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Rapid response to:


Covid-19: Vaccine candidate may be more than 90% effective, interim results indicate

BMJ 2020; 371 doi: (Published 09 November 2020) Cite this as: BMJ 2020;371:m4347

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Rapid Response:

Consider targeted SARS-CoV-2 immunisation in pre-operative clinics, antenatal clinics, and beyond….

Dear Editor,

Preliminary reports of SARS-CoV-2 immunisations with 90% efficacy are a rightful source of hope(1), and bring into focus decisions regarding prioritisation of delivery. In addition to the simple, and justified, prioritisation of SARS-CoV-2 immunisation by age and comorbidities that forms the foundation of the approach outlined by the government(2), we should also consider highly targeted approaches that optimise the efficiency of healthcare provision particularly in contexts where COVID related disruptions have been most keenly felt.

As has been widely reported, disruptions to healthcare for non-COVID illnesses have been, and continue to be, widespread(3), and already lengthy elective surgery waiting lists have increased dramatically due to cancelations and delays(4). Targeted immunisation delivered in pre-op clinics, combined with the already established prioritisation of healthcare workers, could mitigate some of these ongoing negative impacts, through facilitating the return of elective surgical capacity. Equally, antenatal appointment immunisations of birth partners could facilitate their full presence during childbirth, whose restricted access over the last year has been a considerable source of distress. Other situations where targeted approaches may be relevant include palliative care, as the fear of dying alone due to COVID related restrictions in healthcare settings is a major concern for many people(5).

Decisions regarding immunisation prioritisation are challenging, and simplicity is vital. However, targeted approaches for specific groups could expedite returning capacity to care delivery, and in doing so, mitigate some of the broader negative health impacts resulting from COVID related care disruption.

1. Mahase E, Covid-19: Vaccine candidate may be more than 90% effective, interim results indicate. BMJ. 2020.
2. Department Of Health and Social Care. JCVI: updated interim advice on priority groups for COVID-19 vaccination. 2020.
3. Philip K, Cumella A, Farrington-Douglas J, Laffan M, Hopkinson N. Respiratory patient experience of measures to reduce risk of COVID-19: findings from a descriptive cross-sectional UK wide survey. BMJ open. 2020;10(9):e040951.
4. Griffin S. Covid-19: Waiting times in England reach record highs. BMJ. 2020.
5. Philip K, Lonergan, B., Cumella, A., Farrington-Douglas, J., Laffan, M., Hopkinson, NS.,. COVID-19 related concerns of people with long-term respiratory conditions: A qualitative study. 2020.

Competing interests: No competing interests

10 November 2020
Keir EJ Philip
Respiratory SpR
NHLI Imperial College London
NHLI, Imperial College London, Royal Brompton Campus, Fulham Rd, London SW3 6HP