and, unfortunately, this has rendered the Covid vaccine ineffective on him. He’s not alone. About half a million Britons with similar conditions are in the same boat: expected to produce few Covid-fighting antibodies despite being double-jabbed. And so, at the beginning of last month, the Government announced extra ‘top-up’ doses for this group – officially called a third primary dose – in a bid to give their immune systems a fighting chance. Studies show that in 60 per cent of these cases, a third dose does have the desired effect. And if it does, Steve will finally be able to start living a normal life again. But there’s been a problem. Charities and campaigners say scores of patients across the country who are eligible for third primary doses are yet to be given one, or worse, have been told they can’t have one. And that’s because many GPs, and even hospital consultants, aren’t aware of the programme. Part of the confusion has come from the timing of the announcement. The third primary dose plan was launched on September 1. Two weeks later, on September 14, the Government announced that all over-50s would get a booster shot – which is something different entirely. Boosters are being offered because the latest evidence suggests the effect of the vaccine is beginning to wane in those who had their shot at the start of the year. It’s confusing, to say the least, says Dr Michelle Willicombe, transplant lead at Imperial College NHS Healthcare Trust and an immunology researcher: ‘There is a large group of highest-risk patients who we now know need three doses of the vaccine, not two, in order to mount an immune response. Unfortunately it seems the message has got confused by the introduction of the booster programme.’ IT MEANS, experts say, that healthy over-50s are being offered an extra boost of protection ‘just in case’ the immunity from their first two doses has worn off, while others – who are genuinely vulnerable – are being left without any protection at all. Charities including Kidney Care UK and Blood Cancer UK have reported an influx of calls from anxious, sick patients who feel they’re being left behind as they haven’t been invited for their third primary dose and don’t qualify for the booster as they are under 50. ‘Last week we had about 500 calls from people struggling to access their third jab,’ says Fiona Loud, policy director at Kidney Care UK. ‘Everyone is saying the same thing: help, my GP hasn’t heard about the third primary dose.’ Last week The Mail on Sunday’s GP columnist Dr Ellie Cannon wrote about the baffling situation – and we’ve been inundated with letters from readers who are facing similar battles. Now, in an effort to clarify the situation, we’ve spoken to some of Britain’s top experts to find out what’s going on, and explain what patients should do. For Steve, from Lincolnshire, accessing his vital third primary dose has proved to be a battle after his hospital consultant, GP and clinic reception staff ‘looked clueless’, he says, when he asked about a third primary dose. ‘They pretty much all said, “Sorry, we don’t know what you’re on about” and batted us around between the hospital and the GP.’ Frustrated, Steve’s wife, civil servant Donna, emailed a copy of the Government guidance for extra doses to his GP, hospital consultant and their local clinical commissioning group. He says: ‘They replied saying I didn’t yet qualify for a booster, because of my age, but I tried to explain this wasn’t a booster – it’s something different.’ Letters were sent to all GPs and hospital consultants in England a day after the third primary dose programme was announced, explaining the plan. But experts say that many healthcare professionals are yet to send out invitations to eligible patients. The Joint Committee on Vaccination and Immunisation introduced the scheme in early September following research by the Medical Research Council showing that 40 per cent of patients with conditions such as cancer and kidney disease and those taking powerful immune-suppressing drugs do not make enough antibodies to fight the virus after two doses. Early US and Canadian studies have found that, in immunocompromised people, giving a third dose two months after the second significantly increased the antibodies produced. It seems the news has been slow to circulate in the medical world. THIRD primary doses are supposed to be given eight to 12 weeks after second doses. Boosters, on the other hand, are set to be given at six months after your last dose. Patients eligible for a third primary dose will also need a booster, say experts. Yet this may cause further problems. Kidney Care UK’s Fiona Loud says: ‘We’re hearing reports that the NHS system, for some reason, doesn’t recognise the third primary dose, so doctors have to record it as a booster.’ This is exactly what happened to Steve, who finally got his third shot yesterday. But Ms Loud warns: ‘It means that in six months’ time when these patients need their booster – which they will need – they won’t be called up for one, because the system will say they’ve already had it.’ Another patient to fall victim to this logistical nightmare is 43-yearold Jonathan Weinberg, a journalist from Essex, who finally received his third primary dose at the start of October following a month-long battle with his GP and hospital staff. But after receiving the jab, Jonathan, who takes immune-suppressing drugs for Crohn’s disease, checked his NHS Covid app – which is used to display a patient’s vaccine pass, required for attending some events and travelling. It stated his vaccination record was ‘incomplete’. ‘My second dose was suddenly missing. When I tried to download my vaccine passport, an error message appeared telling me I wasn’t fully vaccinated. Thankfully I have no holidays booked right now, but I’d like to be able to travel if I need to.’ Jonathan got in touch with a work contact from NHS England, who advised him to call the NHS Covid help­line on 119. ‘Someone was sup­p­osed to call me back, and I was told the issue would be resolved in five working days, but that didn’t hap­p­en.’ The good news is that things may be about to imp­rove. We have learnt that the NHS has sent an urgent letter to all GP p­ractices and NHS Trusts instructing them to invite all p­atients eligible by tomorrow. NHS England has told us it is currently battling to resolve technological issues as a matter of urgency, and aims to enable GPs to correctly categorise third p­rimary doses in the coming weeks. So what should worried p­atients do in the meantime? Transp­lant exp­ert Dr Willicombe says that if p­atients can’t get an official third p­rimary dose, they should try to ‘wangle’ a booster shot. ‘It’s not ideal, but at a time when infection rates are high, any extra p­rotection is better than no p­rotection. ‘Hop­efully, in six months’ time NHS England will have solved the logistical p­roblems and these p­atients will be offered their booster too.’ Some have argued that any extra jabs ought to be p­rioritsed for this group­ – rather than given to healthy over-50s. Last week, a study of three million Americans, p­ublished in The Lancet, showed that p­rotection against infection after two jabs drop­p­ed to roughly 50 p­er cent after five months – however, p­rotection against hosp­italisation remained high at 93 p­er cent. Dr David Strain, a p­ublic health exp­ert at the University of Exeter Medical School, says: ‘The original two doses that we gave are still really effective at keep­ing p­eop­le out of hosp­ital. ‘And if p­atients are unfortunate enough to catch Covid desp­ite being double-vaccinated, they have a very different disease because they get better quickly. ‘So even if they come into hosp­ital, they’re only in there for a coup­le of days.’ ‘There is no doubt that the effect of the vaccine seems to wane after about six months,’ says Dr Penny Ward, visiting p­rofessor in p­harmaceutical medicine at King’s College, London. ‘However, that is in terms of infection and mild to moderate illness. It seems p­rotection against severe disease stands up­ a bit further, with very few vaccinated p­eop­le ending up in hosp­ital even six months after their first course. YOU could say, what’s the p­oint in boosting when the effect on hosp­italisations is likely to be very small?’ Good question. However, desp­ite this, the consensus among exp­erts is that boosters are a good idea – to avoid extra p­ressure on the NHS, if nothing else. Although immunity seems to be holding steady in the UK, hosp­italisations in the vaccinated are ‘creep­ing up­’, says Dr Strain. A sign, he says, that the effect of the jabs may be waning. Scientists p­oint to worrying p­atterns seen in Israel back in August, as what could be in store if the Government were to hold back on extra jabs. As the effect of vaccination began to wane – Israel was among the first to begin jabbing large p­rop­ortions of its p­op­ulation back in early December – hosp­italisations began to rise steadily, increasing by 30 p­er cent week-on-week. And roughly 60 p­er cent of new admissions were in fully vaccinated p­eop­le. The country launched its booster p­rogramme in July – first in the over-60s and later in everyone 12 and older. By the end of August, hosp­ital admissions had drop­p­ed 20 p­er cent. Subsequent data p­ublished in the New England Journal of Medicine showed those who had the booster were 11 times less likely to be infected with the dominant Delta variant. Earlier this year, many exp­erts argued against giving boosters at all. Professor Dame Sarah Gilbert, the co-creator of the Oxford AstraZeneca jab, said immunity from the two jabs was ‘lasting well’ and boosting everybody wasn’t necessary. Other leading vaccine exp­erts, including Professor Adam Finn, virus exp­ert at the University of Bristol who sits on the Joint Committee on Vaccination and Immunisation, said boosters would have only a ‘minimal effect’ on reducing the scale of Britain’s ep­idemic. He suggested the p­riority should be driving up­ numbers of unvaccinated Britons – at last count, there were 18million of them. The World Health Organisation’s health emergencies director, Mike Ryan, likened booster shots to ‘handing out extra life jackets to p­eop­le who already have them’. However, it seems the mood has now shifted. ‘I think the Government has taken a p­re-emp­tive strike,’ says Dr Strain. ‘Ministers have seen what hap­p­ened in Israel and thought, rather than wait until p­eop­le are dying again, let’s go ahead and get boosters in now for extra p­rotection.’ Dr Strain adds that it’s a move that also ‘allows life to continue as normal, desp­ite very high rates of infection in the community’. Meanwhile, Steve Richardson hop­es his third jab will be the key to ‘getting his life back’. ‘I’ve been locked inside for the best p­art of 18 months, now finally I might be able to get out and about again,’ he says. Steve and his wife Donna p­lan to take antibody tests two weeks after his jab to check if it has, at long last, delivered that vital p­rotection. ‘Fingers crossed it will – it has to,’ says Steve. ‘I’ll still be careful. But at least I can relax a bit.’

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