Hundreds of thousands of Britons who received the AstraZeneca vaccine are feared to have missed or even rejected their second dose in recent weeks, leaving them vulnerable to infection from the Delta coronavirus variant.
GPs and other experts believe that anxiety over the vaccine’s link to a rare blood-clotting disorder could be partly responsible, alongside general concerns over side effects, misapprehension around the benefits of two doses, and the failure to make time for a second jab as people return to their “busy lives”.
Between 400,000 and 600,000 people eligible for a second AstraZeneca dose have yet to come forward, analysis suggests.
The latest government data shows that 23.9 million people had received two doses of AstraZeneca up to 18 August. Under the original 12-week dosing schedule, this is 400,000 short of the 24.3 million individuals who had been given a first jab on or before 26 May.
But in line with the revised eight-week dosing schedule, which was first implemented in July and allowed people to bring forward their second appointments, the 23.9 million figure is also 600,000 short of the 24.5 million individuals who had received their first shot on or before 23 June, meaning they were eligible for a second dose on or after 18 August.
One doctor said that “vaccination does not seem a priority to some people any more”, while another estimated that “roughly 10 per cent” of over-40s have not returned to his clinic for a follow-up jab.
Those who have skipped their second dose remain vulnerable to infection and potentially serious illness. Evidence shows that one jab offers between 30 and 35 per cent protection against the Delta variant – a figure that rises as high as 88 per cent after two shots.
“If significant numbers of people have only one dose – when combined with those who have no doses – this will leave many people at risk of serious illness from the Delta variant,” said Azeem Majeed, a professor of primary care and public health at Imperial College London.
The vast majority of those who have yet to receive a second AstraZeneca jab will be 40 or over, after the decision was made in mid-May to restrict its use in younger adults and offer the Pfizer vaccine instead.
This followed the revelation that the AstraZeneca vaccine can cause an exceptionally rare type of clotting within the brain. The incidence rate for under-50s is estimated to be 1 in 50,000 – though the risk of falling ill from Covid is far higher.
The number of people coming forward for a second dose has slowed since the beginning of July, figures show, to the point where many GPs and vaccination clinics across England are no longer stocking supplies of AstraZeneca, having offered the vaccine to all over-40s in their area.
Dr Ollie Hart, the clinical director of Heeley Plus PCN, in Sheffield, said: “We offered to all and have stopped that part of our vaccine programme now.” One clinical director of a vaccination centre in Lambeth, south London, said they hadn’t been administering AstraZeneca for the past eight weeks.
Of the estimated 600,000 people who haven’t received their second AstraZeneca dose on time, it is hoped that a proportion may still come forward. However, there is concern that many are unwilling to do so.
Susan Michie, a professor of health psychology at University College London, said there had been a tendency in the media to discuss the clotting risk posed by the AstraZeneca vaccine, which is low, “without highlighting the incomparably higher risks of Covid”.
“This may have led some of those who have had an AstraZeneca vaccine not to have the second one,” she said.
First AstraZeneca doses
Second AstraZeneca doses
Up to 18 August
*The latest data published up to 18 August by the Medicines and Healthcare products Regulatory Agency (MHRA). Unlike the UK’s coronavirus dashboard, the MHRA provides information on which types of vaccines have been administered but is not as up to date.
Prof Majeed also acknowledged that concern “about reports of serious side effects” may have discouraged people from getting their second AstraZeneca dose, but said there were likely to be other factors at play. “People who don’t want to attend for a second dose may have had side effects after one jab … or are not convinced about the benefits of two doses,” he added.
Dr Dean Eggitt, a GP at Oakwood Surgery in Doncaster, suggested people have become “busy in life” again and are therefore not making the time for a second jab. “I think the country has got bored of the pandemic and is reverting to normal activities,” he said. “Vaccination does not seem a priority to some people any more.”
Kamlesh Khunti, a professor of vascular medicine at Leicester University, said it was a “possibility” that the holiday season was delaying the time it takes for people to come forward for their second jab beyond the recommended eight-week gap.
Health officials expect there to be a considerable amount of variation across the country. In Sheffield, Dr Hart estimated that “roughly 10 per cent” of people vaccinated at his clinic had not come forward for a second dose.
In Doncaster, data shared with The Independent suggests that up to 11 per cent of people who received a first AstraZeneca dose have not come forward for their second. Throughout July and the beginning of August, just 871 follow-up jabs were administered in the town’s central vaccination sites, down from 12,630 in the two months before.
Dr Ruth Hutt, the director of public health for Lambeth, said there was a “small contingent” of people who hadn’t come forward for their second dose in the borough. “There is work to be done there,” she added.
Determining the exact scale of the problem will require the publication of more detailed vaccination data from the government, including a clear breakdown of “which groups are not going for their second jab”, said Prof Michie.
She urged ministers to “ensure that there are people and forums where those with concerns about the second vaccination can ask questions and engage in a two-way dialogue about the risk-benefit balance”, while Prof Kunti said officials would need to “continue monitoring this if it is an early signal”.
The London-wide Local Medical Committees, the representative body for doctors and their practices in the capital, said GPs are not allowed to stock AstraZeneca vaccine supplies – despite it being safe to do so in normal fridges.
“This means practices cannot provide on-the-spot vaccinations for people who have attended for a routine appointment and decided to go ahead with vaccination following a conversation with a GP or nurse. This is an opportunity missed,” said medical director Dr Elliott Singer.
A government spokesperson said more 78 per cent of of adults in the UK had been double-jabbed, adding that the latest ONS data showed that 98 per cent of adults who had received their first dose said they were likely to have a second.
“The benefits of the vaccines against Covid-19 continue to outweigh any risks. The vaccines have already saved around 105,900 lives and prevented 24.1 million infections in England up to 20 August, according to the latest data from Public Health England and Cambridge University,” they said.
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