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Helen Salisbury: Don’t squander patients’ trust in the vaccine rollout

BMJ 2021; 372 doi: (Published 04 January 2021) Cite this as: BMJ 2021;372:n3

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Re: The ethics of delaying the Pfizer BioNtech boosters. Poor comms strikes again...

Dear Editor

Helen Salisbury is quite right, and many GPs nationwide were caught in the same ethical conundrum. Ultimately as Doctors we all wish to work within the ethical frameworks laid down under Good Medical Practice, and also strive to provide safe, evidence based holistic care, while maintaining the trust of our patients. The decision over the delayed Pfizer BioNtech boosters has unnecessarily caused a lot of upset, and workload, and has to some extent undermined patient confidence in the vaccine programme. This is compounded by the WHO stating that they recommend the boosters should be given at 21-28 days:

Within our own PCN (Primary Care Network) we decided unanimously to honour those booked for a 3 week Pfizer BioNtech booster as it felt both unethical and impractical to cancel those who had consented to that schedule.

Our full reasons are detailed here:

Communication has been an ongoing concern during the pandemic. We have had numerous mixed and confusing messages throughout, which potentially pose a public health problem of their own. David Oliver wrote an excellent article on the damage of poor communication on 21.10.2020 which sadly holds true:

With regards to the Pfizer BioNtech boosters, the problem has once again been caused by poor communication. This has yet again caused a lot of totally avoidable upset and distress to patients, work for GP teams, and created a further postcode lottery of who gets their vaccine when, and under what schedule. A far simpler more consistent message would have been for the UKG to explain the rationale for moving the Pfizer BioNtech boosters to 12 weeks (which from my own experience so far this week patients do understand and are happy to consent to when attending for their 1st jab). After the decision was made to delay boosters to 12 weeks, the UKG could simply have stated that this would be the policy moving forwards, and anyone already consented to their 3 week booster would be allowed to have it as planned.

Given the optimism we had over the licence of the Oxford Astra Zenica vaccine the very same day this debacle happened, the UKG have simply scored yet another PR own goal, and once again eroded public trust and confidence in their handling of the Pandemic.

Yours sincerely


Competing interests: I must declare that I had my initial Pfizer BioNtech vaccine on 19.12.2020, and will now probably have my own booster delayed. Being under 50yo and thankfully no risk factors, this feels the correct decision if it allows another person the chance to start their immunisation schedule. I have to trust that the Pfizer BioNtech boosters will be available as promised before 12 weeks, or there will be another difficult decision to make about the safety of 'mix and match' and a further cohort of patients to counsel once again..... Let's hope we do not have that problem too.

06 January 2021
Simon Hodes
General Practitioner
Bridgewater Surgeries, Watford, UK