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Across the UK, removal of the last COVID restrictions is underway. The focus is now on guidance and targeted protection of vulnerable individuals.

Unfortunately, with greater freedom from COVID restrictions comes a rising infection level. Figures from the ZOE COVID study on 10 March revealed an increase of 20% on the previous week, with cases rising in all age groups including the over-55s.

The good news is that following the success of the largest-ever NHS vaccination programme, the UK population, especially the over-55 age group, is currently well-protected from serious illness and hospitalisation from COVID. However, immunity wanes, so what are the plans to maintain vaccine protection and how will future campaigns be delivered?

Spring booster dose for the most vulnerable

Currently, all individuals aged 12+ years are eligible for vaccination and adults are eligible for a 3rd or booster dose at least 3 months after their 2nd dose. According to government data, over two-thirds of the eligible population have received a booster dose, while more than 91% of individuals aged 12+ years have had at least one vaccine dose.

However, many of the oldest and most vulnerable individuals received their last dose in September/October 2021 and may now have declining levels of immunity. Therefore, on 21 February, the Joint Committee on Vaccination and Immunisation (JCVI) recommended a spring booster dose, at around 6 months after the last dose, for the 75+ age group, residents of care homes for older adults, and individuals aged 12+ years who are immunosuppressed.

The spring booster will be rolled out across all nations of the UK. Eligible adults aged 18+ years will receive either the Moderna or Pfizer-BioNTech vaccine, while children aged 12 to 18 years will be offered the Pfizer-BioNTech vaccine.

The spring booster campaign is likely to begin in April but NHS England has confirmed that, to avoid impacting on core NHS services, primary care networks (PCNs) will not be in a driving role.

COVID vaccination of children aged 5 to 11 years

Following a recommendation from the JCVI in December 2021, the NHS already offers two 10 mcg doses of the Pfizer-BioNTech vaccine to children aged 5 to 11 years in a clinical risk group, or who are a household contact of someone who is immunosuppressed.

Following updated advice from the JCVI on 16 February, a non-urgent offer of COVID-19 vaccination will be extended to all UK children aged 5 to 11 years, from April. Children will be offered two doses of Pfizer-BioNTech vaccine, at least 12 weeks apart.

Children without underlying health conditions are at low risk of serious illness from COVID-19 infection, and the vast majority may already have been exposed, so natural immunity is likely to be high in this group. The primary aim of vaccinating these children will be to safeguard against potential future waves of COVID-19, protecting a very small number of children from serious illness and hospitalisation, and offering some protection from mild infection.

Due in part to concerns over GP workloads, PCNs are not expected to lead delivery of COVID-19 vaccines to this cohort of healthy children. Most appointments for this group will be made via the National Booking System.

The priority for most children will be to catch-up with other childhood immunisation programmes. JCVI chair Professor Wei Shen Lim said: “Other important childhood vaccinations, such as MMR and HPV, have fallen behind due to the pandemic. It is vital these programmes continue and are not displaced by the rollout of the COVID-19 vaccine to this age group.”

Also from April, advice will change for 12-year-olds in school year 7 (born after 31 August 2009), who should preferably receive the 10 mcg paediatric dose of Pfizer vaccine, even after an adult first dose.

Autumn COVID boosters

The JCVI has advised that an autumn booster campaign is likely. Consequently, NHS England has instructed practices and commissioners to plan for a 15-week programme of vaccinations for individuals in JCVI priority groups 1–6 or 1–9, with flexibility to surge capacity to other groups if required. More details will be made available nearer the time.

Mandatory vaccinations

Finally, following a government U-turn on 31 January, the policy of mandatory COVID vaccination for all patient-facing NHS staff in England has been revoked, subject to parliamentary approval. In a letter, NHS England asked employers not to serve notice of termination to affected employees.

For medico-legal support and advice regarding COVID-19 vaccinations, please contact Medical Defense Society.