LONDON — It's the ultimate first-world problem. While more than 130 countries are still waiting for coronavirus vaccines, the wealthiest nations have doses on offer from multiple makers, and people rolling up their sleeves want to know: Can I choose which shot I get?
The choice is complicated by the fact that there is not supposed to be any choice. There is no private option in Britain for this. The vaccines are bought, distributed and deployed by the state-funded National Health Service, which serves all, rich and poor, free at the point of service — with no one allowed to jump the queue or pick and choose.
The official NHS policy is to take what is offered, or as a spokesman put it: “It will either be Pfizer or Oxford at a site depending on deliveries. People can choose their preferred site but not their vaccine.”
But, as in any system, there are end runs and insider plays, where staffers who work at health clinics, for example, may tip off family and friends to what’s on offer. Some folks have resorted to “hospital hopping,” making or canceling vaccination appointments based on rumors of which shot is being injected where.
British regulators have said both vaccines are just great. “Both give very high protection against severe disease,” and “both vaccines have good safety profiles,” the Joint Committee on Vaccination and Immunization reported. The government has ordered 140 million doses of those two, plenty to vaccinate the entire adult population of 54 million people by the fall. (Britain has also authorized Moderna’s vaccine, but its 17 million doses won’t begin to arrive until the spring.)
At issue for public health services are: efficacy, cost, supply, ease.
But consumers may also consider nationalism, branding and buzz — what they’ve heard from friends or read on the Internet.
The question of choice hasn’t been much of an issue in the United States, where the two vaccines in use — Pfizer and Moderna — are basically equivalent, both “Made in USA,” both relying on the same technology and producing the same results in clinical trials. A U.S. regulatory decision on Oxford-AstraZeneca is expected in April.
But because the United Kingdom and the European Union have already authorized all three, and because there’s greater distinction between Oxford and the others, some here have formed strong opinions about which they want, and which they don’t.
Pfizer is more expensive, it uses a sexy new platform to deploy messenger RNA, and it appears to work somewhat better at preventing mild to moderate cases.
In clinical trials, with two full doses, Pfizer was 95 percent effective at stopping symptomatic covid-19. So was Moderna. Oxford’s data has been messier. Its trials in the U.K. found it to be 62 percent effective. Using a bit more data, British regulators calculated that a two-dose regimen produces a 70 percent reduction in symptomatic disease. The European Medicines Agency put the number at 60 percent.
On the most-watched public affairs show in Britain, the BBC host Andrew Marr asked the question on many minds: “If I am sitting at home and my doctor rings me up and says, ‘Good news Andrew, we can get you a vaccine!’ At the moment, looking at the results that have come out, I might well say, ‘Excellent, can I have the Pfizer one or the Moderna one rather than the AstraZeneca one?’ Because their efficacy rate is much higher.”
That’s the sense emerging across Europe, where French health-care workers and Italian teachers are demanding the Pfizer or Moderna vaccines, and Germany is reporting no-shows at Oxford vaccine appointments.
The hesitation was reinforced after South African researchers found that the virus variant first identified there may elude the Oxford-AstraZeneca vaccine. South Africa has halted its AstraZeneca rollout.
About a dozen countries in Europe are also avoiding the Oxford vaccination for people over 65, noting that early trials didn’t include enough volunteers in that age group to prove effectiveness.
But many in Britain prefer the Oxford brand. They’ve seen its inventors, the confident Sarah Gilbert and the calming Andrew Pollard, on television — and to them, the Oxford option just feels right.
Paul Williams, a doctor and former Labour Party member of Parliament, told The Washington Post that some patients were declining Pfizer appointments, saying, “No thanks, I’ll wait for the English one.”
Williams said he thought the preference was generated by Prime Minister Boris Johnson’s bully endorsement of the homegrown product “from our brilliant British scientists.” Wags suggested vaccine doses should feature a Union Jack on the vials, even though AstraZeneca is a British-Swedish pharmaceutical company.
Alternatively, Oxford is one of the top universities in the world, and the name alone conjures up a mix of emotions for Britons — pride, envy, desire, dislike — which have prompted some parody videos that have been widely shared on social media.
Josh Berry, a stand-up comic, posted a clip impersonating an Oxford snob who humble-brags, “I just didn’t want to settle for the Pfizer one. No offense. It’s been incredibly enabling actually. It’s not that other vaccines are worse. But one just gives your immune system a better foundation.”
Pfizer, incidentally, is a U.S.-based pharmaceutical giant, but the vaccine was developed by a German Turkish couple running a small cutting-edge company called BioNTech. So to some in Europe, the Pfizer shot is “the German one.”
Both jabs have limited transient side effects, common to vaccines, such as pain and tenderness at the injection site, headache, tiredness, muscle pain, a general feeling of being unwell, chills, fever, joint pain and nausea.
Early on, the Pfizer vaccination produced a few episodes of extreme allergic reaction among those who are very vulnerable, and that turned some off the vaccine. Social media is filled with stories about how the Oxford or Pfizer shot made posters feel the day after their first dose.
Andrew Pollard, a leader of the Oxford vaccine team, told The Post, “For me, personally, I would have whichever vaccine offered, because the most important thing with vaccination is to have the dose in your arm.”
Pollard cautioned against fixating on precise numbers in early clinical trials. “The problem with the trials, unless you run the trials head-to-head, you don’t really know whether a 95 percent figure on trial and 62 percent in another trial mean the same thing,” he said.
Gilbert, the co-developer of the Oxford shot, confessed that “there were days when I just don’t want to read the newspapers because it’s just more AstraZeneca bashing, and I don’t really understand why that is.”
She said that “real-world head-to-head results” comparing Pfizer and Oxford are coming soon in Britain. “Then we’ll see how it looks.”
Anesthesiologist Gareth Greenslade got the Pfizer jab at the hospital where he works. His wife, a nurse, got the AstraZeneca vaccine at a vaccination center in Bristol.
They would have happily taken either, he said. But he confessed he wanted Pfizer “because it is a new technology and doctors are geeky.”
As he put it, the Oxford-AstraZeneca vaccine is “fairly traditional,” made from a weakened chimpanzee cold virus that carries a snip of DNA to mimic the viral spike protein. “So from the point of view of stopping you from dying, AstraZeneca does it,” Greenslade said.
But he liked to imagine the Pfizer dose inside him, built upon new mRNA biotech — “It’s just such an elegant idea to teach the cells to produce a harmless protein, and then it all goes away again, but the immune system is sitting there, like a coiled spring.”
Asked whether people should get a preference, Greenslade said, “In an ideal world, yes.”
But, he said, the Pfizer shot, needing specialty freezers for transport and storage, is more likely to be found at large hospitals, and the AstraZeneca one is more likely to be found at smaller venues where the vaccine can be popped into a normal fridge — which is another way to guess which vaccine might be offered where.
For some, these discussions of choice are frustrating. Just hurry up, they say.
A quarter of the population has gotten at least one vaccine dose, and coronavirus cases have been declining dramatically. Yet Britain remains in its third national lockdown. The country has the highest per capita death toll in Europe over the course of the pandemic, and on many days is the worst in the world. Its health system is battered and has been overwhelmed. Patients needing routine surgeries have been put on year-long waiting lists.
Linda Bauld, professor of public health at the University of Edinburgh, said people being allowed to select their preferred vaccine clashed with Britain’s model of nationalized health care.
“Supply is a challenge and will continue to be a challenge. So it’s not fair to others to have that choice, in a publicly funded system,” she said.
If people were to insist on one type of vaccine, Bauld said, “they may be taking it from someone else, or taking someone’s second dose. That’s at odds with the universal health-care system in place.”
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