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

Perception

Because the first COVID-19 vaccine was licensed to be used within the UK in December 2020, the main target of the COVID-19 vaccination program has been and continues to be the discount of significant sickness (hospitalization and mortality) within the inhabitants, whereas defending the NHS.

Because the transition continues from pandemic emergency response to pandemic restoration, the Joint Committee on Vaccination and Immunization (JCVI) has begun contemplating the COVID-19 vaccination program for 2023. The present period of Omicron is characterised by:

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

In the meantime, the chance of extreme COVID-19 continues to be disproportionately greater amongst individuals in older age teams, residents of care properties for the aged, and other people with sure underlying well being situations. . In comparison with the preliminary phases of the pandemic, way more is now recognized about SARS-CoV2 an infection. Nonetheless, there stays lingering uncertainty concerning the evolution of the virus, the sturdiness and extent of immunity, and the epidemiology of an infection. These uncertainties restrict the rapid improvement of a routine vaccination program towards COVID-19.

Recommendation

JCVIThe tentative steerage for planning functions previous to 2023 is as follows:

• in fall 2023, individuals at excessive threat of extreme COVID-19 could also be supplied a booster dose of vaccine in preparation for winter 2023 to 2024

• moreover, for a smaller group of individuals (reminiscent of older individuals and those that are immunocompromised), a further booster dose could also be supplied in spring 2023

• emergency vaccine responses could also be required if a brand new variant of concern emerges with clinically important organic variations from the Omicron variant

JCVI additionally advises that:

• the 2021 booster provide (third dose) for individuals aged 16 to 49 who are usually not a part of a scientific threat group ought to finish according to the tip of the autumn 2022 vaccination marketing campaign^{[footnote 1]}

• in any other case wholesome individuals aged 5 to 49 who develop a brand new well being drawback in 2023 inserting them in a scientific threat group can be supplied a major and/or booster vaccination in the course of the subsequent seasonal vaccination marketing campaign, relying on the case. Vaccination outdoors of those marketing campaign durations can be topic to particular person scientific judgment

• Main COVID-19 vaccination ought to evolve, throughout 2023, in direction of a extra focused provide throughout vaccination campaigns to guard these most prone to extreme COVID-19. This would come with:

  • residents of an aged care dwelling and employees working in aged care properties
  • frontline well being and social service employees
  • all adults aged 50 and over
  • individuals between the ages of 5 and 49 belonging to a scientific threat group, as outlined within the Inexperienced Paper
  • individuals aged 12 to 49 who’re family contacts of immunosuppressed individuals
  • individuals aged 16 to 49 who’re carers, as set out within the Inexperienced Paper

• analysis ought to be thought of to tell the optimum timing of booster vaccinations to guard towards extreme COVID-19 (hospitalizations and deaths) for teams which have totally different ranges of scientific threat

Concerns

It’s estimated that over 97% of adults in England had antibodies to SARS-CoV-2, both by an infection or vaccination, by the tip of August 2022 (Reference 1). In Britain, an estimated 93-99% of kids aged 12-15, and 74-98% of kids aged 8-11, had antibodies towards SARS-CoV-2 on the finish of August 2022 ( references 1 and a pair of). Pure immunity alone gives good ranges of safety towards extreme COVID-19, whereas the mix of pure and vaccine-induced immunity (hybrid immunity) is related to even greater ranges of safety (references 3, 4 and 5). This excessive stage of robust inhabitants immunity developed over the previous 2½ years is usually monitored by the UK Well being Safety Company (UKHSA) public well being surveillance applications.

Not all hospitalizations and deaths attributed to SARS-CoV-2 an infection are vaccine preventable occasions. Because of the excessive transmissibility of the Omicron variant, in addition to an infection which can be asymptomatic or solely mildly symptomatic, people requiring hospital look after causes aside from COVID-19 could coincidentally turn into contaminated with SARS- CoV-2. Such hospitalizations can’t be prevented by vaccination towards COVID-19. However, some very susceptible individuals can develop a extreme type of COVID-19 regardless of their vaccination; these individuals usually have underlying well being situations that additionally confer a excessive susceptibility to severe sickness from different infections. Within the UK, in the course of the Omicron period (till week 43, 2022), the best hospitalization charges had been constantly seen amongst individuals aged 75 and over, whereas an infection charges (non-severe illness) had been elevated in any respect ages and significantly in youthful individuals (References 6 and seven).

Revised estimates of the quantity wanted to vaccinate (NNV) to keep away from hospitalization in the course of the Omicron period point out that 800 individuals aged 70 and over ought to obtain a booster within the fall of 2022 (a fourth dose) to keep away from hospitalization as a result of COVID-19. The correspondent NNV for individuals aged 50-59 is 8,000 and for individuals aged 40-49 who are usually not in a scientific threat group, it’s 92,500 (Appendix 1).

In November 2021, JCVI boosters suggested for wholesome adults 40-49 years of age as a result of epidemiology on the time. With the emergence of the Omicron variant on the finish of November 2021, the provide was prolonged to wholesome people aged 16 to 39 as a part of an emergency response (see JCVI replace on recommendation for COVID-19 vaccination of kids and younger individuals and the UK vaccine response to the Omicron variant: JCVI recommendation). Since April 2022, uptake of the preliminary booster dose of the COVID-19 vaccine has been lower than 0.1% per week amongst all eligible individuals below the age of fifty (Determine 62c in reference 8). Primarily based on present information, sustaining the booster (third dose) provide to those teams is taken into account to be of restricted continued worth and the general affect on immunization protection is negligible.

Main vaccination gives have been broadly out there since 2021. Uptake of those vaccine gives has plateaued in current months throughout all age teams (Determine 62a in Ref 8). Because the begin of 2022, lower than 0.01% of eligible individuals per week over the age of 12 have obtained a primary dose of the COVID-19 vaccine. A extra focused provide of major vaccination throughout marketing campaign durations will permit these efforts to be higher focused and NHS assets for use extra successfully.

Though the COVID-19 vaccination program has been very efficient total, there are specific socio-economic and ethnic teams the place vaccination protection stays decrease (Reference 6). Tackling well being inequities is a long-term effort that cuts throughout all UK immunization applications. Constructing belief, and extra particularly belief in vaccines, requires constant and decided investments of time, assets and other people. Acceptable and ample communication ought to be offered previous to adjustments to the first vaccination provide to optimize uptake amongst those that are eligible however haven’t but accepted the vaccination provide.

Future variants and their affect on epidemiology

Because the virulence of any new rising variant can’t be reliably predicted, fast response measures could also be required within the occasion of considerable adjustments in inhabitants immunity towards the circulating dominant variant, together with any new variant of concern.

JCVI hold the epidemiology of COVID-19 below overview and supply steerage for a fast response, as wanted.

References

1. Newest coronavirus (COVID-19) data from the Workplace for Nationwide Statistics (ONS): Antibodies.

2. Unpublished information from the UK Well being Safety Company.

3. Protecting efficacy of prior SARS-CoV-2 an infection and hybrid immunity towards Omicron an infection and extreme illness: a scientific overview and meta-regression.

4. Danger of SARS-CoV-2 reinfection and COVID-19 hospitalization in individuals with pure and hybrid immunity: a retrospective cohort examine within the complete inhabitants in Sweden.

5. Safety towards Omicron (B.1.1.529) BA.2 reinfection conferred by major Omicron BA.1 or pre-Omicron an infection with SARS-CoV-2 in healthcare employees with and with out mRNA vaccination: a test-negative case-control examine.

6. Nationwide influenza and COVID-19 surveillance experiences: 2022 to 2023 season.

7. Coronavirus (COVID-19) within the UK Dashboard.

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