Covid-19: New data on Oxford AstraZeneca vaccine backs 12 week dosing interval

Dear Editor

We read with great interest your news item (1) titled “Covid-19: New data on Oxford AstraZeneca vaccine backs 12 week dosing interval”. This news is very welcome and vindicates the stand taken by the UK to vaccinate more people with the first dose at the expense of time taken to provide the second dose. Health services across the world have had to make rapid changes to policies in their ongoing response to the Covid-19 pandemic. There has been ongoing debate about the UK government’s decision to delay the second dose of the Pfizer/BioNTech (2) and we responded to this (3). There are other areas of policy where the decision makers have come under criticism. We have discussed on the pages of the BMJ who should prioritise the population for vaccination and how? (4). There has been demand from various sectors including the police (5), teachers (5) and port workers (6) to be included in the vaccine prioritisation list. The prioritisation groups vary across the nations of the world (7). There are some who may refuse to have the Vaccine, such as the care home workers (8) and the question being asked is should they be prevented from working? Non pharmaceutical interventions are key to the success to contain the pandemic. However, this has the potential to infringe on an individual’s liberty. Hence politicians have to make difficult decisions with imperfect and rapidly evolving science.

The decision thus far has been made by elected politicians based on Scientific advice from their advisors. The Government has been criticised for considering ‘Draconian Measures’ to prevent COVID-19 rise (9) as well as potentially paying individuals money, who test positive to self-isolate (10). There is public unease at the increasing number of cases and deaths. Nearly a third (31.2%) of all deaths in England and Wales in the week ending 1 January involved covid-19, show data from the Office for National Statistics. (11)

The importance of involving and actively seeking citizen’s voice is well recognised (12). A Citizens’ Jury is the bringing together of a diverse group of between 12 and 25 members of the public who are usually randomly chosen to represent the cross section of the community. Their task is to work through an issue, share ideas and perspectives, explore options, and eventually come up with a set of recommendations (12). In this country we have world beating system in the form National Institute of Health and clinical excellence (13) which has a track record engaging the citizen in complex and difficult prioritisation decisions when available evidence is incomplete and limited, and resources are scarce. Although citizen’s juries have their limitations (14) they are a key tool in engaging and seeking the voice and perspective of citizens.

In our view this is the best way to move forward, as it will complement shared policy decision-making, thus far the voice of the general public in matter relating to COVID-19 has been largely left unheard. By taking on the citizen’s perspective hearts, and minds of the people can be won, thereby ensuring increase adherence and compliance to help us conquer this pandemic and ensuring that the virus will fail, and humanity will triumph.

Currently many of these difficult policy decisions are defended by politicians and scientists. However, would it not be great if we have an independent voice, a respected lay person as Chair of the NCCJ puts across to the public the views of a cross section of society and how they agreed on their advice to the Government.

Hence our call to the nation is to establish a National COVID Citizen’s Jury to engage the public, increase compliance and ultimately contain the pandemic and save lives and livelihoods. We recommend the government tasks NICE to undertake this important piece work and no doubt as it has been the case on many previous occasions NICE will do a superb job of brining the citizen’s voice to key national decision making in the pandemic era and beyond.

1 Jacqui Wise. Covid-19: New data on Oxford AstraZeneca vaccine backs 12 week dosing interval [BMJ] Published 3 February 2021. [accessed 3rd February 2021]; Available from: https://www.bmj.com/content/372/bmj.n326

2 Revisiting the UK’s strategy for delaying the second dose of the Pfizer covid-19 vaccine [BMJ] 20th January 2021. [accessed 21st January 2021]; Available from: https://blogs.bmj.com/bmj/2021/01/20/revisiting-the-uks-strategy-for-del...

3 Badrinath P. COVID19 Battle – Race to vaccinate the nation: bring on the little boats and let us play our part. BMJ 10th January 2021. [accessed 21st January 2021]; Available from: https://www.bmj.com/content/372/bmj.n18/rr-3

4 Badrinath P. COVID19: The COVID19 vaccination lottery – Who should get it, who decides and how? BMJ 18th November 2020. [accessed 21st January 2021]; Available from: https://www.bmj.com/content/371/bmj.m4471/rr

5 James Bickerton. Teachers and police officers URGE coronavirus vaccine fast track after 'awful' attacks Published 20th January. [accessed 21st January 2021]; Available from: https://www.express.co.uk/news/uk/1386367/Coronavirus-vaccine-news-UK-te...

6 Renee Eng. Port Workers Hope to Be Prioritized for COVID-19 Vaccine Published 3:30 PM ET DEC. 16, 2020 [accessed 21st January 2021]; Available from: https://spectrumnews1.com/ca/la-west/news/2020/12/16/port-workers-hope-t...

7 Aleksandra Krzysztoszek . Polish prosecutors to get priority vaccine access Published 20th January. [accessed 21st January 2021]; Available from: https://www.euractiv.com/section/politics/short_news/polish-prosecutors-...

8 Sarah Knapton, Fifth of staff in some care homes refuse Covid vaccine believing they are 'invincible' Published 17th January. [accessed 25th January 2021]; Available from: https://www.telegraph.co.uk/news/2021/01/17/fifth-staff-care-homes-refus...

9 Tony Winterburn. Boris Johnson’s Government is Considering ‘Draconian Measures’ To curb The Spread of Covid-19 Published 11th January. [accessed 25th January 2021]; Available from: https://www.euroweeklynews.com/2021/01/11/boris-johnsons-government-is-c...

10 Alastair Jamieson, Ashley Cowburn, Coronavirus: Government ‘could pay £500 to everyone who tests positive’ to encourage self-isolation Published 22nd January. [accessed 25th January 2021]; Available from: https://www.independent.co.uk/news/health/covid-payment-500-pounds-posit...

11 Shaun Griffin. Covid-19: Deaths rise after Christmas in England and Wales [BMJ] Published 12thJanuary. [accessed 21st January 2021]; Available from: https://www.bmj.com/content/372/bmj.n100

12 The Scottish Health Council. Our Voice Citizens’Jury on Shared Decision-making Published March 2019 [accessed 21st January 2021]; Available from: https://www.hisengage.scot/media/1170/citizens_jury_final_report_mar19.pdf

13 Rachel Iredale, Associate Professor of Public engagement at the University of South Wales and Katie Cooke, Measuring the mountain’s Project Manager. Report of the Online Citizens’ Jury on Social Care Published 17th December 2020 [accessed 21st January 2021]; Available from: https://gov.wales/sites/default/files/publications/2020-12/measuring-the...

14 Jackie Street, Katherine Duszynski, Stephanie Krawczyk, Annette Braunack-Mayer. The use of citizens' juries in health policy decision-making: a systematic review May 2014 [accessed 21st January 2021]; Available from: https://pubmed.ncbi.nlm.nih.gov/24657639/

Dr Maham Iqbal, GP trainee ST2 Doctor in Public Health, West Suffolk Hospital and Directorate of Public Health
Dr Padmanabhan Badrinath, Consultant in Public Health Medicine, Suffolk County Council & Associate Clinical Lecturer, University of Cambridge. Directorate of Public Health, Endeavour House, Suffolk County Council, Ipswich, IP1 2BX. p.badrinath@suffolk.gov.uk

Disclaimer: The views expressed here are the personal view of the authors and in no way represent the views of his employer, Suffolk County Council.

Conflict of interest: The authors work in a local authority Public Health Department. Dr P Badrinath leads the local specialist COVID response team.