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Second COVID vaccine? Can I have a Pfizer instead of Astra?

August 22nd, 2021

“If  have my first COVID vaccine as ASTRA vaccine, can I have the second one as Pfizer?”

This is a common question.

There is in fact good data that an ASTRA then a PFIZER work better than 2 Astra, and this combination is done overseas eg France, but sadly banned in Australia – probably due to supply constraints. (The federal government failed to order enough Pfizer vaccine early on when they had the chance.)

This ‘ strollout’ is so shambolic that we,  who have been using multidose vials and giving every possible vaccine for 32 years, are still are not allowed to give Pfizer – only Astra. ( At this stage, we have been told to expect Pfizer vaccine supplies in early October )

Astra #1 Pfizer #2.   … is not allowed at present

I have had two patients try to access Pfizer as their 2nd dose for valid medical reasons. Both were knocked back by the Pfizer clinics in Brisbane. The Australian Immunisation Record (AIR) records all the COVID vaccines of everyone in Australia.  You can’t hide the Astra dose you have already had. (The ones making these rules are politicians, not clinicians.)

In an ideal world

In fact, it would make more sense to me to say – everyone who has Astra can be offered a Pfizer booster when stocks arrive if they wish.   (That way, people wouldn’t feel “trapped” into one “vaccine track” or another. They might go out and at least get something.)

Just to reiterate, there is no “trapped”.  It is safe to have different brands of vaccines along the way, if the choice is available and there is a reason to do so.

Yes, the Pfizer vaccine is maybe a little better at stopping symptomatic disease and transmission in the short term. However, both vaccines are OUTSTANDING at stopping severe effects, and hospitalisation. If there was a choice, I would say have Pfizer for both especially for those under 60 years of age.  Sadly there is not a choice (yet). Once the Pfizer and Moderna vaccines arrive in vast quantities in about October/ Nov, I suspect that suddenly doctors may be permitted to use our clinical judgment again. ..Watch this space.

The other thing to point out,  is that we don’t yet have complete data about the longevity of the vaccine protection against COVID and whether booster doses are needed and when.  Quite a few vaccines for other diseases require boosters after 6 months or even a year or more, even if the target germ or virus is not changing – which in the case of COVID it sadly is changing as new variants appear.

Delta is coming and quarantine is not perfect

The important thing is that the SARS-CO Virus and especially the Delta variant will escape from hotel quarantine. This virus has escaped (every 44 positive cases) from quarantine in Australia. It is most unlikely to stop now. We need better quarantine facilities.  Meantime it is better to be fully vaccinated ASAP. ( If you need an appointment go here.)

If you are unlucky and come in contact with Delta COVID after one Astra vacine only, then you are still at risk of severe effects and hospitalisation. The best thing to do now is to have the second Astra 8 weeks after the first dose.  Then, you will at least be SAFE.

Down the track, we all may need to have a ‘variant booster’. But we will still be alive to have that booster.  Here is a story from a doctor in the USA at the coal face of the Pandemic 2.0.  It highlights nicely why failing to be vaccinated is the worst option.

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