Our spokesperson Dr Steve Taylor was on Good Morning Britain to talk about a new drive to encourage uptake of the MMR jab

The Doctors’ Association UK (DAUK) has supported a national campaign to boost the uptake of the MMR vaccine following a rise in cases of measles.

NHS England is urging parents and carers to book children in for their missed measles, mumps and rubella (MMR) in a drive to protect children from becoming seriously unwell.

Our spokesperson Dr Steve Taylor, a GP in the north west of England, was interviewed on national television today about the importance of being vaccinated against measles and where people can get immunised.

Speaking to ITV1’s Good Morning Britain, Dr Taylor said: “I’m old enough to remember when it was quite a serious condition.

“The MMR vaccine was introduced in 1988, and since then we’ve hardly seen measles.

“Measles is a horrible condition. It’s a horrible illness to have as a child, and sometimes it’s really bad.”

Dr Taylor said that people whop have not been vaccinated should contact their GP to arrange an appointment.

“It’s very easy to do,” Dr Taylor added.

These are the UK coronavirus stories you need to know about today.

Latest on Jabs vs Variants

The Pfizer/BioNTech and Oxford/AstraZeneca vaccines were less effective against symptomatic COVID-19 when people were exposed to the Delta variant of SARS-CoV-2 compared with the Alpha variant, according to a study in the New England Journal of Medicine.

After two doses:

• Pfizer/BioNTech was 93.7% effective against Alpha, and 88% against Delta
• Oxford/AstraZeneca was 74.5% effective against Alpha, and 67% against Delta

“The fact [that] there is still notable effectiveness is encouraging. However, complacency is not warranted, since the virus will continue to cause at least mild disease even in some [of] those vaccinated with two doses,” Stephen Evans, an epidemiologist at the London School of Hygiene & Tropical Medicine told Medscape Medical News.

Pay Strike?

There’s been more reaction to the 3% NHS pay rise for England and Wales that was announced yesterday evening. It was said to be in recognition of “extraordinary” pandemic efforts.

Doctors’ Association UK said it was “callous” to exclude junior doctors from the increase.

Chair, Dr Jenny Vaughan, said: “Any improvement on the derisory 1% previously offered to NHS workers is welcomed, but 3% barely takes the edge off the erosion of doctors’ pay over two decades. Doctors in the NHS have suffered a 30% pay cut in real terms, and after inflation this ‘pay rise’ will ultimately be a pay freeze. DAUK’s campaign ‘fair say for fair pay’ demonstrated the extremes staff have been put through during the pandemic – the effects of which are only starting to be realised.

Read the full article here.

‘It is natural to be fearful of something so new, but as a doctor, I urge those hesitating to weigh the balance of risks and base the decision to be vaccinated on the science.’

‘Based on the current data available, it is entirely possible that the risk of the vaccine causing clots is zero and the cases are coincidental. The MHRA estimates there is around a one in 250,000 risk (four per million) of developing blood clots from the AstraZeneca vaccine in the UK.’

‘The background risk is uncertain but is estimated to be between two to 16 cases per million people each year…To put this into context, women have been dealing with the risk of developing a blood clot from taking oral contraceptive pills for years…Millions continue to choose it and take it safely – and indeed, an unplanned pregnancy presents an even greater risk of blood clots than taking the pill.’

Dr Ellen Welch

Metro article written by DAUK’s Editorial Lead, Dr Ellen Welch, who gratefully received both doses of the AstraZeneca vaccination while pregnant and would happily do so again!

What is the ChAdOx1 nCoV-19 vaccine?

Developed by Oxford University in partnership with AstraZeneca, the ChAdOx1 nCoV-19 vaccine is a replication-deficient chimpanzee adenovirus that has been engineered to express the coronavirus spike glycoprotein gene. This method of vaccine delivery makes use of our lack of pre-existing immunity to chimpanzee adenoviruses, conferring immunogenic properties that stimulate the immune system to mount a response against both the adenovirus and the coronavirus spike protein it carries.

Efficacy of ChAdOx1 nCOV-19

Phase 2 trials, the results of which were published in November, demonstrated the ability of ChAdOx1 nCoV-19 to stimulate spike-specific humoral and cellular immune responses in trial participants. In comparison, this latest paper published in the Lancet describes the interim results of phase 3 trials for the vaccine, representing the first peer-reviewed publication of SARS-Cov-2 vaccine efficacy to date. The purpose of these phase 3 trials is to assess the safety of the vaccine, and to determine whether the ChAdOx1 nCOV-19 vaccine protects against symptomatic, virologically confirmed COVID-19.

11,636 people in total participated in the phase 3 trials in Brazil and the UK; participants in each trial were randomly allocated to receive either a prime-boost regimen of the ChAdOx1 nCOV-19 vaccine, or a control product (two doses of the meningitis MenACWY vaccine, or MenACWY followed by saline). Across both studies, 5807 people received the vaccine, of which 0.5% went on to develop symptomatic COVID-19 at least 14 days after receiving the second dose of vaccine. In comparison, 5829 people were allocated to the control group, of which 1.7% developed symptomatic COVID-19. Vaccine efficacy was calculated to be 70.4% from these results.

Though all participants in the vaccine arm of the trials received an initial dose followed by a booster dose, this initial dose varied between cohorts. In the Brazil trial, all subjects in the vaccine arm received two standard doses, whilst in the UK trial, the vaccine arm comprised two cohorts with different dosage regimens: low-dose followed by standard dose (LD/SD), and standard dose followed by standard dose (SD/SD). Though it was originally planned that all subjects in the vaccine group would receive two standard doses, the batch of vaccines administered to the initial cohort was retrospectively found to contain a lower dose of ChAdOx1 nCOV-19 viral particles than intended. The reason for this was unexpected interference between a non-active ingredient of the vaccine and the spectrophotometry assay used to measure the viral dose being used. This was amended for subsequent cohorts, who received the standard dose for both initial and booster doses.

When participants in the vaccine arm are split into subgroups according to dose regimen, the analysis shows a significant increase in vaccine efficacy in the LD/SD group within the UK trial (reported as 90.0%), compared to the SD/SD group taken as a whole across both trials (62.1%). Age was considered as a possible confounding factor in these results, given that LD/SD participants were all 18-55 years, in comparison to the SD/SD group which included participants in the 18-55, 56-69, and ≥70 age groups. The interval between doses also varied between the LD/SD and SD/SD groups: in the LD/SD group, only 0.8% had a second dose within 8 weeks of the first dose – this was because the LD/SD group had already received the priming dose when, on the basis of antibody response findings in the UK phase 1/2 trial, the phase 3 trial protocol was modified to a two-dose regimen. Subgroup analysis restricting the UK SD/SD group to participants aged 18-55 with less than 8 weeks’ interval between vaccine doses did not substantially alter the finding: vaccine efficacy in the restricted UK SD/SD group did increase slightly (from 60.3% to 65.6%), but with a higher p-value and wider confidence intervals implying more uncertainty about the result. In the discussion section of the paper, the study authors suggest several possible mechanisms that could explain this unexpected finding.

In addition to symptomatic COVID-19 infection, the study looked at whether there was a difference in the number of COVID-19 cases occurring more than 21 days after the first dose of vaccine, compared to controls. This analysis was restricted to participants that received two standard doses of the vaccine. Overall, ten cases requiring hospitalisation occurred >21 days after the first dose, notably all of which were in the control group. Of these participants, two had severe COVID-19 (WHO score ≥6), and one case was fatal.

Preliminary results as to whether the vaccine reduces incidence of asymptomatic infection, which was detected in the UK trial through weekly NAAT testing of participants, are also published in this paper. In the UK trial, the incidence rate of asymptomatic infection was slightly reduced in the vaccine group compared to the control group, with vaccine efficacy calculated as 27.3%. As the study authors note however, the wide confidence interval for this result suggests a need for a greater sample size in order to draw reliable conclusions.

One limitation of this study is the lack of efficacy data for older adults, with only 8.3% of participants aged 56-69 years, and 3.8% of participants aged ≥70 years. The study did not perform subgroup analysis for vaccine efficacy stratified by age group due to the limited data, however this has been identified as a priority once further data becomes available.

Safety profile of ChAdOx1 nCOV-19

Safety analysis for the vaccine included data from 23,848 participants enrolled in four trials. This included participants from the earlier phase 1/2 studies (which evaluated safety and immunogenicity of the vaccine) in the UK and South Africa, in addition to participants in the vaccine arm of phase 3 trials. A similar number of adverse events were recorded in trial participants that received the vaccine and those who did not: 84 adverse events classified as either serious or of special interest occurred in vaccine recipients, versus 91 adverse events in participants who received MenACWY or saline. Of the adverse events in the vaccinated participants, only two were considered to be possibly related to the vaccine, including one case of transverse myelitis, and one case of fever >40°C.

Conclusions:

Overall, these interim results suggest that the Oxford-AstraZeneca vaccine has an acceptable safety profile and is effective at reducing symptomatic COVID-19 infection. The authors also identify several unanswered questions that additional data and subgroup analysis will help to resolve as the study continues, including the duration of protection offered by the vaccine, whether vaccine efficacy is affected by age, ethnicity, and dose regimen, and the ability of the vaccine to prevent asymptomatic spread of the virus.

Jenny said: “Our NHS heroes are still fighting this virus even though the days of clapping at 8 o’clock are well behind us. Those risking their lives deserve clarity and assurance that they matter.”

Zainab added: “Heading into the toughest winter the NHS has ever seen, the announcement of a new, more transmissible strain of COVID-19 could have disastrous impacts on frontline staff and patients if the government does not act now.

“Without a universal policy to vaccinate frontline patient-facing staff as a priority, and no review of current PPE guidance, we could be facing avoidable staff sickness and absence over the already difficult winter months. We are also concerned that, without escalating the current PPE guidelines, staff themselves will be at risk of not only contracting the virus but passing it onto the vulnerable patient population.”

The article also highlights the results of a DAUK survey indicating that most frontline doctors have “no idea” when they might get the vaccine.

Article is available at: https://news.doctors.net.uk/news/32369 (account needed)

DAUK’s Lizzie Toberty was featured in this Bloomberg article that highlighted the communication failures that risked derailing the mass vaccination in response to the pandemic.

“There’s always this underlying feeling of chaos … Our worry is that if we’re having problems delivering flu vaccines which we deliver to a limited number of people every year, then how can we be confident if we organize a Covid-19 program that the supply chain is definitely going to be there?”

The article can be found at: https://www.bloomberg.com/news/articles/2020-11-25/row-over-england-flu-shots-prompts-fear-of-covid-vaccine-chaos

Dr Lizzie Toberty is a GP in Sunderland and a member of the Doctors’ Association UK, a doctor-led grassroots lobbying and campaigning group advocating for the medical profession and the wider NHS.

She said:

“We can do it, I believe that we can, but we need to be given the right support, we need to be given the right information and we need to be given the right resources and right now we’re lacking on all three.

“The way it’s been negotiated with NHS England and between the GP committee (GPC) at the British Medical Association (BMA) has been rushed.”

Read the full article here: