JCVI assertion on the COVID-19 vaccination programme for 2023: 8 November 2022

Overview

For the reason that first COVID-19 vaccine was authorised to be used within the UK in December 2020, the purpose of the COVID-19 vaccination programme has been, and continues to be, the discount of extreme illness (hospitalisation and mortality) throughout the inhabitants, whereas defending the NHS.

Because the transition continues away from a pandemic emergency response in the direction of pandemic restoration, the Joint Committee on Vaccination and Immunisation (JCVI) has begun to think about the 2023 COVID-19 vaccination programme. The present Omicron period is characterised by:

• excessive ranges of inhabitants immunity acquired by way of vaccination and/or pure an infection
• decrease illness severity in comparison with an infection resulting from earlier SARS-CoV-2 variants

Throughout this time, the danger of extreme COVID-19 continues to be disproportionately higher in these from older age teams, residents in care properties for older adults, and individuals with sure underlying well being circumstances. In comparison with the preliminary phases of the pandemic, rather more is now understood concerning SARS-CoV2 an infection. Nonetheless, there stays ongoing uncertainty concerning virus evolution, the sturdiness and breadth of immunity, and the epidemiology of an infection. These uncertainties restrict the speedy growth of a routine immunisation programme towards COVID-19.

Recommendation

JCVI’s interim recommendation for planning functions forward of 2023 is that:

• in autumn 2023, individuals at increased threat of extreme COVID-19 may very well be provided a booster vaccine dose in preparation for winter 2023 to 2024

• as well as, for a smaller group of individuals (similar to individuals of older age and those that are immunosuppressed) an additional booster vaccine dose could also be provided in spring 2023

• emergency surge vaccine responses could also be required ought to a novel variant of concern emerge with clinically vital organic variations in comparison with the Omicron variant

JCVI additionally advises that:

• the 2021 booster supply (third dose) for individuals aged 16 to 49 years who are usually not in a medical threat group ought to shut in alignment with the shut of the autumn 2022 vaccination marketing campaign^{[footnote 1]}

• in any other case wholesome individuals aged 5 to 49 years who develop a brand new well being situation in 2023 that locations them in a medical threat group can be provided major vaccination and/or a booster vaccine through the subsequent seasonal vaccination marketing campaign, as acceptable. Vaccination exterior these marketing campaign intervals can be topic to particular person medical judgement

• major course COVID-19 vaccination ought to transfer, over the course of 2023, in the direction of a extra focused supply throughout vaccination campaigns to guard these individuals at increased threat of extreme COVID-19. This would come with:

  • residents in a care residence for older adults and employees working in care properties for older adults
  • frontline well being and social care staff
  • all adults aged 50 years and over
  • individuals aged 5 to 49 years in a medical threat group, as set out within the Green Book
  • individuals aged 12 to 49 years who’re family contacts of individuals with immunosuppression
  • individuals aged 16 to 49 years who’re carers, as set out within the Green Book

• analysis must be thought of to tell the optimum timing of booster vaccinations to guard towards extreme COVID-19 (hospitalisations and deaths) for teams who’re at completely different ranges of medical threat

Issues

It’s estimated that over 97% of adults in England had SARS-CoV-2 antibodies, both from an infection or vaccination, by the tip of August 2022 (reference 1). In Nice Britain, an estimated 93 to 99% of youngsters aged 12 to fifteen years, and 74 to 98% of youngsters aged 8 to 11 years, had antibodies towards SARS-CoV-2 on the finish of August 2022 (references 1 and a pair of). Pure immunity alone offers good ranges of safety towards extreme COVID-19 whereas the mix of pure and vaccine-induced immunity (hybrid immunity) is related to even increased ranges of safety (references 3,4 and 5). This excessive stage of sturdy inhabitants immunity developed over the previous 2 and a half years is underneath common monitoring by way of UK Well being Safety Company (UKHSA) public well being surveillance programmes.

Not all hospitalisations and deaths ascribed to SARS-CoV-2 an infection are vaccine-preventable occasions. As a result of excessive transmissibility of the Omicron variant, along with an infection that may be asymptomatic or solely mildly symptomatic, individuals who require hospital look after non-COVID-19 causes could also be coincidentally contaminated with SARS-CoV-2. Such hospitalisations are usually not preventable by way of COVID-19 vaccination. In distinction, some extremely susceptible people might develop extreme COVID-19 regardless of being vaccinated; these people typically have underlying well being circumstances that confer excessive susceptibility to extreme illness from different infections as effectively. Within the UK, through the Omicron period (as much as week 43, 2022), the best charges of hospitalisations had been constantly noticed in individuals aged 75 years and over, whereas charges of an infection (non-severe sickness) had been excessive throughout all ages and particularly amongst youthful individuals (references 6 and seven).

Revised estimates of the quantity wanted to vaccinate (NNV) to forestall one hospitalisation through the Omicron period point out that 800 individuals aged 70 years and above would have to be given a booster in autumn 2022 (a fourth dose) to forestall one hospitalisation from COVID-19. The corresponding NNV for individuals aged 50 to 59 years is 8,000 and for individuals aged 40 to 49 years who are usually not in a medical threat group is 92,500 (Appendix 1).

In November 2021, JCVI advised boosters for healthy adults aged 40 to 49 years because of the epidemiology on the time. With the emergence of the Omicron variant in late November 2021, the supply was prolonged to wholesome people aged 16 to 39 years as a part of an emergency surge response (see JCVI update on advice for COVID-19 vaccination of children and young people and UK vaccine response to the Omicron variant: JCVI advice). Since April 2022, uptake of the preliminary booster dose of COVID-19 vaccine has been lower than 0.1% per week in all eligible individuals underneath 50 years of age (Determine 62c in reference 8). Based mostly on the present knowledge, retaining the booster (third dose) supply open to those teams is taken into account of restricted ongoing worth and the general impression on vaccine protection is negligible.

The presents of major course vaccination have been extensively accessible since 2021. Uptake of those vaccine presents have plateaued in latest months throughout all age teams (Determine 62a in reference 8). For the reason that starting of 2022, lower than 0.01% of eligible people per week over the age of 12 years, obtained a primary COVID-19 vaccine dose. A extra focused supply of major course vaccination throughout vaccination marketing campaign intervals will allow these efforts to be extra targeted and permit extra environment friendly use of NHS sources.

Though the COVID-19 vaccination programme has been very profitable general, there are some socioeconomic and ethnic teams the place vaccine protection stays decrease (reference 6). Addressing well being inequalities is a long-term effort that’s related to all UK immunisation programmes. Constructing belief, and particularly vaccine confidence, requires regular decided investments of time, sources and individuals. Acceptable and ample communication must be offered upfront of adjustments to the first course vaccination supply to optimise uptake amongst those that are eligible however have but to simply accept the supply of vaccination.

Future variants and their impression on epidemiology

Because the virulence of any new emergent variant can’t be reliably predicted, fast response measures could also be required ought to there be substantial adjustments in inhabitants immunity towards the dominant circulating variant, together with any new variant of concern.

JCVI will preserve the epidemiology of COVID-19 underneath evaluation and can present recommendation for a surge response, as required.

References

1. Workplace for Nationwide Statistics (ONS) Coronavirus (COVID-19) latest insights: antibodies.

2. UK Well being Safety Company unpublished knowledge.

3. Protective effectiveness of prior SARS-CoV-2 infection and hybrid immunity against Omicron infection and severe disease: a systematic review and meta-regression.

4. Risk of SARS-CoV-2 reinfection and COVID-19 hospitalisation in individuals with natural and hybrid immunity: a retrospective, total population cohort study in Sweden.

5. Protection against Omicron (B.1.1.529) BA.2 reinfection conferred by primary Omicron BA.1 or pre-Omicron SARS-CoV-2 infection among health-care workers with and without mRNA vaccination: a test-negative case-control study.

6. National flu and COVID-19 surveillance reports: 2022 to 2023 season.

7. Coronavirus (COVID-19) in the UK dashboard.

8. National flu and COVID-19 surveillance report: 27 October 2022 (week 43).