Helen Salisbury: Bumps in the road to covid vaccine rollout
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4925 (Published 21 December 2020) Cite this as: BMJ 2020;371:m4925Read our latest coverage of the coronavirus outbreak
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Dear Editor
Helen Salisbury: Bumps in the road to covid vaccine rollout
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4925 (Published 21 December 2020)
I just wanted to make the observation that the rollout of the Covid Vaccine so far has been hailed as a great success story – and notable this is largely down to hard working, innovative GP Teams up and down the country, who have gone the extra mile to make this happen, largely on goodwill, with staff working long shifts on their days off or holidays to help out, on a poorly costed contract, and with no pump priming funding.
It is striking in a country such as the UK, with a world renowned Primary Care infrastructure, that GP teams have been largely bypassed and unharnessed thus far in the pandemic response, yet £24 Billion has been sunk in private test and trace for example (note the ANNUAL budget for all of Primary Care is around £12 Billion). It is not hard to imagine that if a fraction of that £24 Billion had instead been invested into existing Primary Care and Public Health infrastructure, what a return for the money it would have been, and how it would have strengthened our trusted services, and left a lasting legacy. My colleague Sohie Park lays this out perfectly in this BMJ piece (Ref 1) that “the potential contribution of primary care has been largely overlooked in the UK’s response to covid-19”.
Helen Salisbury is clearly a coal face GP who has organised and run a Covid vaccine clinic. As Helen rightly says the "GP vaccine programme as currently agreed with the BMA will rely on the dedication of an already overstretched workforce, and is certainly in stark contrast to the profligate way that money has been spent on the privatised test and trace system and PPE procurement". Many of the public (& maybe many NHS staff too) do not realise that General Practices are mostly small businesses run by a bunch of partners (Ref2). GPs tend to stay in post for years or decades and work in a flexible way navigating complicated NHS contracts of various sized carrots and sticks paid in arrears for their efforts.
While some GPs have merged to run ‘super practices’ and some GPs are run by corporate chains, on the whole many GPs still tend to be old fashioned ‘Partnerships’ run as small business enterprises, and embedded in their communities. As such they are very flexible, and able to quickly adapt and make changes on the ground. We have seen 2 remarkable examples over the last 9 months:
1) Over the weekend of 14-15th March 2020 nearly all GP Practices totally reconfigured to make ‘hot’ and ‘cold’ zones, and adopted new technology to allow remote working including video calls and advanced SMS with the option to reply with text and photos. This digital revolution happened almost overnight, remains our ‘digital PPE’ and this technology and ‘webside manner’ will doubtless be a lasting effect of Covid-19.
2) Over the last few weeks GP teams nationwide have worked tirelessly and at pace once again to absorb huge amounts of emails and guidance about a very fragile new vaccine, with complex cold chain and reconstitution regulations. We have re-organised our practices once again while trying to maintain core services, setting up mini ‘in house Nightingales’ or renting local halls and gyms with pop up vaccination bays (often in collaboration with local groups of GPs working in Primary Care Networks serving 30-50,000 patients - Ref 3). Our managers and admin teams have been amazing in setting up clinics and calling (by phone) up to 975+ elderly patients at short notice. Despite having fully computerised patient records we have been asked to train up and use a new alien IT system (PharmaOutcomes), which is slowing us down , and does not keep a record in real time (on our own clinical software) of who has been vaccinated. This would be rather useful when we are trying to recall patients at short notice for spare vaccines or have an enquiry about side effects. (Ref 4)
Although the chances of an allergic reaction a to a vaccine are stated as 1 in a million by the Resus Council (Ref 5), the current guidance at present is to observe all patients for 15 minutes post Covid vaccination. The chances of a reaction may be even lower for the Pfizer BioNtech vaccine as it has no egg products used in its manufacture, and also because we are no longer vaccinating anyone with a history of severe allergy or anaphylaxis.
The "15 minute wait" poses a huge logistical challenge, compounded by social distancing rules, and is making it an ever greater challenge to vaccinate at pace with a time limited batch of the Prizer BioNtech vaccine (as we only have 3.5 days to use up 975 doses from delivery).
Surely the chances of someone (patient or carer) acquiring an infection while waiting around for 15 minutes following a covid vaccination are much higher than 1 in a million ? And one could also argue that anything which slows down the rate at which we can offer a mass vaccination programme (assuming a ready vaccine supply) is leaving far more patients at risk for longer, and is thus far more likely to cause harm (and NHS work), that a 1 in a million allergy risk?
If we truly wish to ‘protect the NHS and save lives’ then perhaps the MHRA and CMOs need to carefully look at the true risks of an allergic reaction (and thus the need for a 15 minute wait for all patients following a Covid vaccine), compared with the risk of the wait itself, and the benefits of vaccinating our vulnerable patients at pace to help prevent further morbidity and mortality - while working towards herd immunity ?
REFS
1) https://www.bmj.com/content/370/bmj.m3691
2) https://www.kingsfund.org.uk/publications/updated-gp-contract-explained?...
3) https://www.kingsfund.org.uk/topics/general-practice/primary-care-networ...
4) https://twitter.com/HelenRSalisbury/status/1341425615505940487?s=20
https://twitter.com/fentonaw/status/1340035519414153217?s=20
5) https://www.resus.org.uk/about-us/news-and-events/rcuk-publishes-anaphyl...
Competing interests: No competing interests
Issues more pressing than vaccine rollout for the collective welfare
Dear Editor,
The core issue is not vaccine rollout but is the answer to the question: will vaccines work ? Vaccines have been developed extraordinarily fast for this pandemic, with policymakers and pharmaceutical companies collectively taking a very strange decision bound certainly not by medical criteria but by a pseudopolitical purpose which is to offer guarantee that "it will be over soon", disrespecting all rules of vaccine theory, in particular the fact that you need to have a stable target, a virus / bacteria that has stabilized after circulating for very long (thousands of years...) over the population. The bet of decisionmakers is clearly the placebo effect : that a constant stream of reassuring news will produce the jump in immunity, from some feel-good-induced chemical reaction in the body of the commoner, together with the vaccines.
This is totally opposed to the rapid stream of mutations that is natural with a virus that both circulates very rapidly and has a relatively mild lethality rate, in a population that is very dense, strongly contaminated with alpha-emitting nanoparticulates (the main weakener of internal immunity, as I have demonstrated with wideranging WHO DALYs data in the chapter on alpha-emitting nanoparticulates in my From an Einstein Syndrome to the People - see also my peer reviewed papers through my blog www.florentpirot.blog - the BMJ once published an article on how the WHO itself was suppressing evidence on depleted uranium and health https://www.bmj.com/content/333/7576/990.2 - these nanoparticulates, that have many sources, natural and artificial (not only DU... radon, particles in diesel and other fuels, in phosphated fertilizers (hence Po210 in cigarettes), in coal, for instance), are also the most important source of virus & bacteria mutations, this was also dealt with in the alpha-emitting nanoparticulates chapter in my book, three draft versions being also archived https://hal.archives-ouvertes.fr/hal-01786377v3). It seems that ONE of these mutations has attracted considerable media attention - the first one happening after MY paper on Salvia officinalis & Salvia microphylla against COVID19 has been published (https://doi.org/10.28933/ijcr-2020-11-1805). Yet many mutations happened already before. Further, that one new mutation does not lead to any serious questioning as concerns the many vaccines being commercialized... It is blankly asserted that the mutation does not change anything.
Indeed with a placebo bet, the real efficiency of the vaccine does not matter so much as matters the suppression of contradictory news in the media. It's about repeating always and always the same message. Together with another which is that "it is technology that will save humans". People that have no real relation to nature but see themselves as part of a civilization concept, eat meat and have forgotten their genetic closeness to the veggie-eating bonobo... trying to pretend to themselves and to others that they can have control of human bodies that, themselves are part of the same nature they do not really understand. It is pretty much "group theory" - that by surrounding the weak, with hugs, by concealing them the true harshness of the outdoors they will spontaneously heal, like a Magic Kiss effect - in the bubble.
With vaccines as with drugs a big issue is cytokine-storm-syndrome like effects. A number of cases have already arisen, clinical trials have not shown the perfect innocuousness of vaccines. In a body saturated with alpha-emitting nanoparticulates, with a mRNA vaccine for instance, when the virus comes, one alpha decay can get part of the mRNA into the virus, teaching it a new ability that makes it able to thrive in the conditions that were aimed at destroying it. Likewise in cytokine storm syndrome with a drug, the virus gets part of the drug into its RNA or DNA and learns to feed on the drug (explaining the explosive nature of CSS). With an inactivated virus the alpha decay may cause a mutation that wakes up said inactivated virus.
Professionals have to stop believing in the saint-simonism that has driven medical research until now - the Promethean nevrosis of humans believing they can thrive without nature, believing they can deal with genetic codes as blocks like masons using bricks to build walls... Many drugs of pharmaceutical labs are actually copies of natural chemical compounds taken from far away (in a jungle, in coral reefs...), reuniting with the original components instead of their synthetic copies makes for more efficient cures, but it also is an issue of individual behaviour, with the need for diets free of animal products, for a much broader information of the public on the dangers for health of alpha-emitting nanoparticulates, and hopefully a transformation of the pharmaceutical industry into other businesses (for instance purification of soils with naturally high radioactivity, extracting alpha-emitting nanoparticulates significantly improves agricultural productivity) after medicinal plants take the market space they are entitled to.
Competing interests: No competing interests