GPs have been told to deliver six doses from all Pfizer vaccine vials, amid updated guidance from the medicines regulator.
It comes as the BMA has said that GP practices should assume they will be able to deliver six doses from each vial of Pfizer vaccine when booking patients in for their second jab – although there was confusion regarding a BMA claim that NHSE may make ‘top up’ deliveries to ensure this.
In December, it was revealed that GPs may be able to get an extra dose of the Pfizer/BioNTech Covid-19 vaccine out of some vials, if a full sixth dose could be extracted.
At the time, NHS England said that GPs were permitted to use a sixth dose if in their professional judgment they could draw up the full 0.3ml, but that vaccinators should not mix residue from two vials to make full dose.
Now, the Medicines and Healthcare products Regulatory Agency (MHRA) has updated its product information to state that the Pfizer vaccine ‘is manufactured with enough volume for six doses’, if delivery guidance is followed.
The guidance, updated last week, said: ‘After dilution, vials of Covid-19 mRNA Vaccine BNT162b2 contain six doses of 0.3 mL of vaccine.
‘In order to extract six doses from a single vial, low dead-volume syringes and/or needles should be used. If standard syringes and needles are used, there may not be sufficient volume to extract a sixth dose from a single vial.’
GPs should not ‘pool’ excess vaccine from multiple vials, it reiterated.
Meanwhile, the health secretary has told MPs that it is ‘now standard practice’ to deliver six doses from each Pfizer vaccine vial.
Speaking in the House of Commons this week, Matt Hancock said vaccinators should use all ‘available’ doses – including six doses per Pfizer vial and 11 doses from ten-dose AstraZeneca vials where possible.
He said: ‘The need to use every last drop of this precious vaccine is paramount. The standard operating protocol clearly states that all vaccine doses that are available should be used.
‘If you can get 11 doses out of the 10-dose AstraZeneca vial then do so, it’s now standard practice to get six out of the previously five-dose Pfizer vial and you should have a reserve list of people in categories one to four to be able to call up at the end of the day if there’s any spare.’
Meanwhile, the BMA said in an update for GPs: ‘Practices should plan for six doses per vial for second dose, but where there is not enough for a sixth dose, NHSE/I will look to make an emergency delivery of smaller amounts of more vaccine to make up the difference.’
NHS England denied to Pulse that this was the case, but BMA GPC chair Dr Richard Vautrey told Pulse that NHS England has ‘assured’ the BMA that ‘sites will receive the necessary vaccines that they need to administer second doses and if there is a need for additional amounts that they will supply it’.
The news comes amid a lack of clarity on delivery schedules for second doses.
In its latest GP Committee update, the BMA said practices need to start booking patients in for their second jabs and that it has urged NHS England to confirm deliveries for March and April.
The email update, sent to practices on Friday, said: ‘We have raised with NHSE/I the need for practice sites to be able to start planning for giving second doses by booking appointments.
‘This requires confirmation of delivery schedules in March and April, particularly of the Pfizer vaccine. We hope NHSE/I will be able to confirm arrangements for this shortly.’
NHS England told Pulse that vaccine delivery dates for second dose clinics in March will be provided to GP sites shortly.
A spokesperson said: ‘Vaccines delivered to the NHS are sent out as soon as possible to vaccination sites, which as much notice given of delivery dates as possible, as supplies come online and are made available to the NHS.’
It comes as the health secretary this week told MPs he has ‘a high degree’ of confidence that supplies of Covid vaccines will be sufficient for patients to be able to get the ‘right’ second dose after 12 weeks.
But the Government yesterday launched a new study on the interchangeability of Covid vaccines with a view to making the vaccination programme ‘more flexible’.
It comes amid concerns of supply shortages, including if the EU moves to restrict vaccine exports.
Last month, GPs were told that they may also be able to extract an additional dose from vials of the Oxford/AstraZeneca vaccine, which comes in both 10 and eight-dose vials.
But it is not available to GPs, so we can’t have been doing it wrong – it is only available to MVCs and hospital centres?????? did they forget that when writing these silly diktats?
GP here and we have been using batches of pfizer.
I hate the told to. Gps advised it is safe to do so may be more civilised language.
It was fairly obvious that 6 doses were available in the Pfizer jab in December, and most have been doing it on the occasions when push delivery has worked. Why does it take the policy makers 2-3 months to “decide” or even “mandate” us to do what common sense and experience told us to do.
We don’t need more mandates, we need to trust and reward our trained professionals for being professionals -not just policy followers.