MD, PhD, MAE, FMedSci, FRCP, FRCPEd.

I am not in the habit of using my blog for telling personal anecdotes, but today I make an exception.

I just got both my flu and my COVID jabs. For this, I had made an appointment at my GP surgery, arrived in time and swiftly received the flu vaccination from a nurse. For the COVID jab, I was told to make an appointment at a pharmacy, because the GP surgery would not do this.

So, I made an appointment at one of the few pharmacies in Cambridge that offer this service. When I arrived, I was surprised how crammed the space was where customers had to wait their turn. It felt as though I had arrived in a third world country. The room was so small that I (and with me everyone else) could not help overhearing the OTC consultations that took place between the customers and the pharmacist.

In particular, there was a young man seeking help. He had had a vaccination [I did not catch which] and fainted a few hours later. He was worried and asked the pharmacist for advice. The pharmacist told him to consult his GP. The man explained that he had tried, but could not get an appointiment until 3 weeks. The pharmacist then gave him 2 medications for his problem together with instructions how to take them. The man thanked him, paid and left the pharmacy. A few minutes later I was called into the tiny consulting room, received my COVID immunisation, thanked the pharmacist and went home.

Here are the questions raised by this seemingly banal series of events:

  • Why is it impossible for my GP practice to give me both flu and COVID jabs at the same time?
  • Would it not be much more economical for the NHS to do this?
  • Would it not have wased less of my time as well?
  • Why was the worried man who had fainted told to wait 3 weeks for a GP appointment?
  • Why are worried patients not seen more swiftly!
  • Why did the pharmacist precribe him 2 medications? (I am not aware of any drug that would be effective in such a case.)
  • Pharmacists are supposed to be available for patients with minor ailments; but does that not mean they have an obvious conflict of interest when they then sell drugs that are of questionable usefullness to desperate people?

It seems to me that, with a more thoughtful organisation, the NHS could run better and cheaper. It also occurred to me that one has to sympathise with people who are put off by this sort of thing and subsequently prefer to consult practitioners of so-called alternative medicine.

PS

I am pleased to report that none of the two vaccinations caused the slightest adverse effects.

22 Responses to Two jabs and seven questions

  • All good questions, though I would expect that YOU would know that there hasn’t been a single study to test the safety of having the Covid and flu vaccines together (but if I’m wrong here, I’d love to see the study)…but like so much else in “vaccine science,” no one is testing them to evaluate safety. Oh well, whether you have 7 questions or just one, don’t expect any public health official to be able to answer any of them.

    • As I was not sure about formal tests, I asked AI. Here is the answer:
      Safety: Studies, such as the ComFluCOV trial in the UK, have concluded that it is safe for people to receive a COVID-19 vaccine and a seasonal influenza vaccine at the same time.
      Side Effects: Side effects are generally comparable to receiving either vaccine alone, or there may be a slight increase in common, mild-to-moderate side effects like pain at the injection site, fatigue, headache, and muscle ache. These reactions are typically short-lived.
      Immune Response (Immunogenicity): The studies have shown that the immune response produced by both the COVID-19 vaccine and the flu vaccine is preserved and not negatively impacted when they are given simultaneously. In fact, some research suggests the immune response to the flu vaccine may even be slightly boosted.
      Logistics: Simultaneous administration is often recommended by public health authorities, like the CDC and the WHO, as it is a highly convenient and efficient way to ensure high vaccination coverage for two major respiratory illnesses, especially in vulnerable populations.
      In most cases where co-administration is done, the vaccines are given at separate injection sites (e.g., one in each arm).
      The general consensus from these clinical data supports the practice of co-administering the COVID-19 and flu vaccines to streamline vaccination efforts and protect individuals against both viruses.

    • @Dana Ullman
      Some remarks:
      – Of all medical interventions, vaccines are among the best tested for safety. Your accusation that “no one is testing them to evaluate safety” is untrue, a.k.a. a lie. Also note that ‘testing for safety’ of vaccines does not end after the phase 3 trial (usually with tens of thousands of people). In fact, safety monitoring never ends; officials and manufacturers all over the world are constantly on the lookout for possible problems.
      – There is no reason to suspect that combining multiple vaccines, each with a good safety track record, could be harmful in any way. No such combination of vaccines has ever been identified. And this isn’t strange at all. Unlike other pharmaceutical products, vaccines all do exactly the same thing: they stimulate the immune system to create antibodies and memory cells against specific pathogens or parts thereof. Combining two vaccines is virtually the same as contracting two viruses at the same time – something that happens all the time. But unlike those viral infections, vaccination can’t cause deadly illnesses (apart from anaphylactic shock, which is exceedingly rare).

      But I completely understand that you don’t know all this, and that this ignorance causes uncertainty and suspicion. After all, you are still in your mental phase where you believe in magic, e.g. that shaking plain water turns it into a medicine. So why wouldn’t two vaccines go nuclear when combined?

    • Phase IV trial:

      Lazarus R, Baos S, Cappel-Porter H, Carson-Stevens A, Clout M, Culliford L, Emmett SR, Garstang J, Gbadamoshi L, Hallis B, Harris RA, Hutton D, Jacobsen N, Joyce K, Kaminski R, Libri V, Middleditch A, McCullagh L, Moran E, Phillipson A, Price E, Ryan J, Thirard R, Todd R, Snape MD, Tucker D, Williams RL, Nguyen-Van-Tam JS, Finn A, Rogers CA; ComfluCOV Trial Group.
      Safety and immunogenicity of concomitant administration of COVID-19 vaccines (ChAdOx1 or BNT162b2) with seasonal influenza vaccines in adults in the UK (ComFluCOV): a multicentre, randomised, controlled, phase 4 trial.
      Lancet. 2021 Dec 18;398(10318):2277-2287.
      doi:10.1016/S0140-6736(21)02329-1.
      Epub 2021 Nov 11.
      PMID: 34774197; PMCID: PMC8585490.

    • Mr. Ullman, if you could spare a moment to elucidate the matter of the laboratory that can distinguish…. As requested by me ninety-five times previously…….

  • Had the surgery run out of COVID jabs? The other possibility is that COVID vaccines come in six doses ampoules and if there’s only one patient who needs it, it’s an expensive waste of five doses.

    My wife is a practice nurse and flu and COVID jabs are routinely administered simultaneously where she works. She was off doing them this morning..

    Oh and Dana, of course there are studies showing the safety. We know you’re an idiot but for once try not to demonstrate it so obviously by pulling ignorant assertions out of your arse and try doing a little bit of looking things up.

    https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2825813

    Other studies have shown that as well as being safe, simultaneous administration produces an enhanced immune response.

  • I am very worried about this so called FCP initiative by NHS that includes pharmacists. It’s almost as if no one has told the pharmacist of this new role or at least if they have the pharmacist is rejecting it. Like you my visits to the pharmacist always involve my overhearing what should be a confidential conversation and EVERY time involves the pharmacist saying ‘see your gp ‘ . Recently an 84 year-old lady showed the pharmacist a scab on her elbow asking for a soothing cream. Pharmacist just barked ‘ that’s infected ‘ – see your gp. 84 year old ladies do as their told and dont complain. I intervened and drove her to.local surgery – she was on foot – SURGERY told her to return in the afternoon – 84vyears and no gp could have just have squeezed her in there and then to assess her scab
    When she returned gp said not infected and leave alone. Took all.of 2 minutes to bundle her out the door. . I get the pharmacist possibly did not want to take any chances with 84 ear old but still offered no reassurance or check that she could actually make it to gp – just the barked – it’s infected see gp.

    On a sad note – one week. 84 year old died. Wonder whether either pharmacist or gp missed an.opportunity

  • Not a brilliant experience for you and especially the “fainting man”. Where I live flu and COVID vaccines were administered by our GP in one visit. As you will know most GP practices are independent contractors and to some degree can decide which NHS services they offer. But to not offer immediate support to a person who fainted post vaccination is not good.

  • Here’s my anecdote: Have had both flu and mRNA COVID shots in the same arm at the same time for the past three years. Unremarkable symptoms, no different than single shot. Asked for a third (RSV) at the same time a couple of years ago, and that is where they drew the line. Had to go back for that one. Pharmacy in Vons supermarket USA. They advertise vaccines well before flu season starts. Made appt online, comfortable, spacious waiting room, never crowded.

  • “The Pfizer Job
    How Pfizer carried out the biggest pharma trial heist ever – and the regulators swallowed it hook, line and sinker.”:
    https://www.arkmedic.info/p/the-pfizer-job

  • Where I receive my shots, they give me the choice of having either the ones that inject a microchip into your system or the ones that cause autism. It’s hard to make up my mind so I alternate year-to-year. So far, the only obvious results are that I haven’t gotten flu or covid – but there’s still no evidence or a chip in my body nor have I become autistic.

    S**t happens. Or maybe it doesn’t?

  • In the US, if someone is worried about their health and don’t want to wait to see their GP, they’re directed to the ED or Urgent Care. I have Kaiser insurance, which is considered one of the worst (until compared with all the other options), and they leave it to me as to whether I get one or both shots at once. They even send a nurse out to my workplace to do annual flu shots.

  • I’ve had all the flu and COVID vaccinations, in opposite arms and in the same arm. The only vaccination that gave any bother at all was the shingles one, which made my arm a bit sore for a day or two.

  • I covered a conference that Jonas Salk attended. He was a very vocal advocate for adjuvants – things that make vaccines even more effective.
    One way to make some vaccines more effective is to give them at the same time as other shots.
    So, it may be that like the COVID vaccine & some cancer immunotherapies, having it at the same time as your flu shot may actually prime the immune system better.

    • From the Phase IV trial (Lazarus 2021) that I mentioned above:

      Introduction
      International recommendations in the 2020–21 influenza season were to separate influenza and COVID-19 vaccines by 14 days. The main reasons for this were to avoid inaccurate attribution of side-effects to the newly approved COVID-19 vaccines and insufficient data to inform concomitant vaccination. It is necessary to establish whether concomitant vaccination is safe and whether this would increase reactogenicity rates, as increased rates might negatively influence vaccine uptake—this is particularly important as the most widely used COVID-19 vaccines produce relatively high rates of expected systemic adverse reactions, such as fever, compared with other vaccines. Additionally, in some cases concomitant vaccination alters the immunogenicity of administered vaccines.

      Discussion
      Concomitant administration of influenza vaccines with other vaccines has been studied for other vaccine types, including pneumococcal polysaccharide and conjugate vaccines. Relative reductions have been reported for some pneumococcal serotypes in some studies, but these have not proven to be clinically significant. These studies show that concomitant administration has no effect on humoral responses to influenza vaccine, consistent with the findings reported here.

      Similar to our findings, Toback and colleagues[14] found no significant differences in reactogenicity between those receiving concomitant vaccination compared with the COVID-19 vaccine alone. By contrast, a significant difference was seen in the geometric mean ELISA units between the group receiving concomitant vaccination versus COVID-19 vaccine alone, with a geometric mean ratio of 0·57 (95% CI 0·47–0·70), below the WHO 0·67 geometric mean ratio cutoff, suggesting immune interference. Importantly, there was no difference in the efficacy of concomitant vaccination. The key difference between Toback and colleagues’ trial and ours is that the influenza vaccine was administered with the first dose, not the second dose, of COVID-19 vaccine.

      For proper context, read the paper in its entirety.

  • This is how things look in Germany.

    According to STIKO recommendations, there is no longer a requirement to wait 14 days between COVID-19 vaccinations and the administration of other so-called inactivated vaccines. The vaccinations can be administered simultaneously, i.e., at the same time. The injections should be given in different limbs.

    The influenza vaccination should be administered as usual in late fall (from October to mid-December). Provided that there is an indication for vaccination against both influenza and COVID-19, the two vaccines can be administered simultaneously.

    It is particularly important to provide detailed information to the person being vaccinated about the possible increased temporary local and systemic vaccine reactions when COVID-19 vaccines and influenza vaccines are administered simultaneously.

    https://www.rki.de/SharedDocs/FAQs/DE/Impfen/Influenza/FAQ_Liste_Impfempfehlung.html#entry_16870854

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