The UK’s covid-19 vaccination programme is a recognised success. As of 12 September 2021, 89% of people aged 16 and over in the UK have received one dose of a covid-19 vaccine, and 80% have had their second dose. Public Health England estimate over 143,600 hospitalisations and 108,600-116,200 deaths have been prevented to date by the vaccination programme in England to date[1].
The independent Joint Committee on Vaccination and Immunisation (JCVI) has published its advice on covid-19 booster vaccinations. Her Majesty’s Government (HMG) have accepted this advice and all four parts of the UK intend to follow the JCVI’s advice.
In JCVI’s view, the primary objective of a 2021 covid-19 booster programme is to maintain protection against severe covid-19 disease, specifically hospitalisation and deaths, over winter 2021-22. They have noted that this is exceptional advice aimed at maintaining protection in those most vulnerable, and to protect the NHS.
The JCVI’s advice is based on evidence from a number of sources, including UK data on the duration of vaccine-induced protection against severe covid-19. The Committee note that, as not enough time has passed to enable a clear understanding of the level of protection six months after completion of the primary vaccine course in all persons, extrapolation of some data has been required. Taking a precautionary position, JCVI considers that on balance, it is preferable to ensure protection is maintained at a high level throughout the winter months in adults who are more vulnerable to severe covid-19, rather than implement a booster programme too late to prevent large increases of severe covid-19 in previously double vaccinated individuals.
JCVI advises that for the 2021 covid-19 booster vaccine programme individuals who received vaccination in phase 1 of the covid-19 vaccination programme—priority groups 1-9 —should be offered a third dose covid-19 booster vaccine. This includes:
Those living in residential care homes for older adults.
All adults aged 50 years or over.
Frontline health and social care workers.
All those aged 16 to 49 years with underlying health conditions that put them at higher risk of severe covid-19—as set out in the Green Book—and adult carers.
Adult household contacts of immunosuppressed individuals.
As most younger adults will only have received their second covid-19 vaccine dose in late summer or early autumn, the benefits of booster vaccination in this group will be considered at a later time when more information is available. In general, younger, healthy individuals may be expected to generate stronger vaccine-induced immune responses from primary course vaccination compared to older individuals. Pending further evidence otherwise, booster doses in this population may not be required in the near term. JCVI will review data as they emerge and consider further advice at the appropriate time on booster vaccinations in younger adult age groups, children aged 12-16 years with underlying health conditions, and women who are pregnant.
JCVI advises that the booster vaccine dose is offered no earlier than six months after completion of the primary vaccine course, and that the booster programme should be deployed in the same order as during phase 1, with operational flexibility exercised where appropriate to maximise delivery. Persons vaccinated early during phase 1 will have completed their primary course approximately six months ago. Therefore, it would be appropriate for the booster vaccine programme to begin in September 2021, as soon as is operationally practicable.
JCVI advises a preference for the Pfizer vaccine to be offered as the third booster dose irrespective of which product was used in the primary schedule. There is good evidence that the Pfizer vaccine is well tolerated as a third dose and will provide a strong booster response.
Alternatively, individuals may be offered a half dose (50pg) of the Moderna vaccine, which should be well tolerated and is also likely to provide a strong booster response. A half dose (50pg) of Moderna vaccine is advised over a full dose due to the levels of reactogenicity seen following boosting with a full dose within the CoV-Boost trial.
Where mRNA vaccines cannot be offered e.g. due to contraindication, vaccination with AstraZeneca vaccine may be considered for those who received AstraZeneca vaccine in the primary course.
With deployment of booster vaccines imminent, I am now updating the House on the liabilities HMG has taken on in relation to further vaccine supply via this statement and a Departmental Minute containing a description of the liability undertaken. The agreement to provide indemnity with deployment of further doses to the population increases the statutory contingent liability of the covid-19 vaccination programme.
Given the proximity between receiving JCVI advice and deployment, we regret that it has not been possible to provide 14 sitting days’ notice to consider these issues in advance of the planned booster vaccination in the UK.
Deployment of effective vaccines to eligible groups has been and remains a key part of the Government’s strategy to manage covid-19. Willingness to accept the need for appropriate indemnities to be given to vaccine suppliers has helped to secure access to vaccines with the expected benefits to public health and the economy alike much sooner than may have been the case otherwise.
Given the exceptional circumstances we are in, and the terms on which developers have been willing to supply a covid-19 vaccine, we along with other nations have taken a broad approach to indemnification proportionate to the situation we are in.
Even though the covid-19 vaccines have been developed at pace, at no point and at no stage of development has safety been bypassed. The MHRA approval for use of the currently deployed vaccines clearly demonstrates that these vaccines have satisfied, in full, all the necessary requirements for safety, effectiveness, and quality. We are providing indemnities in the very unexpected event of any adverse reactions that could not have been foreseen through the robust checks and procedures that have been put in place.
I will update the House in a similar manner as and when other covid-19 vaccines or additional doses of vaccines already in use in the UK are deployed.
HM Treasury has approved the proposal.
A Departmental Minute will be laid in the House of Commons providing more detail on this contingent liability.
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