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.
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’.
