Getting your clinically vulnerable child vaccinated against COVID-19 – advice from a parent

Parent Yvonne Woodford compiled this advice for other parents after a long struggle to get her clinically vulnerable disabled daughter vaccinated.

Yvonne finally secured the vaccine but only after contacting a range of key people from government ministers to local vaccine centre mangers.

Arranging a Specific Patient Direction – including template

Covid vaccines are not licensed for children aged under 16.  However, if your child’s doctor thinks your clinically vulnerable child would benefit, they can be vaccinated ‘off label’ or ‘off licence’. This means the clinician recommending the Covid vaccine for your child needs to sign a Specific Patient Direction.

The direction enables doctor/clinicians to take responsibility for prescribing the vaccine even if another clinician administers it to your child.

You can use the template below if a clinician is willing to prescribe the vaccination for your child ‘off licence’ but is unable to administer directly themselves for whatever reason (eg the hospital is not a hub for Covid vaccinations etc).  This template covers all the information that needs to be included in a Specific Patient Direction signed by the clinician.

• If you know the name of the person who will give the vaccine to your child, the doctor can email this completed template to them copying in the Clinical Commissioning Group, the vaccination centre and yourself.
• If you do not know the name of the person who will be vaccinating your child, this completed directive will need to put on official headed paper, signed by the clinician and emailed to the GP, CCG and head of the local vaccination centre.

[TEMPLATE]

Please provide the patient named herein with the medication set out below:

Patient Details

Name: xxxxxxxx

Date of Birth: xxxxxxxx

NHS Number: xxxxxxx

Prescription

Medicine Name: xxxxxxx <<Should be Pfizer>>

First Dose amount: xxxxxxxx

Second Dose amount: xxxxxxx

The first dose to be given as soon as possible and the second dose to be given between  [xxxxx] and [xxxx] weeks after the first dose.

Yours faithfully

<<Clinicians Name>>>

<<Clinicians position/role/title etc>>>>

• Working with your GP to vaccinate you clinically vulnerable child

Maybe your GP considers your clinically child would benefit from the COVID vaccine. However, they are reluctant to prescribe or administer the vaccine ‘off licence’ because their individual medical insurance does not cover this. In these circumstances, is worth politely reminding them that all GPs and their staff are automatically covered by the state-backed GP indemnity scheme (bma.org.uk)  for delivering NHS services too.

Involving your local Clinical Commissioning Group (CCG)

Some supportive GPs still may feel they do not have the power to prescribe the vaccine to your child if they do not meet specific criteria set out in the Green Book chapter on Covid vaccination (see section 4 below). 

Many GPs take their lead from their Clinical Commissioning Group (CCG) who often interpret these criteria very narrowly.  CCGs are often the organisation running out-of-hospital vaccine centres, and they set rules. This means you may well need to make sure that the CCG is happy the vaccine can be given in one of their centres. For example, they might need to make arrangements to make sure the centre is suitable for vaccinating a child. Find out how to contact your CCG.

Interpreting the Green Book guidance for Covid vaccinations for children

Covid-19 Greenbook chapter 14a (publishing.service.gov.uk) sets out the criteria for vaccinating children with the Covid-19 vaccine.

Many GPs and CCGs interpret the Green Book narrowly as meaning the Covid vaccine should only be considered for children under 16 with severe neuro-disabilities who get reoccurring respiratory infections and who spend time in specialist residential settings for children with complex needs. However, the office of Lord Bethell, the undersecretary of state for health who leads on Covid vaccines, confirmed in writing that the decision ultimately lies with the doctor responsible for the patient:

‘Paediatricians should discuss the benefits and risks and limited safety data with children, young people and their parents or guardians. The matter of whether to vaccinate a child should always be ultimately a decision to be made by the physician responsible for the patient.’

So, this means the current system allows for clinicians to recommend vaccination in children and for it to be given in those circumstances.

Which Covid vaccine?

The Green Book says either the Pfizer or Astra Zeneca vaccine can be used in children and young people under-16 ‘off label’. However, the NHS has also recommended that Pfizer should be ‘the vaccine of choice’ for children and young people because it is licensed for young people aged 16 and over.

Aside from in Scotland, the Pfizer vaccine is not currently available at vaccination centres, so your child may need to be vaccinated in a hospital hub or a Primary Care Network site.  Bear this in mind when you are arranging for you disabled child to be vaccinated.

Read more on Covid vaccines.