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With autumn and winter approaching, COVID-19 continues to circulate in the UK. In England, the infection rate appears relatively stable, reflecting the remarkable success of the vaccination programme to date. Over 80% of people are now fully vaccinated, with a high level of protection against hospitalisation and death from COVID-19.

What will happen over the next few months is uncertain though. Early data shows protection starting to wane several months after vaccination, especially in people at higher risk from infection.

As a precautionary measure, the Joint Committee on Vaccination and Immunisation (JCVI) has advised the rollout of a COVID-19 vaccine booster programme to maintain protection for those people most at risk of serious disease through the winter months.

COVID booster for over-50s and at-risk groups

On 14th September, JCVI advised the government to begin the COVID booster programme for people who were vaccinated during Phase 1 of the vaccine programme (priority groups 1 to 9).

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, and adult carers
  • adult household contacts of immunosuppressed individuals.

Rollout to begin in September

The COVID booster programme has the go-ahead in all four nations of the UK. Health and Social Care Secretary, Sajid Javid, confirmed that the government accepted the JCVI advice, and declared “the NHS is preparing to offer booster doses from next week”.

According to the JCVI, booster jabs should be given at least 6 months after completion of the primary vaccine course, and priority groups will receive them in the same order as during Phase 1.

Since anyone vaccinated early in Phase 1 will have received their second dose about 6 months ago, the rollout of the booster campaign will begin in September.

Pfizer-BioNTech vaccine is the preferred booster

After examining data from the COV-BOOST trial, JCVI stated a preference for the Pfizer-BioNTech vaccine as the booster, regardless of which vaccine brand was used for the primary doses. In the trial, the Pfizer-BioNTech vaccine was well tolerated and provided a strong response when administered as a third dose.

A half dose of the Moderna vaccine is an alternative option for the booster. The AstraZeneca vaccine may be considered for people who cannot receive mRNA vaccines, if they received it previously.

“Winter is coming”: protect against COVID-19 and flu

Chief Medical Adviser, Prof Chris Whitty, has warned that “winter is coming” and that respiratory viruses such as flu would be “hugely advantaged”. In anticipation of this, the NHS has been preparing to deliver the COVID booster programme alongside the seasonal influenza vaccination programme to provide protection to at-risk groups.

Now the JCVI strongly advises that those receiving the COVID booster should also take up an offer for the influenza vaccine, if eligible. This is in light of results from the ComFluCOV trial showing co-administration of both vaccines is generally well tolerated and there is no reduction in immune response to either vaccine.

The two vaccines may be co-administered in the same appointment where “operationally practical”. This is expected to “allow more efficient use of resources and a better service for patients, as well as potentially helping to improve uptake of both vaccines”.

Third vaccine dose for people with severely weakened immune systems

The COVID booster programme is separate to the third vaccine dose already being offered to people with severely weakened immune systems, as advised by JCVI on 1st September.

This third dose is being offered as part of the primary COVID-19 vaccination schedule 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.” Studies have shown that these people often have lower levels of antibodies against COVID-19 after vaccination compared with the wider population.

COVID boosters for younger adults to be considered later

In the UK, most young adults will have had their second vaccine dose within the last 6 months, so immune protection is likely at a high level. The JCVI said that they will continue to review the emerging scientific data relating to the duration of immunity for less vulnerable groups, and consider the benefits of booster doses for young adults at a later date.

If you need advice or support relating to COVID-19 vaccinations or any other medico-legal issue, please contact the expert team at Medical Defense Society.