Transplant patient Steve Richardson has barely left his house since the end of February last year, because he’s terrified of catching Covid. And with good reason.
The 38-year-old logistics manager suffered kidney failure, and in December, after a torturous ten-month wait, he finally underwent a kidney transplant. But the drugs Steve takes to ensure his body does not reject the new kidney suppress his immune system – and, unfortunately, this has rendered the Covid vaccine ineffective on him.
He’s not alone. About half a million Britons with similar conditions are in the same boat: expected to produce few Covid-fighting antibodies despite being double-jabbed.
Steve Richardson, 38, from Lincolnshire, pictured right with his wife Donna, suffered kidney failure and had a life-saving transplant in December. However, the anti-rejection drugs he needs to take suppress his immune system leaving the Covid-19 vaccine ineffective
Transplant recipients receive far less protection from the Covid-19 vaccination because of the drugs they take to suppress their immune systems to prevent their body from rejecting the organ
And so, at the beginning of last month, the Government announced extra ‘top-up’ doses for this group – officially called a third primary dose – in a bid to give their immune systems a fighting chance.
Studies show that in 60 per cent of these cases, a third dose does have the desired effect. And if it does, Steve will finally be able to start living a normal life again.
But there’s been a problem. Charities and campaigners say scores of patients across the country who are eligible for third primary doses are yet to be given one, or worse, have been told they can’t have one. And that’s because many GPs, and even hospital consultants, aren’t aware of the programme.
Part of the confusion has come from the timing of the announcement. The third primary dose plan was launched on September 1. Two weeks later, on September 14, the Government announced that all over-50s would get a booster shot – which is something different entirely.
Boosters are being offered because the latest evidence suggests the effect of the vaccine is beginning to wane in those who had their shot at the start of the year.
It’s confusing, to say the least, says Dr Michelle Willicombe, transplant lead at Imperial College NHS Healthcare Trust and an immunology researcher: ‘There is a large group of highest-risk patients who we now know need three doses of the vaccine, not two, in order to mount an immune response. Unfortunately it seems the message has got confused by the introduction of the booster programme.’
It means, experts say, that healthy over-50s are being offered an extra boost of protection ‘just in case’ the immunity from their first two doses has worn off, while others – who are genuinely vulnerable – are being left without any protection at all.
Charities including Kidney Care UK and Blood Cancer UK have reported an influx of calls from anxious, sick patients who feel they’re being left behind as they haven’t been invited for their third primary dose and don’t qualify for the booster as they are under 50.
Charities including Kidney Care UK and Blood Cancer UK have reported an influx of calls from anxious, sick patients who feel they’re being left behind as they haven’t been invited for their third primary dose and don’t qualify for the booster as they are under 50
‘Last week we had about 500 calls from people struggling to access their third jab,’ says Fiona Loud, policy director at Kidney Care UK. ‘Everyone is saying the same thing: help, my GP hasn’t heard about the third primary dose.’
Last week The Mail on Sunday’s GP columnist Dr Ellie Cannon wrote about the baffling situation – and we’ve been inundated with letters from readers who are facing similar battles.
Now, in an effort to clarify the situation, we’ve spoken to some of Britain’s top experts to find out what’s going on, and explain what patients should do.
For Steve, from Lincolnshire, accessing his vital third primary dose has proved to be a battle after his hospital consultant, GP and clinic reception staff ‘looked clueless’, he says, when he asked about a third primary dose. ‘They pretty much all said, “Sorry, we don’t know what you’re on about” and batted us around between the hospital and the GP.’
Frustrated, Steve’s wife, civil servant Donna, emailed a copy of the Government guidance for extra doses to his GP, hospital consultant and their local clinical commissioning group. He says: ‘They replied saying I didn’t yet qualify for a booster, because of my age, but I tried to explain this wasn’t a booster – it’s something different.’
Letters were sent to all GPs and hospital consultants in England a day after the third primary dose programme was announced, explaining the plan. But experts say that many healthcare professionals are yet to send out invitations to eligible patients.
Third primary doses are supposed to be given eight to 12 weeks after second doses. Boosters, on the other hand, are set to be given at six months after your last dose
The Joint Committee on Vaccination and Immunisation introduced the scheme in early September following research by the Medical Research Council showing that 40 per cent of patients with conditions such as cancer and kidney disease and those taking powerful immune-suppressing drugs do not make enough antibodies to fight the virus after two doses. Early US and Canadian studies have found that, in immuno-compromised people, giving a third dose two months after the second significantly increased the antibodies produced.
Why don’t my Covid tests match, and is a super-cold on the way?
Q: My lateral flow test was positive but my PCR came back negative. Should I isolate?
A: If you have Covid symptoms, then yes. Government guidance states that anyone who gets a positive lateral flow test should then get a PCR test to confirm whether they have the virus and should self-isolate.
But last week, public health authorities said they were investigating why a ‘high number’ of lateral flows were testing positive, only for the follow-up PCR test to come back negative.
While the cause is unknown, scientists have urged the public to heed the result of their initial test.
Both lateral flow tests – the rapid result tests that can be done at home – and PCR tests – the gold standard used by NHS Test and Trace – are accurate at detecting the virus, but they are not perfect.
Dr Meaghan Kall, a Government epidemiologist, said: ‘If you have symptoms, plus either a positive lateral flow test or PCR, you have Covid and should stay home – even if your next PCR test is negative.’
Q: Is there really a super-cold going around?
A: To add to the confusion, it appears the UK is currently experiencing a wave of infections from the common cold that have serious Covid-like symptoms.
GPs have reported a rise in severe coughs, colds and viral infections, and studies suggest the symptoms of the dominant Delta Covid variant are more like a cold than any previous version.
According to Professor Tim Spector, an epidemiologist at King’s College London, these include muscle aches, runny noses and sore throats.
Many scientists predicted that common respiratory infections would bring severe symptoms this autumn and winter. Prolonged social distancing over the past 18 months during the pandemic means that people have not been exposed to viruses as they usually are, which has left their immune systems weaker.
The UK Health Security Agency (formerly Public Health England) confirmed a clear rise in cold cases last week.
Professor Martin Hibberd, an infectious diseases expert at the London School of Hygiene and Tropical Medicine, said: ‘These things are more likely to knock you down for a while than they did before Covid.’
It seems the news has been slow to circulate in the medical world.
Third primary doses are supposed to be given eight to 12 weeks after second doses. Boosters, on the other hand, are set to be given at six months after your last dose.
Patients eligible for a third primary dose will also need a booster, say experts. Yet this may cause further problems. Kidney Care UK’s Fiona Loud says: ‘We’re hearing reports that the NHS system, for some reason, doesn’t recognise the third primary dose, so doctors have to record it as a booster.’
This is exactly what happened to Steve, who finally got his third shot yesterday.
But Ms Loud warns: ‘It means that in six months’ time when these patients need their booster – which they will need – they won’t be called up for one, because the system will say they’ve already had it.’
Another patient to fall victim to this logistical nightmare is 43-year-old Jonathan Weinberg, a journalist from Essex, who finally received his third primary dose at the start of October following a month-long battle with his GP and hospital staff. But after receiving the jab, Jonathan, who takes immune-suppressing drugs for Crohn’s disease, checked his NHS Covid app – which is used to display a patient’s vaccine pass, required for attending some events and travelling. It stated his vaccination record was ‘incomplete’.
‘My second dose was suddenly missing. When I tried to download my vaccine passport, an error message appeared telling me I wasn’t fully vaccinated. Thankfully I have no holidays booked right now, but I’d like to be able to travel if I need to.’
Jonathan got in touch with a work contact from NHS England, who advised him to call the NHS Covid helpline on 119. ‘Someone was supposed to call me back, and I was told the issue would be resolved in five working days, but that didn’t happen.’
The good news is that things may be about to improve. We have learnt that the NHS has sent an urgent letter to all GP practices and NHS Trusts instructing them to invite all patients eligible by tomorrow.
NHS England has told us it is currently battling to resolve technological issues as a matter of urgency, and aims to enable GPs to correctly categorise third primary doses in the coming weeks.
So what should worried patients do in the meantime?
Transplant expert Dr Willicombe says that if patients can’t get an official third primary dose, they should try to ‘wangle’ a booster shot. ‘It’s not ideal, but at a time when infection rates are high, any extra protection is better than no protection.
‘Hopefully, in six months’ time NHS England will have solved the logistical problems and these patients will be offered their booster too.’
Some have argued that any extra jabs ought to be prioritsed for this group – rather than given to healthy over-50s.
Last week, a study of three million Americans, published in The Lancet, showed that protection against infection after two jabs dropped to roughly 50 per cent after five months – however, protection against hospitalisation remained high at 93 per cent.
Dr David Strain, a public health expert at the University of Exeter Medical School, says: ‘The original two doses that we gave are still really effective at keeping people out of hospital.
‘And if patients are unfortunate enough to catch Covid despite being double-vaccinated, they have a very different disease because they get better quickly.
‘So even if they come into hospital, they’re only in there for a couple of days.’
‘There is no doubt that the effect of the vaccine seems to wane after about six months,’ says Dr Penny Ward, visiting professor in pharmaceutical medicine at King’s College, London.
‘However, that is in terms of infection and mild to moderate illness. It seems protection against severe disease stands up a bit further, with very few vaccinated people ending up in hospital even six months after their first course.
You could say, what’s the point in boosting when the effect on hospitalisations is likely to be very small?’
Good question. However, despite this, the consensus among experts is that boosters are a good idea – to avoid extra pressure on the NHS, if nothing else.
Although immunity seems to be holding steady in the UK, hospitalisations in the vaccinated are ‘creeping up’, says Dr Strain. A sign, he says, that the effect of the jabs may be waning.
Scientists point to worrying patterns seen in Israel back in August, as what could be in store if the Government were to hold back on extra jabs. As the effect of vaccination began to wane – Israel was among the first to begin jabbing large proportions of its population back in early December – hospitalisations began to rise steadily, increasing by 30 per cent week-on-week.
And roughly 60 per cent of new admissions were in fully vaccinated people. The country launched its booster programme in July – first in the over-60s and later in everyone 12 and older.
By the end of August, hospital admissions had dropped 20 per cent. Subsequent data published in the New England Journal of Medicine showed those who had the booster were 11 times less likely to be infected with the dominant Delta variant. Earlier this year, many experts argued against giving boosters at all.
Professor Dame Sarah Gilbert, the co-creator of the Oxford AstraZeneca jab, said immunity from the two jabs was ‘lasting well’ and boosting everybody wasn’t necessary. Other leading vaccine experts, including Professor Adam Finn, virus expert at the University of Bristol who sits on the Joint Committee on Vaccination and Immunisation, said boosters would have only a ‘minimal effect’ on reducing the scale of Britain’s epidemic.
He suggested the priority should be driving up numbers of unvaccinated Britons – at last count, there were 18 million of them.
The World Health Organisation’s health emergencies director, Mike Ryan, likened booster shots to ‘handing out extra life jackets to people who already have them’. However, it seems the mood has now shifted.
‘I think the Government has taken a pre-emptive strike,’ says Dr Strain. ‘Ministers have seen what happened in Israel and thought, rather than wait until people are dying again, let’s go ahead and get boosters in now for extra protection.’
Dr Strain adds that it’s a move that also ‘allows life to continue as normal, despite very high rates of infection in the community’.
Meanwhile, Steve Richardson hopes his third jab will be the key to ‘getting his life back’.
‘I’ve been locked inside for the best part of 18 months, now finally I might be able to get out and about again,’ he says.
Steve and his wife Donna plan to take antibody tests two weeks after his jab to check if it has, at long last, delivered that vital protection.
‘Fingers crossed it will – it has to,’ says Steve.
‘I’ll still be careful. But at least I can relax a bit.’