This morning I had a scheduled flu shot and a surprise COVID jab in a special Saturday session run by my G.P in London. I had already booked my 2 minute slot for the flu vaccine but got a message via the NHS app that they also had COVID boosters available today only. The clinic was extended to allow anyone in the target group to turn up. (For the record seven hours in: Right arm — Pfizer BioNTec Comirnaty covid vaccine — no problem. Left arm — flu vaccine — a bit sore)
The eligible groups and roll-out are very different in England compared to the USA. (The arrangements in the other home nations are almost identical) The approval of vaccine safety and efficacy goes up to government minister level and is based on advice from the Chief Medical Officer. In turn they receive recommendations to approve use and a recommended roll-out schedule from senior doctors and researchers. (In practice the four CMOs co-ordinate. England with the largest in the union, therefore with the largest budget, doing much of the heavy lifting). Once approved, implementation of the plans is handed over to the NHS. Here is where there are the most significant differences, one of which caused my surprise at getting the COVID shot.
One part will cause surprise to Americans — not everyone is eligible for a free vaccination from the NHS, This is a cost factor. With previous exposure to the flu and COVID viruses and for most previous vaccination against COVID, the vaccines are considered redundant for large groups of people. The prime purpose of vaccines is to reduce the severity of disease and, in the case of the UK especially, reduce demand for hospital beds. Consequently the eligibility for a free COVID vaccine is now the same as for free Flu vaccination on the assumption that those otherwise healthy will have mild disease. In the UK it probably helps that there is fully paid sick leave by law that many do not mind a week at home with man flu. ( /s)
Broadly the emphasis is on those at most risk from the disease and those who care for them or share their household. The main change was to raise the age of general access to free shots from 50 last year to 65 this. Those over 65 without comorbidities like me (OK, I could do with loosing a kilo or ten) got their last booster a year ago, Note that the general roll-out is by age cohort, starting with those over 85 living in the community.
The NHS vaccination service usually arrange sessions in care homes and hospitals first of all. With the NHS the early cohorts of vaccinees (?) in the community are invited make an appointment. For flu these are sent out automatically by SMS and NHS app messages or letter, by the GP (or their staff). The doctors can flag on the computer records for carers or those at risk from comorbidities for them to be invited early.
I’ve known Dr M, the Principle partner in the practice, for many years. Even from the days before the fancy new building was put up. He’s a lovely Muslim chap of South Asian (Indian) descent. He is well respected in the Muslim doctors’ association in the UK. (I mention his religion because of some historically different positions in Islamic medicine like openness to “alternatives” like acupuncture if they work for the patient.)
Sadly he us too busy running his team these days to do much coalface work but he seems to enjoy running the Saturday clinics he has down to a T. The building has a long corridor of offices with an emergency exit leading off one waiting room. On the Saturdays the flow is reversed. One of the clerical staff sit in the lobby by the “exit” and do check-in and previously did the screening in case of egg allergy. Nip down the corridor to sit in the vacant of two chairs, expose arm, wished goodbye. That’s how he can give bookings every two minutes.
This time it was just a receptionist for check-in, give name to the practice nurse. I must admit I was a few minutes late but I was the last “flu” callup and the waiting room/shooting gallery was empty. It was good to see Dr M. So after deciding to get the flu shot in my already bare left shoulder (unseasonably warm day so was wearing a T-shirt) we moved on to the right. As he was busy I asked which of the approved boosters it was. Dr M, “OK I’m now going to give you COVID. Me: “I hope not!”. Nice to have a bit of banter with him.
My surprise was getting them both at the same time as the roll-out only started a few weeks ago and that the GP did it. His surgery is fairly big and well equipped but he does not have the deep freeze fridges needed to store the vaccine. Previously the COVID vaccines were given at hospitals or bigger community health centres which had. I think I have solved the mystery. The surgery is close to a sheltered housing/care home facility with others nearby. I suspect a Vaccine Service team had arranged to vaccinate their residents and staff but had “extras”. Rather than waste them they obviously called on Dr.M. Whatever, it saved the slog to the hospital session.even if it is a nice location in a big tent opposite Parliament.
These vaccines do provide protection from the scary new variant and cross-immunity from exposure to other variants and previous vaccines will protect those not in at-risk groups from serious illness at least in the UK with known levels of very high exposure. (from various data sources including government sampling and the ZOE COVID tracking project) Those in high risk groups, carers and in accommodation with them should certainly seek a booster as soon as they become available.