The Joint Committee on Vaccination and Immunisation (JCVI) has advised a number of COVID-19 vaccination programmes in the UK. JCVI has been developing advice on extension of the UK programme, including whether to offer booster doses to those aged 18 to 39 years, second doses for those aged 12 to 15 years, and first and second doses for those aged 5 to 11 years. This process has been expedited and reviewed in light of the emergence of the Omicron variant.
The Secretary of State for Health and Social Care has asked JCVI to rapidly advise on a strategy to save lives, protect the NHS and reduce disease activity as far as possible. We do not yet know the extent of protection COVID-19 vaccines will provide against the Omicron variant. Protection against infection and against serious disease can be different, and such information is crucial to the development of an optimal vaccination programme. It may be that higher levels of antibody induced by vaccines directed at the original ‘wild type’ variant will provide better protection against the Omicron variant, as has been demonstrated in laboratory studies with respect to other variants. Studies are underway nationally and internationally to determine the validity of this assertion.
Optimising individual protection ahead of a wave of infection will provide the largest benefit in terms of reducing the impact of the Omicron variant on the UK population. Additional data regarding the Omicron variant will take some time to accrue. Waiting for such data before taking some actions risks a suboptimal delayed response.
JCVI advises the following immediate measures within the COVID-19 vaccine programmes:
- Booster vaccination eligibility should be expanded to include all adults aged 18 years to 39 years.
- Booster vaccination should now be offered in order of descending age groups, with priority given to the vaccination of older adults and those in a COVID-19 at-risk group. Booster vaccination should not be given within 3 months of completion of the primary course.
- Severely immunosuppressed individuals who have completed their primary course (3 doses) should be offered a booster dose with a minimum of 3 months between the third primary and booster dose. Those who have not yet received their third dose may be given the third dose now to avoid further delay. A further booster dose can be given in 3 months, in line with the clinical advice on optimal timing.
- Both the Moderna (50 microgram) and Pfizer-BioNTech (30 microgram) vaccines should be used with equal preference in the COVID-19 booster programme. Both vaccines have been shown to substantially increase antibody levels when offered as a booster dose.
In addition, JCVI advises the following secondary measure, subject to appropriate consideration by deployment teams regarding feasibility.
All children and young people aged 12 to 15 years should be offered a second dose (30 micrograms) of the Pfizer-BioNTech COVID-19 vaccine at a minimum of 12 weeks from the first dose. The interval between vaccines may be reduced to at least 8 weeks between doses if the emerging epidemiological data supports this (and those aged 16 to 17 may also be offered their second dose with an interval of at least 8 weeks).
The overall intention of the measures advised above is to accelerate the deployment of COVID-19 vaccines before the peak of any impending Omicron wave. There is currently no data to indicate that Omicron infection is associated with a change in the pattern of susceptibility to serious COVID-19 (hospitalisation and death). Persons of older age, or who are in COVID-19 at-risk groups are likely to remain at higher risk from serious COVID-19; therefore, vaccination should be prioritised accordingly.
Continued efforts should be made to offer COVID-19 vaccination (first, second and booster doses) to adults who have yet to receive any COVID-19 vaccinations.
Vaccination of those aged 5 to 11 years
No vaccine is currently authorised in the UK for use in children aged 5 to 11 years. JCVI will continue to review data on the potential benefits and risks of vaccination of children aged 5 to 11 years and will issue separate advice in due course.
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