The tricky business of vaccinating young people…

Wednesday and Saturday for the past 8 weeks have been vaccination days in the pharmacy. The community pharmacy Covid19 vaccination service (CPCV) was launched at the end of March and 340 out of our 525 pharmacies signed-up. It’s a well-planned service and pharmacists have considerable clinical freedom and autonomy to get on with vaccinating the age cohorts, in support of GPs and the bigger vaccination centres, with one key requirement; no wastage of the precious vaccine! We get ten, 4 ml AstraZeneca Covid19 vaccine vials at a time, each vial with eight 0.5 ml shots and once opened a vial must be used up in 6 hours. So to avoid wastage and let the dispensary day job continue we plan clinics that aim for 18 patients a day (two vials) knowing there is really nine-shots in a vial and some clients will not turn up (DNAs). In the beginning, this strategy worked and once we had a three-vial day with 27 vaccinated with no wastage. It might seem modest but with 340 pharmacies in the programme could add conservatively 40,000 vaccinations a month. Adding community pharmacies to the list of vaccinators addresses a key challenge for any large vaccination initiative; assuring public access. One of the outstanding achievements of the UK Covid19 vaccination programme is the accessibility of the vaccine to the population.

It’s great to be actively at the heart of one of the most impressive clinical interventions ever. We started at the end of March first jabbing the over-50s who are a pretty compliant bunch; the fag-end of the Baby-Boomers, a group still with a vestige of peace and love and a modicum of social conscience. They turn up, they turn up on time, they present their deltoid muscles and they don’t moan. They know that the vaccine is for them but it is also for others.

Then the age cohorts dropped to the over-45s, then the over-35s and finally the over-30s and now today it’s down to over 25s with informed consent; the Millennials and Generation Z. As we descended the age groups, resistance to vaccination increased exponentially. Younger vaccinees, the cohort that includes my children, are, and I risk a gross generalisation here; petty, self-obsessed and risk-averse and boy does a lure-fitted needle put the fear of God into them. What a bunch of ninnies and as a parent I accept my responsibilities for this.

The task of engaging the Millennials, and now Generation Z, is harder than I ever imagined. If it wasn’t difficult enough, in early May the UK Vaccination Board (JCVI) lobbed a grenade into vaccine public confidence. Rare clotting disorders associated with the AZ vaccine were not going away. The UK medicine regulator MHRA investigated 279 cases linked to 45 deaths out of 27 million vaccinations. This is roughly a risk of 1 clotting event in 100,000 vaccinations and 1 death in 500,000 vaccinations. This story, according to the media editors, was worthy of headlines for about four days just as the 30-somethings were coming to the realisation that they might need a vaccine certificate to drink in the pub or dance in Ibiza and thus were finding the motivation to come forward. Why did our media editors choose not to cover the risk of myocarditis with the Pfizer jab? Then government offered to provide an alternative to the AZ vaccine for the under 40s while saying this age group could still have the AZ vaccine if they wished. Confusing mixed messages.

There was an immediate impact. I had five DNAs out of 18 booked. They simply didn’t turn up. I phoned the first 10 on my emergency backup list but all asked if my vaccine was the “one that causes blood clots” and since it was, they would wait for the Pfizer vaccine. We couldn’t offer the Pfizer vaccine, I explained, because to provide it would require a fridge that could freeze a penguin. And other pharmacies are reporting the same. Many are cancelling clinics because they have so many DNAs or cancellations and can’t risk major vaccine wastage. The bizarre effect of this is it is stopping those who want the vaccine from getting it.

I thought that this age group had little insight into their numerical, mathematical and statistical ignorance. The risk of one of them dying from a vaccine-related blood clot is similar to getting killed by lightning. The risk of dying from drinking alcohol is similar at 1 in 800,000, as is drowning in the bath – a swimming pool is way riskier with a drowning risk of 1 in 450,000 and the riskiest thing they could ever do is to get into a car as the risk of being killed in the next year in a road traffic accident is 1 in 17,500. If you are so worried about risk, why; drink alcohol, take a regular bath, walk in a park when there are clouds in the sky or get in a car? Millennials are not so ignorant. They tell me their risk of dying from Covid19 is 1 in 500,000 so why would they get vaccinated as this is the same as the vaccine blood clotting death risk. They are wrong on the risk but at least they are using some form of risk-benefit analysis which authorities have completely failed to counter.

We have failed to properly recognise the inherent individualism in this age cohort. Motivation to get vaccinated comes from personal values, beliefs and a clear selfish benefit. Politically motivated rumblings about the AZ vaccine in March were politically motivated and now we have almost destroyed the credibility of this excellent vaccine certainly in the eyes of younger age groups. This risks a failure in our vaccination programme and potentially severe consequences.

It’s time to consider other approaches and Brian O’Neill has already suggested these. Stop them visiting the pub or flying to Ibiza or refuse them the £100 August bonus until vaccinated. This approach was used in the 1950s with the Rubella vaccine and it improved uptake. We also need to get other vaccine options into GP practices and community pharmacies to assure access. Evidence suggests the Pfizer vaccine is stable at 2 to 8^o C in a normal fridge for at least a few weeks. Above all we need to robustly clarify the facts on which this age-cohort make informed choices to perhaps opt for the AZ vaccine which is still a very safe and effective vaccine. Otherwise, I will be wasting more of the AZ vaccine and be blocking those who are keen to get it because some people just don’t show up.

Photo by spencerbdavis1 is licensed under CC BY-NC-SA