England Preps COVID-19 Plans for Fall

Since the first COVID-19 vaccine was authorized for use in the United Kingdom (UK) in December 2020, the aim of COVID-19 vaccinations has been and continues to be the reduction of severe disease.

In Great Britain, most children had antibodies against the SARS-CoV-2 coronavirus at the end of August 2022.

While natural immunity alone provides good levels of protection against severe COVID-19, the combination of natural and vaccine-induced immunity (hybrid immunity) is associated with even higher levels of protection.

Over 15 million people aged 50 years and over have received an autumn booster in England as of January 23, 2023.

This immunity developed during the pandemic is regularly monitored by UK Health Security Agency (UKHSA). However, there remains ongoing uncertainty regarding virus evolution, the durability and breadth of immunity, and infection epidemiology.

As the transition continues away from a pandemic emergency response toward pandemic recovery, the Joint Committee on Vaccination and Immunisation (JCVI) recently published conditions for the 2023 COVID-19 vaccination program in the UK.

Since the risk of severe COVID-19 continues to be disproportionately more significant in those from older age groups, residents in care homes and persons with certain underlying health conditions, the JCVI's interim advice for planning ahead of 2023 is that:

• in autumn 2023, persons at higher risk of severe COVID-19 could be offered a booster vaccine dose in preparation for winter 2023 to 2024,
• in addition, for a smaller group of persons (older age and immunosuppressed), an extra booster vaccine dose may be offered in spring 2023,
• emergency surge vaccine responses may be required should a novel variant of concern emerge with clinically significant biological differences compared to the Omicron variant.

JCVI also advises that:

• The 2021 booster offer (third dose) for persons aged 16 to 49 years who are not in a clinical risk group should close in alignment with the close of the autumn 2022 vaccination campaign,
• Otherwise, healthy persons aged 5 to 49 who develop a new health condition in 2023 that places them in a clinical risk group would be offered primary vaccination and/or a booster vaccine during the next seasonal vaccination campaign, as appropriate. Vaccination outside these campaign periods would be subject to individual clinical judgment,
• primary course COVID-19 vaccination should move, throughout 2023, towards a more targeted offer during vaccination campaigns to protect those persons at higher risk of severe COVID-19 including residents in a care home for older adults and staff working in care homes for older adults and frontline health and social care workers,
• all adults aged 50 years and over,
• persons aged 5 to 49 years in a clinical risk group, as set out in the Green Book,
• persons aged 12 to 49 years who are household contacts of people with immunosuppression,
• persons aged 16 to 49 years who are carers, as set out in the Green Book

Professor Wei Shen Lim, Chair of COVID-19 vaccination on the JCVI, commented in a media release on January 25, 2023, "The COVID-19 vaccination program continues to reduce severe disease across the population while helping to protect the NHS."

"That is why we have advised planning for further booster vaccines for persons at higher risk of serious illness through an autumn booster program later this year."

Furthermore, research should be considered to inform the optimal timing of booster vaccinations to protect against severe COVID-19 for groups at different clinical risk levels.

And addressing health inequalities is a long-term effort relevant to all UK immunization programs.

Building trust, specifically vaccine confidence, requires steadily determined investment of time, resources, and persons.

Appropriate and adequate communication should be provided in advance of changes to the primary course vaccination offer to optimize uptake among eligible people who have yet to accept the offer of vaccination.

To learn more about UK vaccination data from different sources, visit this webpage.