JCVI Statement on the 2023 COVID-19 Vaccination Program: November 8, 2022

Review

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 disease (hospitalization and mortality) in the population, while protecting the NHS.

As the transition from pandemic emergency response to pandemic recovery continues, the Joint Committee on Vaccination and Immunization (JCVI) began considering the 2023 COVID-19 vaccination program. The current Omicron era is characterized by:

high levels of population immunity acquired through vaccination and/or natural infection
lower disease severity compared to infection due to previous variants of SARS-CoV-2

During that time, the risk of severe illness from COVID-19 remains disproportionately higher among older age groups, nursing home residents, and people with certain underlying health conditions. Compared to the initial stages of the pandemic, much more is now understood about SARS-CoV2 infection. However, uncertainty remains regarding the evolution of the virus, the durability and breadth of immunity, and the epidemiology of infection. These uncertainties limit the immediate development of a routine immunization program against COVID-19.

Advice

JCVIInterim advice for planning purposes before 2023 is as follows:

in the fall of 2023, people at higher risk of severe disease from COVID-19 could be offered an additional dose of the vaccine in preparation for the winter of 2023 to 2024.
in addition, a small group of people (such as the elderly and immunocompromised) may be offered an additional dose of the vaccine in spring 2023.
emergency vaccine responses may be necessary if a new variant of concern with clinically significant biological differences compared to the Omicron variant emerges

JCVI also advises that:

the 2021 booster offer (third dose) for people aged 16 to 49 years who are not in the clinical risk group should close in line with the end of the vaccination campaign in autumn 2022.^{[footnote 1]}
otherwise healthy persons aged 5 to 49 who develop a new health condition in 2023 that places them in a clinical risk group will be offered primary vaccination and/or booster vaccination during the next seasonal vaccination campaign, as appropriate. Vaccination outside the period of this campaign is subject to individual clinical assessment
the primary course of vaccination against COVID-19 should move during 2023 towards a more targeted offer during vaccination campaigns to protect people at higher risk of severe disease from COVID-19. This would include:
- residents of homes for the elderly and staff working in homes for the elderly
- health and social workers on the front line
- all adults aged 50 and over
- persons aged 5 to 49 years in the clinical risk group, as specified in Green book
- persons aged 12 to 49 who are in household contact with persons with immunosuppression
- persons aged 16 to 49 who are caregivers, as specified in Green book
research should be considered to determine the optimal timing of vaccination to protect against severe COVID-19 disease (hospitalization and death) for groups at different levels of clinical risk

Considerations

It is estimated that more than 97% of adults in England had antibodies to SARS-CoV-2, either from infection or vaccination, by the end of August 2022 (reference 1). It is estimated that in Great Britain 93 to 99% of children aged 12 to 15 years and 74 to 98% of children aged 8 to 11 years had antibodies against SARS-CoV-2 at the end of August 2022 (references 1 and 2). . Natural immunity alone provides good levels of protection against severe COVID-19 disease, while a combination of natural immunity and vaccine-induced immunity (hybrid immunity) is associated with even higher levels of protection (references 3,4 and 5). This high level of strong population immunity developed over the last 2 and a half years is regularly monitored by the UK Health Safety Agency (UKHSA) public health surveillance programs.

Not all hospitalizations and deaths attributed to SARS-CoV-2 infection are vaccine-preventable events. Due to the high transmissibility of the Omicron variant, along with an infection that may be asymptomatic or with only mild symptoms, persons requiring hospital care for reasons unrelated to COVID-19 may be accidentally infected with SARS-CoV-2. Such hospitalizations cannot be prevented by vaccination against COVID-19. In contrast, some very vulnerable people may develop severe disease from COVID-19 despite being vaccinated; these people often have underlying health conditions that make them highly susceptible to serious illnesses and other infections. In the UK, during the Omicron era (up to week 43 in 2022), the highest rates of hospitalization were consistently seen in people aged 75 and over, while rates of infections (mild illnesses) were high across all age groups, particularly among younger people (references 6 and 7).

Revised estimates of the number needed for vaccination (NNV) to prevent one hospitalization during the Omicron era show that 800 people aged 70 years and older would need to receive a booster vaccination in the fall of 2022 (fourth dose) to prevent one hospitalization due to COVID-19. Corresponding NNV for persons aged 50 to 59 it is 8,000, and for persons aged 40 to 49 who are not in the clinical risk group it is 92,500 (Appendix 1).

IN November 2021, JCVI recommended vaccinations for healthy adults aged 40 to 49 years due to the epidemiology of that time. With the appearance of the Omicron variant at the end of November 2021, the offer was extended to healthy people aged 16 to 39 years as part of the emergency response to the wave (see JCVI the latest information on advice on vaccination against COVID-19 for children and young people and British vaccine response to the Omicron variant: JCVI advice). As of April 2022, receipt of a priming dose of the COVID-19 vaccine was less than 0.1% per week among all eligible persons younger than 50 years (Figure 62c in reference 8). Based on current data, keeping the booster (third dose) offer open to these groups is considered to have limited lasting value, and the overall impact on vaccine coverage is negligible.

Primary vaccination offers are widely available from 2021. Take-up of these vaccine offers has increased in recent months across all age groups (Figure 62a in reference 8). As of the beginning of 2022, less than 0.01% of weekly eligible persons over the age of 12 received the first dose of the COVID-19 vaccine. A more targeted offering of the primary vaccination course during the vaccination campaign period will allow these efforts to be more focused and enable more efficient use of NHS resources.

Although the vaccination program against COVID-19 is generally very successful, there are some socioeconomic and ethnic groups where vaccination coverage remains lower (reference 6). Tackling health inequalities is a long-term effort that is relevant to all vaccination programs in the UK. Building trust, especially trust in vaccines, requires constant and determined investments of time, resources and people. Adequate and appropriate communication should be provided prior to changes in the offer of the primary course of vaccination to optimize uptake among those who are eligible but yet to take up the offer of vaccination.

Future variants and their impact on epidemiology

Since the virulence of any newly emerging variant cannot be reliably predicted, rapid response measures may be necessary if there are significant changes in population immunity against the dominant circulating variant, including any new variant of concern.

JCVI will monitor the epidemiology of COVID-19 and provide emergency response advice, as needed.

References

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