Following last year’s advice from the Joint Committee on Vaccination and Immunisation (JCVI), Public Health Scotland has been working with the Scottish Government and NHS boards to develop plans for the roll out of Scotland’s Respiratory Syncytial Virus (RSV) vaccination programme to protect newborns, infants and older adults.
RSV is a common respiratory virus that generally causes mild illness with cold-like symptoms. Most cases recover after 2-3 weeks of illness, but RSV can cause severe illness in some people, including newborns, infants and older adults, leading to complications and hospitalisation.
With the new programme set to commence later in the summer, some information is now available on NHS inform and more detail will follow soon.
The UK has become the first country to approve a dual vaccine which tackles both the original Covid virus and the newer Omicron variant.The vaccine will now be part of the autumn booster campaign.
The Joint Committee on Vaccination and Immunisation (JCVI) has published its advice on which vaccines should be used in this year’s autumn booster programme.
All of the available boosters provide good protection against severe illness from COVID-19 and the Committee has emphasised that getting a booster in good time before the winter season is more important for those eligible than the type of vaccine that is received.
The vaccines advised for use in the autumn booster programme are:
For adults aged 18 years and above:
Moderna mRNA (Spikevax) bivalent Omicron BA.1/Original ‘wild-type’ vaccine
Moderna mRNA (Spikevax) Original ‘wild-type’ vaccine
Pfizer-BioNTech mRNA (Comirnaty) Original ‘wild-type’ vaccine
in exceptional circumstances, the Novavax Matrix-M adjuvanted wild-type vaccine (Nuvaxovid) may be used when no alternative clinically suitable UK-approved COVID-19 vaccine is available
For people aged 12 to 17 years:
Pfizer-BioNTech mRNA (Comirnaty) Original ‘wild-type’ vaccine
For people aged 5 to 11 years:
Pfizer-BioNTech mRNA (Comirnaty) Original ‘wild-type’ vaccine paediatric formulation
‘Bivalent’ vaccines have been developed by global manufacturers since the emergence and dominance of the Omicron variant. These vaccines contain two different antigens (substances that induce an immune response) based on two different COVID-19 strains, or variants. The original mRNA vaccines contain one antigen (monovalent), based on the original ‘wild-type’ strain.
Studies indicate the Moderna bivalent vaccine produces a marginally higher immune response against some variants than the Moderna mRNA Original ‘wild-type’ vaccine. The clinical relevance of these small differences is uncertain.
The committee will consider further bivalent vaccines for use in the programme as they are approved by the MHRA.
In its latest advice the JCVI has stated that, where feasible, it would be preferable for a single type of booster vaccine to be offered throughout the duration of the autumn programme for simplicity of deployment.
Professor Wei Shen Lim, Chair of COVID-19 immunisation on the JCVI, said: “All of the available booster vaccines offer very good protection against severe illness from COVID-19. As more vaccines continue to be developed and approved, the JCVI will consider the benefits of including them in the UK programme.
“It is important that everyone who is eligible takes up a booster this autumn, whichever vaccine is on offer. This will increase your protection against being severely ill from COVID-19 as we move into winter.”
Dr Mary Ramsay, Head of Immunisation at UKHSA, said: “Although cases of COVID-19 are relatively low at present, we are expecting to see the virus circulating more widely during the winter months.
“The booster is being offered to those at higher risk of severe illness and by taking up the booster vaccine this autumn, you will increase your protection ahead of the winter months, when respiratory viruses are typically at their peak.”
The Joint Committee on Vaccination and Immunisation (JCVI) has provided interim advice to the UK government regarding coronavirus (COVID-19) booster doses this autumn.
The boosters would be for more vulnerable adults, alongside frontline social care and health workers, in order to maintain their protection over the winter against severe COVID-19.
The advice should be considered as interim and for the purposes of operational planning for the autumn for the NHS, care homes and wider health community.
The committee recognises that there is considerable uncertainty with regards to the likelihood, timing and severity of any potential future wave of COVID-19 in the UK in the year ahead.
Despite these uncertainties, winter will remain the season when the threat from COVID-19 is greatest for individuals and for health communities.
As in autumn 2021, the primary objective of the 2022 autumn booster programme will be to increase population immunity and protection against severe COVID-19 disease, specifically hospitalisation and death, over the winter period.
The JCVI’s current view is that in autumn 2022, a COVID-19 vaccine should be offered to:
residents in a care home for older adults and staff
frontline health and social care workers
all those 65 years of age and over
adults aged 16 to 64 years who are in a clinical risk group
Professor Wei Shen Lim, Chair of COVID-19 vaccination on the JCVI, said: “Last year’s autumn booster vaccination programme provided excellent protection against severe COVID-19, including against the Omicron variant.
“We have provided interim advice on an autumn booster programme for 2022 so that the NHS and care homes are able to start the necessary operational planning, to enable high levels of protection for more vulnerable individuals and frontline healthcare staff over next winter.
“As we continue to review the scientific data, further updates to this advice will follow.”
Throughout the pandemic, evidence has clearly shown that COVID-19 has disproportionately affected those in older age groups, residents in care homes for older adults, and those with certain underlying health conditions, particularly those who are severely immunosuppressed.
It is important that those who are eligible for the spring booster currently being rolled out – specifically adults aged 75 years and over, residents in a care home for older adults, and individuals aged 12 years and over who are immunosuppressed – still come forward to ensure they are protected.
The JCVI will continue its on-going review of the vaccination programme and the epidemiological situation, particularly in relation to the timing and value of doses for less vulnerable older adults and those in clinical risk groups ahead of autumn 2022.
The committee will announce its final plans for the autumn programme, including further detail on the definitions of clinical risk groups, in due course.
Boosters continue to provide high levels of protection against severe disease from Omicron in older adults
Latest data from UKHSA shows booster doses are continuing to provide high levels of protection against severe disease from the Omicron variant among older adults.
Figures show that around 3 months after they received the third jab, protection against hospitalisation among those aged 65 and over remains at about 90%.
With just 2 vaccine doses, protection against severe disease drops to around 70% after 3 months and to 50% after 6 months.
The Joint Committee on Vaccination and Immunisation (JCVI) has taken this latest evidence into account in their ongoing review of the booster programme.
The Committee advises that at this present time:
there is no immediate need to introduce a second booster dose, or fourth jab, to the most vulnerable (care home residents and those aged over 80) – the timing and need for further booster doses will continue to be reviewed as the data evolves
priority should continue to be given to rolling out first booster doses to all age groups
unvaccinated individuals should come forward for their first 2 doses as soon as possible
Professor Wei Shen Lim, the JCVI’s chair of COVID-19 immunisation, said: “The current data shows the booster dose is continuing to provide high levels of protection against severe disease, even for the most vulnerable older age groups.
“For this reason, the committee has concluded there is no immediate need to introduce a second booster dose, though this will continue to be reviewed.
“The data is highly encouraging and emphasises the value of a booster jab. With Omicron continuing to spread widely, I encourage everyone to come forward for their booster dose, or if unvaccinated, for their first 2 doses, to increase their protection against serious illness.”
The latest study looked at booster doses in those aged over 65, who were among the first to be eligible when the booster rollout began in mid-September.
Whilst with a booster dose, the duration of protection against severe disease remains high, protection against mild symptomatic infection is more short-lived and drops to around 30% by about 3 months.
People aged 60 to 69 and adults aged 16 and over with underlying health conditions have begun to receive invitations for their flu and COVID-19 booster vaccinations through the post.
Appointments for this group will take place at a local community clinic and will run from late October and throughout November.
Currently, as per JCVI advice, we are vaccinating people in the highest risk groups for both flu and COVID-19 including those who are aged 70 years and over, people in older adult care homes, those who are on the Highest Risk List and frontline health and social care workers.
In addition we are delivering flu vaccinations to children under 2 years old who have underlying health conditions, preschool children aged 2-5, all school pupils, pregnant women and all NHS healthcare workers.
The winter flu and COVID-19 vaccination programme is working together to reduce the risks for both types of illness. Wherever possible, those eligible for the booster jab will receive both the flu vaccine and COVID-19 boosters on the same day. This is safe and effective to do.
More than 1.5 million COVID-19 and flu vaccinations have been administered since September 6.
For those in the underlying health conditions group, the type of health condition will guide whether they will be given a flu jab, the COVID-19 booster, or both vaccines.
Details on who is eligible for these vaccinations and when they can expect an invitation are available on NHS Inform.
Health Secretary Humza Yousaf said: “For those eligible for the COVID-19 boosters, appointments can only take place six months (24 weeks) after your second dose. As such, it may take several weeks before you receive your invitation letter. We remain on track with Scotland’s booster programme prioritising those at the highest risk for both COVID-19 and flu.
“We started this as soon as possible following the JCVI advice – that the booster dose should be offered no earlier than six months after completion of the primary vaccine course. It is important to note that many people in the original early priority cohorts of the initial vaccination programme had already had a 6 month gap prior to this JCVI advice.
“In addition to delivering the COVID-19 vaccine boosters, this year we are offering a record number of free flu vaccines to help protect the people of Scotland. It is the biggest ever flu vaccination programme in Scotland reaching over 4 million people.
“Appointments for both vaccines are being scheduled based on clinical need and age and it will take until the middle of January for everyone to be offered their vaccines. Boosters will be offered to many of the groups who routinely have the flu vaccine to protect people from both illnesses. To support this, we are ensuring those most vulnerable are vaccinated first.
“But I would like to stress: everyone who is eligible will be offered a vaccination. If you haven’t received your appointment letter yet, please be patient. You do not have to do anything now – you will be contacted, notifying you of your appointment.
“The flu virus changes every year, so you need to get the vaccine every year to stay protected. The vaccine cannot give you flu, but it can help stop you catching it, or suffering severe symptoms. The COVID-19 vaccine does not offer any protection from flu, you need to get the separate flu vaccine.
“Flu can be extremely serious and is very infectious. With COVID-19 still circulating in the community we can best protect those most at risk as well as ease pressure on our National Health Service and social care services by encouraging everyone eligible to get vaccinated against flu.”
Scottish Labour said: “This is more proof that the SNP are failing to protect the most vulnerable this winter: They’ve shifted goalposts for booster jabs.
“Many will now have to wait at least another month for a third jag. Cases are spiralling and we need faster action from the Government.”
To find out more about vaccine eligibility and when you will be invited visit:
nhsinform.scot/fluandcovid19vaccsguide
For more information about the flu vaccine, visit:
nhsinform.scot/fluvaccine
For more information about the COVID-19 booster visit:
– Covid-19 booster vaccinations get underway today
– Lothian launches drop-in clinics for 12 to 15-year-olds
Residents in care homes for older people are the first to be offered coronavirus (COVID-19) booster vaccinations from today (Monday).
This group will be offered both flu and COVID-19 booster vaccines after the Joint Committee on Vaccination and Immunisation advised that they could be given alongside one another.
From tomorrow (Tuesday 21 September) frontline health and social care workers are able to book an appointment for a booster jab online at NHS Inform. The portal can be used by all health and social care workers to book a flu vaccine.
Adults aged 70 years and over and those 16 years and over who are on the highest risk list (previously known as the shielding list) will begin to be contacted by letter or by their GP from the end of September.
People on the highest risk list who were severely immunosuppressed at the time of their last COVID-19 vaccination will be offered a third primary dose instead.
Other eligible groups – including all those aged 16 to 49 years with underlying health conditions, adult carers, unpaid and young carers, adult household contacts of immunosuppressed individuals and all adults over 50 – will be able to book an appointment online from October.
Meanwhile, also from today (Monday) children and young people aged 12 -15 years old can go to drop-in clinics for a vaccination if they wish to get their jab before they receive their letter inviting them for a scheduled appointment. Everyone in this age group will be invited for vaccination at a community based clinic or a school delivery session from 27 September.
Heath Secretary Humza Yousaf said: “I am pleased to see the booster programme getting underway for residents in care homes for older people, offering longer lasting protection against severe COVID-19 illness.
“The booster programme will run alongside our biggest ever flu vaccine programme as both of these programmes are important for individual and for public health and wherever possible, those eligible will be offered COVID-19 booster and flu vaccines together.
“We are also starting vaccination of 12-15 year olds after Scottish Ministers accepted advice from the four UK Chief Medical Officers. This group can now head to drop-in clinics for their jabs or wait for a letter offering them a scheduled appointment.”
NHS Lothian launches drop-in clinics for 12 to 15-year-olds
Young people aged 12 to 15 will be able to get a COVID-19 vaccine at drop-in clinics across Lothian from today (September 20).
Mass clinics in West Lothian, Edinburgh and Midlothian will open their doors to young people as part of the latest phase of the national vaccination programme.
Pyramids, Gorebridge and Lowland Hall vaccination clinics will be the first in Lothian to administer the lifesaving vaccine, before more clinics are added to the list over coming days.
Pat Wynne, Director of Nursing for Primary and Community Care, NHS Lothian said: “We are delighted to offer drop-in clinics for young people aged 12-15.
“These clinics will enable young people to attend, without a prior appointment to receive their vaccination.
“We recognise that young people, as well as their parents and guardians may have questions regarding the COVID vaccination and we encourage them to visit the pages on NHS Inform where there is a range of information available.
“Alongside this, our teams at Pyramids, Gorebridge and Lowland Hall are one hand to answer any questions people may have.
“Vaccination remains critically important in the continued fight against COVID-19 and we welcome the further expansion of the vaccination programme across Lothian.”
The clinics are opening their doors following the publication and government acceptance of the advice of the four Chief Medical Officers (CMOs) to offer a single dose of the COVID vaccine to all healthy 12-15-year-olds.
Young people do not need to be registered with a GP to attend, however it is requested that they are accompanied by their parent or guardian.
As well as the drop-in clinics for 12-15’s, NHS Lothian continues to operate a range of COVID vaccination clinics in locations across Lothian.
Mr Wynne added: “We continue to offer vaccination clinics across Lothian for anyone who requires a first dose of the vaccine, or who is now due their second dose. I would urge anyone who has still to be vaccinated to pop along.”
Move follows unanimous advice to ministers from the four UK Chief Medical Officers
Parental consent will be sought prior to vaccination
People aged 12 to 15 in England will be offered one dose of the Pfizer/BioNTech COVID-19 vaccine, following advice from the four UK Chief Medical Officers (CMOs), the Health and Social Care Secretary has announced. The Scottish Government is expected to make an announcement later today.
In line with the recommendation of the independent Joint Committee on Vaccination and Immunisation (JCVI), the government sought the views of the four UK CMOs on the wider issues that are relevant to the health of children.
The UK Government has accepted the advice of the four UK CMOs and the NHS is preparing to deliver a schools-based vaccination programme, which is the successful model used for vaccinations including for HPV and Diphtheria, Tetanus and Polio (DTP), supported by GPs and community pharmacies. Invitations for vaccination will begin next week.
Parental, guardian or carer consent will be sought by vaccination healthcare staff prior to vaccination in line with existing school vaccination programmes.
Healthy school-aged children aged 12 to 15 will primarily receive their COVID-19 vaccination in their school with alternative provision for those who are home schooled, in secure services or specialist mental health settings.
Health and Social Care Secretary, Sajid Javid said: “I have accepted the recommendation from the Chief Medical Officers to expand vaccination to those aged 12 to 15 – protecting young people from catching COVID-19, reducing transmission in schools and keeping pupils in the classroom.
“I am very grateful for the expert advice I have received from the Joint Committee on Vaccination and Immunisation and UK Chief Medical Officers.
“Our outstanding NHS stands ready to move forward with rolling out the vaccine to this group with the same sense of urgency we’ve had at every point in our vaccination programme.”
THE CHIEF MEDICAL OFFICERS’ LETTER READS:
To: Sajid Javid MP, Secretary of State for Health and Social Care, HM Government Eluned Morgan AS/MS, Minister for Health and Social Services, Welsh Government Humza Yousaf MSP, Cabinet Secretary for Health and Social Care, Scottish Government Robin Swann MLA, Minister of Health Northern Ireland Executive
13 September 2021
Dear Secretary of State, Cabinet Secretary and ministers,
Universal vaccination of children and young people aged 12 to 15 years against COVID-19
Background
The Joint Committee on Vaccination and Immunisation (JCVI) in their advice to you on 2 September 2021 on this subject said: ‘Overall, the committee is of the opinion that the benefits from vaccination are marginally greater than the potential known harms… but acknowledges that there is considerable uncertainty regarding the magnitude of the potential harms.
The margin of benefit, based primarily on a health perspective, is considered too small to support advice on a universal programme of vaccination of otherwise healthy 12 to 15-year-old children at this time…. JCVI is constituted with expertise to allow consideration of the health benefits and risks of vaccination and it is not within its remit to incorporate in-depth considerations on wider societal impacts, including educational benefits. The government may wish to seek further views on the wider societal and educational impacts from the Chief Medical Officers of the 4 nations, with representation from JCVI in these subsequent discussions.‘
You accepted this recommendation from JCVI, and wrote to us on 2 September 2021 stating “We agree with the approach suggested by JCVI, and so we are writing to request that you take forward work (drawing on experts as you see fit) to consider the matter from a broader perspective, as suggested by the JCVI.”
In doing so we have been fortunate to have been informed by the independent expertise of leaders of the clinical and public health profession from across the UK. This has included Presidents and Chairs or their representative of:
Royal College of Paediatrics and Child Health
Royal College of General Practice
Royal College of Psychiatry
Faculty of Public Health
Academy of Medical Royal Colleges representing all the other Royal Colleges and Faculties
Association of Directors of Public Health
Regional Directors of Public Health
national public health specialists
experts in data and modelling
We are very grateful to them for taking considerable time and effort to consult their own colleagues in all 4 nations at short notice to get a comprehensive view of the balance of informed medical opinion and experience across the UK.
The UK’s independent regulator of medicines and vaccines the Medicines and Healthcare products Regulatory Agency (MHRA) is in law the appropriate body to determine whether, based on risk-benefit grounds, a vaccine is safe and effective to use and so grant a licence. They have done so for children and young people aged over 12 years for two vaccines against COVID-19, those manufactured by Pfizer and Moderna. Their assessment is that benefits exceed risks on an individual basis. We take their independent opinion as read. The MHRA position on mRNA vaccines is similar to the relevant regulatory approvals granted in the same age groups in multiple other jurisdictions including but not limited to the USA, the European Union, and Canada.
The independent JCVI is the proper body to give advice on how to deploy a vaccine which has a prior favourable risk-benefit decision and authorisation from MHRA including whether it has a sufficiently large benefit to be worth deploying on a larger, population scale. Like MHRA they consider the benefits of vaccination in this age group exceed the risks (i.e. it is better to be vaccinated than not vaccinated in this age group).
They balanced the risk of COVID-19 against the risks of vaccination, including myocarditis. When forming its advice, the JCVI considered vaccine use according to clinical risk groups, thus identifying different groups according to their potential to benefit from vaccination.
For 12 to 15 year olds who do not have underlying health conditions that place them at higher risk from severe COVID-19, the JCVI considered that the size of both the risk and the benefit are at an individual level very small, and the overall advantage for vaccination, whilst present, is therefore not sufficiently large to recommend universal vaccination on their usual criteria.
They deemed the extent to which vaccination might mitigate the impacts of COVID-19 on education was beyond the usual remit of the JCVI. They recognised however that given the substantial scale of the impact of COVID-19 on all children and young people, which goes beyond normal clinical benefit and risk, wider issues could, exceptionally, be relevant hence their suggestion to consult UK CMOs.
The JCVI have already recommended that children and young people aged 12 to 17 with specific underlying health conditions, and children and young people who are aged 12 years and over who are household contacts of persons who are immunocompromised are offered two doses of a vaccine, normally Pfizer BioNTech BNT162b2. They have recommended all young people 16 to 17 are offered an initial first dose of vaccine.
The UK has benefited from having data from the USA, Canada and Israel, which have already offered vaccines universally to children and young people aged 12 to 15.
The UK CMOs start from the position that the MHRA and JCVI set out on individual benefit-risk calculations for this age group, and have not revisited this. We accept that at an individual level benefit exceeds risk but this advantage is small, and we have taken the JCVI figures as the UK current position on this question.
The Chair of the JCVI Prof. Lim has been a member of our group to ensure that there is no duplication of effort or conflict between the views of UK CMOs and the JCVI. We have been fortunate to have been joined also by the lead Deputy Chief Medical Officers for vaccines Prof. Van Tam (England), Prof. Steedman (Scotland) and Dr. Chada (Northern Ireland) and the DHSC Chief Scientific Adviser, Prof. Chappell. The final advice is that of the Chief Medical Officers, but informed by independent senior clinical and public health input from across the UK.
UK CMOs have decided in their ToR that we will only consider benefits and disbenefits to those aged 12 to 15 from vaccinating this age group, including indirect benefits. Whilst there may be benefits to other age groups, these have not been considered in our advice below.
Issues of vaccine supply were not factors considered in decision making.
The UK CMOs are aware of the extensive range of non-clinical views but this UK CMOs advice is purely clinical and public health derived and has not taken issues outside their clinical and public health remit into account. There is a subsequent political process where wider societal issues may be considered by ministers in deciding how they respond to this advice.
Advice
All drugs, vaccines and surgical procedures have both risks and benefits. If the risks exceed benefits the drug, vaccine or procedure should not be advised, and a drug or vaccine will not be authorised by MHRA. If benefits exceed risks then medical practitioners may advise the drug or vaccine, but the strength of their advice will depend on the degree of benefit over risk.
At an individual level, the view of the MHRA, the JCVI and international regulators is that there is an advantage to someone aged 12 to 15 of being vaccinated over being unvaccinated. The COVID-19 Delta variant is highly infectious and very common, so the great majority of the unvaccinated will get COVID-19. In those aged 12 to 15, COVID-19 rarely, but occasionally, leads to serious illness, hospitalisation and even less commonly death. The risks of vaccination (mainly myocarditis) are also very rare. The absolute advantage to being vaccinated in this age group is therefore small (‘marginal’) in the view of the JCVI. On its own the view of the JCVI is that this advantage, whilst present, is insufficient to justify a universal offer in this age group. Accepting this advice, UK CMOs looked at wider public health benefits and risks of universal vaccination in this age group to determine if this shifts the risk-benefit either way.
Of these, the most important in this age group was impact on education. UK CMOs also considered impact on mental health and operational issues such as any possible negative impact on other vaccine programmes, noting that influenza vaccination and other immunisations of children and young people are well-established, important, and that the annual flu vaccine deployment programme commences imminently.
The UK CMOs, in common with the clinical and wider public health community, consider education one of the most important drivers of improved public health and mental health, and have laid this out in their advice to parents and teachers in a previous joint statement. Evidence from clinical and public health colleagues, general practice, child health and mental health consistently makes clear the massive impact that absent, or disrupted, face-to-face education has had on the welfare and mental health of many children and young people. This is despite remarkable efforts by parents and teachers to maintain education in the face of disruption.
The negative impact has been especially great in areas of relative deprivation which have been particularly badly affected by COVID-19. The effects of missed or disrupted education are even more apparent and enduring in these areas. The effects of disrupted education, or uncertainty, on mental health are well recognised. There can be lifelong effects on health if extended disruption to education leads to reduced life chances.
Whilst full closures of schools due to lockdowns is much less likely to be necessary in the next stages of the COVID-19 epidemic, UK CMOs expect the epidemic to continue to be prolonged and unpredictable. Local surges of infection, including in schools, should be anticipated for some time. Where they occur, they are likely to be disruptive.
Every effort should be taken to minimise school disruption in policy decisions and local actions. Vaccination, if deployed, should only be seen as an adjunct to other actions to maintain children and young people in secondary school and minimise further education disruption and therefore medium and longer term public health harm.
On balance however, UK CMOs judge that it is likely vaccination will help reduce transmission of COVID-19 in schools which are attended by children and young people aged 12 to 15 years. COVID-19 is a disease which can be very effectively transmitted by mass spreading events, especially with Delta variant. Having a significant proportion of pupils vaccinated is likely to reduce the probability of such events which are likely to cause local outbreaks in, or associated with, schools. They will also reduce the chance an individual child gets COVID-19. This means vaccination is likely to reduce (but not eliminate) education disruption.
Set against this there are operational risks that COVID-19 vaccination could interfere with other, important, vaccination programmes in schools including flu vaccines.
Overall however the view of the UK CMOs is that the additional likely benefits of reducing educational disruption, and the consequent reduction in public health harm from educational disruption, on balance provide sufficient extra advantage in addition to the marginal advantage at an individual level identified by the JCVI to recommend in favour of vaccinating this group.
They therefore recommend on public health grounds that ministers extend the offer of universal vaccination with a first dose of Pfizer-BioNTech COVID-19 vaccine to all children and young people aged 12 to 15 not already covered by existing JCVI advice.
If ministers accept this advice, UK CMOs would want the JCVI to give a view on whether, and what, second doses to give to children and young people aged 12 to 15 once more data on second doses in this age group has accrued internationally. This will not be before the spring term.
In recommending this to ministers, UK CMOs recognise that the overwhelming benefits of vaccination for adults, where risk-benefit is very strongly in favour of vaccination for almost all groups, are not as clear-cut for children and young people aged 12 to 15. Children, young people and their parents will need to understand potential benefits, potential side effects and the balance between them.
If ministers accept this advice, issues of consent need to take this much more balanced risk-benefit into account. UK CMOs recommend that the Royal Colleges and other professional groups are consulted in how best to present the risk-benefit decisions in a way that is accessible to children and young people as well as their parents. A child-centred approach to communication and deployment of the vaccine should be the primary objective.
If ministers accept this advice, it is essential that children and young people aged 12 to 15 and their parents are supported in their decisions, whatever decisions they take, and are not stigmatised either for accepting, or not accepting, the vaccination offer. Individual choice should be respected.
Chief Medical Officer for England Prof. Christopher Whitty
Chief Medical Officer for Northern Ireland Sir Michael McBride
Chief Medical Officer for Scotland Dr. Gregor Smith
Chief Medical Officer for Wales Dr. Frank Atherton
Over four in five adults across the UK have received both COVID-19 vaccine doses, with over half of all 16 and 17 year olds coming forward for their first jab.
However COVID numbers continue to rise across the UK. 28,856 new cases were reported yesterday, with 4241 of these in Scotland. The daily Scottish figure is likely to be considerably higher due to an IT problem.
Responding to the advice from the Chief Medical Officers regarding the vaccination of all 12-15 year olds, Bruce Adamson, the Children and Young People’s Commissioner Scotland, said: “We welcome the advice to offer the vaccine to children between the age of 12 and 15. It is important to give them that choice.
“Children and young people have a right to the best possible health, that’s not just about protection from the Covid virus itself, but also the impact on their mental health due to isolation and other factors. The pandemic has impacted their right to education, their right to play, their right to see wider family and friends which is so essential to their development. Their education has been disrupted with two long periods of school closures.
“It is important that children are supported to make informed decisions about their own health. Children of this age group have told me over the last few months that they are in favour of having the choice to be vaccinated. That is not to say that all of them had made a decision about whether they would get a vaccine, but they wanted the option to be available to them. Of course, there have been some children who are concerned about vaccination, or who told me about parental concerns. It is important that there is no stigma attached to the choices that children make about vaccination.
“It is essential that this advice is communicated directly to 12 to 15 year olds in a child-friendly way so they can understand why they are now being offered the vaccine, and can have any questions they might have answered in a way they can understand. Children have the right to access appropriate information on decisions affecting them.
“Parents and carers will play an important role in supporting the decision-making around whether a child chooses to get vaccinated so it is important that they have all of the necessary information to support that choice.”
JVCI advises politicians to seek further advice from CMOs
The four Chief Medical Officers will provide further advice on the COVID-19 vaccination of young people aged 12 to 15 with COVID-19 vaccines following the advice of the independent Joint Committee on Vaccination and Immunisation (JCVI).
The independent medicines regulator, the Medicines and Healthcare products Regulatory Agency (MHRA), has approved the Pfizer and Moderna vaccines for people aged 12 and over after they met strict standards of safety and effectiveness.
The JCVI has advised that the health benefits from vaccination are marginally greater than the potential known harms. It has advised the government to seek further input from the Chief Medical Officers on the wider impacts.
This includes the impact on schools and young people’s education, which has been disproportionately impacted by the pandemic.
UK health ministers from across the four nations have today written to the Chief Medical Officers to request they begin the process of assessing the broader impact of universal COVID-19 vaccination in this age group.
They will now convene experts and senior leaders in clinical and public health to consider the issue. They will then present their advice to ministers on whether a universal programme should be taken forward.
People aged 12 to 15 who are clinically vulnerable to COVID-19 or who live with adults who are at increased risk of serious illness from the virus are already eligible for a COVID-19 vaccine and are being contacted by the NHS, to be invited to come forward.
The JCVI has advised that this offer should be expanded to include more children aged 12 to 15, for example those with sickle cell disease or type 1 diabetes.
Health and Social Care Secretary Sajid Javid said: “Our COVID-19 vaccines have brought a wide range of benefits to the country, from saving lives and preventing hospitalisations, to helping stop infections and allowing children to return to school.
“I am grateful for the expert advice that I have received from the independent Joint Committee on Vaccination and Immunisation.
“People aged 12 to 15 who are clinically vulnerable to the virus have already been offered a COVID-19 vaccine, and today we’ll be expanding the offer to those with conditions such as sickle cell disease or type 1 diabetes to protect even more vulnerable children.
“Along with Health Ministers across the four nations, I have today written to the Chief Medical Officers to ask that they consider the vaccination of 12 to 15 year olds from a broader perspective, as suggested by the JCVI.
“We will then consider the advice from the Chief Medical Officers, building on the advice from the JCVI, before making a decision shortly.”
Scottish Health Minister Humza Yousaf said: “I want to thank the JCVI for today’s advice regarding vaccination for 12 -15 year olds.
“While the JCVI has agreed that the benefits marginally outweigh the risks they are not yet prepared to recommend universal vaccination of 12-15 year olds, however, they have suggested that Health Ministers may wish to ask their respective CMOs to explore the issue further, taking into consideration broader educational and societal impacts.
“Therefore, I have agreed with the other three UK Health Ministers to write a letter asking the four Chief Medical Officers to consider this latest guidance and explore whether there is additional evidence to suggest it would be beneficial to offer vaccination to all 12 – 15 year olds. We have asked for this further work to be conducted as soon as possible.
“A further update will be issued once these discussions have taken place. In the meantime, we will offer the vaccine to those children and young people currently recommended.
“The recent increase in cases of COVID-19 means it remains crucial that everyone who is offered a vaccination takes up the offer.”
The JCVI is advising that people with severely weakened immune systems should have a third vaccine dose as part of their primary COVID-19 vaccination schedule
This third dose should be offered to people over 12 who were severely immunosuppressed at the time of their first or second dose, including those with leukaemia, advanced HIV and recent organ transplants.
These people may not mount a full response to vaccination and therefore may be less protected than the wider population.
This offer is separate to any potential booster programme. The Joint Committee on Vaccination and Immunisation (JCVI) is still deliberating the potential benefits of booster vaccines for the rest of the population and is awaiting further evidence to inform this decision.
Immunosuppression varies widely in severity and duration. Many people who are immunosuppressed have lower levels of antibodies after coronavirus (COVID-19) vaccination, as some studies have shown.
Preliminary data from the OCTAVE trial showed that almost everyone who was immunosuppressed mounted an immune response after 2 doses, as indicated by either antibodies or T cells. However, in around 40% of people, the levels of antibodies were low. It is not clear how much this may affect protection against COVID-19 as antibodies represent only part of a person’s immune response.
People with severe immunosuppression are more likely to be severely ill if they do catch COVID-19.
Studies are ongoing to see how effective a third dose is for immunosuppressed people, but it is very unlikely to cause any harm. Therefore, on balance, the JCVI’s view is that a third dose can be safely offered as it may increase their protection.
Professor Wei Shen Lim, Chair of COVID-19 Immunisation for the JCVI, said: “We want people with severely suppressed immune systems to have the best chance of gaining protection from COVID-19 via vaccination.
“Therefore, we are advising they have a third vaccine dose on top of their initial 2 doses, as we hope this will reduce their risk of severe outcomes such as hospitalisation and death.
The JCVI advises that for adults aged 18 and older, either the Moderna or Pfizer-BioNTech COVID-19 vaccines be administered for the third dose, as a number of studies have reported an increased immune response in some immunosuppressed people after a third dose of an mRNA vaccine.
For those aged 12 to 17, the Pfizer-BioNTech vaccine is preferred.
The decision on the timing of the third dose should be made by their specialist. As a general guide, the third dose should usually be at least 8 weeks after the second dose but with flexibility to adjust the timing so that, where possible, immunosuppression is at a minimum when the vaccine dose is given.
This will enable a better immune response to be generated. For example, it is preferable to give a vaccine dose before someone undergoes chemotherapy, rather than during their treatment.
Those with less serious immunosuppression are not included in this advice but are likely to become eligible for another dose as part of a potential booster programme, pending further advice from the JCVI.
In the event of a booster programme, it is expected that severely immunosuppressed people will also be offered a booster dose, at a suitable interval after their third dose.
A third primary dose is an extra ‘top-up’ dose for those who may not have generated a full immune response to the first 2 doses. In contrast, a booster dose is a later dose to extend the duration of protection from the primary course of vaccinations.
The UK Government accepts JCVI’s advice to offer a third COVID-19 vaccine to people with severely weakened immune systems:
Health and Social Care Secretary Sajid Javid said: “Today I have accepted the expert recommendations from the independent Joint Committee on Vaccination and Immunisation to offer a third vaccine dose to people aged 12 and over with severely weakened immune systems as part of their primary schedule following data from trials of those who are immunosuppressed.
We know people with specific conditions that make them particularly vulnerable to COVID-19 may have received less protection against the virus from two vaccine doses. I am determined to ensure we are doing all we can to protect people in this group and a third dose will help deliver that.
The NHS will contact people as soon as possible to discuss their needs and arrange an appointment for a third dose where clinically appropriate.
This is not the start of the booster programme – we are continuing to plan for this to begin in September to ensure the protection people have built from vaccines is maintained over time and ahead of the winter. We will prioritise those most at risk to COVID-19, including those who are eligible for a third primary vaccine, for boosters based on the final advice of the JCVI.
COVID-19 vaccines have saved more than 105,000 lives and prevented 24 million infections in England alone. They are building a wall of defence and are the best way to protect people from serious illness. I encourage everybody who is eligible to get their jabs as soon as they can.
Professor Jonathan Van Tam, Deputy Chief Medical Officer, said: “We know there are people with severe immunosuppression for whom the first two doses of vaccine have not provided the same level protection as for the general population. The degree of protection will vary by individual, according to degree of immunosuppression and the underlying reasons for that.
So I welcome the advice from JCVI to offer a third primary dose to those with severe immunosuppression, at a bespoke interval, advised by their specialist clinician, and guided by the UK’s immunisation handbook, the Green Book.
We should be doing all we reasonably can to ensure that this group is not disadvantaged and a third primary dose is one step in this direction. We are also working hard to ensure there are other medical interventions that can be used in these groups, including specific treatments like antivirals and monoclonal antibodies.
A JCVI decision on whether young teenagers should be vaccinated is expected ‘within days’.
All young people 16 to 17 years of age will now be offered the coronavirus (COVID-19) vaccination in Scotland.
In line with the latest advice from the Joint Committee on Vaccination and Immunisation (JCVI), they will be offered a first dose of the Pfizer-BioNTech vaccine.
From Friday (6 August), people who are 16 or 17 in mainland Scotland will be invited to register their interest through the online portal at NHS Inform, and will then be sent an appointment via SMS or email.
Eligible young people in Shetland, Orkney and Western Isles will be contacted by their health board and invited to attend clinics.
Alternatively, drop-in clinics will be available for 16 to 17-years-olds. The start date for clinics opening for this age group will be confirmed shortly.
Anyone who doesn’t register an interest or attend a drop-in clinic, once open, will be sent an appointment invitation through the post. It is expected that everyone in this age group will have been offered a vaccination appointment by the end of September.
Chief Medical Officer Dr Gregor Smith said: “In line with the latest JCVI advice we will now be offering a first dose of the COVID-19 vaccination to young people aged between 16 and 17.
“The programme has always carefully assessed all the benefits and potential risks and offered vaccine to groups where this benefit is clear. The research and evidence shows that is the case for this age group and they should now be called forward for an appointment for a COVID-19 vaccine.
“We will continue to follow the expert JCVI advice and will await the outcome of analysis of data on second doses for this age group and any additional future advice on vaccination for those in the 12-15 age group.”
Health Secretary Humza Yousaf said: “Getting vaccinated has never been easier and from Friday, 16 and 17-year-olds in mainland Scotland will be able to book an appointment through the online portal. We know drop-in clinics are a convenient way for young people to get vaccinated and will announce shortly when these clinics will be open for this age group.
“Vaccination continues to be the best way to protect yourself and those around you and I urge anyone who is eligible to take up the offer of the vaccine.
“The national vaccination programme has been a huge success and without doubt, represents our best way out of the pandemic.”
Background
In addition to 16 to 17-year-olds, we have started offering COVID-19 vaccinations to children and young people who are from key groups; and are between 12 to 17 years. Vaccinations will be offered to:
12 to 15-year-olds with severe neuro-disabilities
12 to 15-year-olds with Down’s syndrome
12 to 15-year-olds with underlying conditions resulting in immunosuppression
12 to 15-year-olds with profound and multiple learning disabilities (PMLD)
12 to 15-year-olds with severe learning disabilities
12 to 17-year-olds who have a diagnosed learning/intellectual disability (mild or moderate)
16-year-olds who have any of these above conditions or underlying conditions that place them at higher risk of serious COVID-19 (that were not 16 at the time of the previous invite for all 16 and 17-year-olds in March 2021)
young people aged 12 years and above who live in the same household of persons (adults or children) who are immunosuppressed (we previously invited over 16s who are household contacts of those on the shielding list)
England, Wales and Northern Ireland will also be taking the JCVI advice.
Health and Social Care Secretary Sajid Javid said: Today’s advice from the independent Joint Committee on Vaccination and Immunisation (JCVI) means more young people aged 16 and over can benefit from COVID-19 vaccines.I have accepted their expert recommendations and I have asked the NHS to prepare to vaccinate those eligible as soon as possible.
“The JCVI have not recommended vaccinating under-16s without underlying health conditions but will keep its position under review based on the latest data.
“Those aged 12 to 15 with severe neuro-disabilities, Down’s Syndrome, immunosuppression and multiple or severe learning disabilities, as well as people in this age group who are household contacts of individuals who are immunosuppressed, are already eligible for vaccination.
“JCVI will continue to review data and provide updates on at risk groups aged 12 to 15 and whether any additional groups will be added.
“COVID-19 vaccines have saved more than 60,000 lives and prevented 22 million infections in England alone. They are building a wall of defence against the virus and are the best way to protect people from serious illness. I encourage everyone who is eligible to come forward for both their jabs as quickly as possible.”
