overview
Since the first COVID-19 vaccine was approved for use in the UK in December 2020, the aim of the COVID-19 vaccination program has been and continues to be to reduce severe illness (hospitalization and death) across the population. and continues to be Protecting the NHS.
As the transition from pandemic emergency response to pandemic recovery continues, the Joint Commission on Immunization and Immunization (JCVI) has begun reviewing a COVID-19 vaccination program for 2023. The characteristics of the current Omicron era are:
- High levels of herd immunity acquired through vaccination and/or natural infection
- Less severe disease compared to infection with previous SARS-CoV-2 variants
During this time, the risk of severe COVID-19 continues to be disproportionately high among older age groups, nursing home residents, and those with certain underlying medical conditions. Much more is now understood about SARS-CoV2 transmission compared to the early stages of the pandemic. However, uncertainties still remain regarding viral evolution, immunity persistence and breadth, and epidemiology of infection. These uncertainties limit the immediate development of routine vaccination programs against COVID-19.
advice
JCVIInterim advice for planning purposes ahead of 2023 is:
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In fall 2023, people at high risk of severe COVID-19 may be offered a booster dose of vaccine in preparation for the winter of 2023-2024.
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Additionally, a small number of people (such as the elderly and immunosuppressed) may receive an additional booster vaccine in spring 2023.
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The emergence of a new variant of concern with clinically significant biological differences compared to the Omicron variant may require an emergency surge vaccine response
JCVI It also advises:
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The 2021 booster offer (3rd) for people aged 16-49 who do not belong to a clinical risk group should end in line with the end of the fall 2022 vaccination campaign[footnote 1]
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Healthy persons aged 5 to 49 who develop a new health condition in 2023 and fall into a clinical risk group should receive primary vaccination and/or vaccination during the next seasonal vaccination campaign, as appropriate. Or a booster vaccine will be provided.Vaccinations outside of these campaign periods are subject to individual clinical judgment
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First-course COVID-19 vaccination should transition to more targeted offers during 2023 during vaccination campaigns to protect people at high risk of severe COVID-19. This includes:
- Nursing home residents and nursing home staff
- frontline health workers
- All adults over the age of 50
- Persons aged 5 to 49 years in the clinical risk group as described in green book
- Household contacts of persons aged 12 to 49 who are immunosuppressed
- Caregivers aged 16 to 49 who green book
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Studies should be reviewed to inform the optimal timing of booster vaccination to protect groups at various levels of clinical risk from severe COVID-19 (hospitalization and death).
Considerations
By the end of August 2022, it is estimated that more than 97% of adults in England had SARS-CoV-2 antibodies through infection or vaccination (ref. 1). In the UK, by the end of August 2022, an estimated 93-99% of children aged 12-15 and 74-98% of children aged 8-11 had antibodies to SARS-CoV-2 ( References 1 and 2). Innate immunity alone provides good levels of protection against severe COVID-19, but the combination of innate immunity and vaccine-induced immunity (hybrid immunity) is associated with even higher levels of protection (ref. 3). , 4, and 5). Developed over the past two and a half years, this high level of potent herd immunity is being regularly monitored through the UK’s Health Security Agency (Uksa) Public Health Surveillance Programs.
Not all hospitalizations and deaths resulting from SARS-CoV-2 infection are vaccine-preventable events. Because of the high contagiousness of the Omicron variant and the asymptomatic or mildly symptomatic infection, a person requiring hospitalization for reasons other than COVID-19 may happen to be infected with SARS-CoV-2. There is a possibility that Such hospitalizations cannot be prevented by COVID-19 vaccination. In contrast, some highly vulnerable individuals can develop severe her COVID-19 even if vaccinated. These individuals often have underlying conditions that make them highly susceptible to severe illness from other infections as well. In the UK, during the Omicron era (until week 43 of 2022), the highest hospitalization rates were consistently observed among those aged 75 and over. among young people (refs 6 and 7).
A revised estimate of the number of vaccinations required (NNV) shows that 800 people aged 70 and over should receive a booster (fourth dose) in fall 2022 to prevent one hospitalization due to COVID-19 in the Omicron era. I’m here.Correspond NNV 8,000 in people aged 50-59 years and 92,500 in people aged 40-49 who do not belong to a clinical risk group (Appendix 1).
of November 2021, JCVI Recommended booster for healthy adults aged 40-49 according to epidemiology of the time. Due to the emergence of his Omicron variant in late November 2021, the offer was expanded to healthy individuals aged 16 to 39 as part of the emergency surge response ( JCVI Updated advice on COVID-19 immunization for children and adolescents When UK vaccine response to Omicron variants: JCVI advice). Since April 2022, uptake of the first booster dose of the COVID-19 vaccine has been <0.1% per week in all subjects under the age of 50 (Figure 62c in ref. 8). Based on current data, continuing to open booster (third dose) offers to these groups appears to be of limited ongoing value, with an overall impact on vaccination coverage of Very little.
First-course vaccination offers are widely available from 2021 onwards. Use of these vaccine offers has plateaued in recent months across all age groups (Figure 62a in ref. 8). Since the beginning of 2022, less than 0.01% of eligible individuals aged 12 years or older have received their first COVID-19 vaccine per week. A more targeted delivery of primary course vaccinations during immunization campaigns will allow these efforts to be more focused and NHS resources to be used more efficiently.
Although COVID-19 vaccination programs have been very successful overall, there are some socioeconomic and ethnic groups where vaccination coverage remains low (ref. 6). Tackling health inequalities is a long-term commitment that is relevant to all immunization programs in the UK. Building trust, especially in vaccines, requires a steady investment of time, resources and people. Adequate and appropriate communication should be provided prior to changing primary course vaccination offers in order to optimize vaccination among those who are eligible but have not yet accepted the vaccination offer. .
Future variants and implications for epidemiology
Since the pathogenicity of emerging variants cannot be predicted with certainty, prompt action should be taken if there is a substantial change in herd immunity against dominant circulating variants, including emerging variants of concern. may be required.
JCVI We will continue to research the epidemiology of COVID-19 and provide surge response advice as needed.
References
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Office for National Statistics (ONS) Coronavirus (COVID-19) Latest Insights: Antibodies.
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Unpublished data from the UK Health Security Agency.
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National Influenza and COVID-19 Surveillance Report: 2022-2023 Season.
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National Influenza and COVID-19 Surveillance Report: October 27, 2022 (Week 43).
