UK vaccine adviser recommends a two-stage approach to coronavirus booster vaccine doses, beginning with those most at risk from serious disease

Elderly vaccine

UK vaccine advisers are recommending a two-stage approach to coronavirus booster vaccine doses.

The Joint Committee on Vaccination and Immunisation (JCVI) said that any potential booster programme should be offered in two stages from September, alongside flu vaccination.

It should begin with those most at risk from serious disease, including:

  • adults aged 16 years and over who are immunosuppressed
  • those living in residential care homes for older adults
  • all adults aged 70 years or over
  • adults aged 16 years and over who are considered clinically extremely vulnerable
  • frontline health and social care workers.

JCVI COVID-19 Chair, Professor Wei Shen Lim, said in a statement: ‘The primary objective of any potential COVID-19 booster vaccine programme should be to reduce serious disease, including death.

‘The JCVI’s interim advice is that, should a booster programme be required, a third COVID-19 vaccine dose should be offered to the most vulnerable first, starting from September 2021 to maximise individual protection and safeguard the NHS ahead of winter. Almost all these people would also be eligible for the annual flu vaccine and are strongly advised to have the flu vaccine.

‘We will continue to review emerging scientific data over the next few months, including data relating to the duration of immunity from the current vaccines. Our final advice on booster vaccination may change substantially.’

Stage two groups should be offered a booster dose as soon as practicable after stage one, with an equal emphasis on flu vaccination where eligible:

  • all adults aged 50 years and over
  • all adults aged 16–49 years who are in a flu or COVID-19 at-risk group
  • adult household contacts of immunosuppressed individuals.

The JCVI said most younger adults will have only receive their second COVID-19 vaccine dose in late summer, so the benefits of booster vaccination in this group will be considered at a later stage ‘when more information is available.’

‘Front foot’

England’s Deputy Chief Medical Officer, Professor Jonathan Van-Tam, said in a statement: ‘We want to be on the front foot for COVID-19 booster vaccination to keep the probability of loss of vaccine protection due to waning immunity or variants as low as possible, especially over the coming autumn and winter.

‘The announcement of interim advice from [the] JCVI is good news. It shows that the vaccine experts are thinking carefully about how best to use vaccination to protect the most vulnerable and ensure everyone’s lives can remain as normal as possible for the autumn and winter.

‘Of course, we have to be driven by data, and there will be more data from vaccine booster studies for JCVI to look at over summer, so we should all remember that this advice is interim and might change between now and September; however, [the] JCVI has clearly set out the broad direction of travel which I agree with, and which ministers have accepted.’

Commenting via the Science Media Centre, Dr David Elliman, consultant in community child health, said: ‘[The] JCVI stresses that this is interim advice and that it could change substantially before September. The advice seems very sensible if we are going to offer boosters to all adults. However, that begs the question as to whether they are needed and, if so, should they be given. At the moment there is little clinical or laboratory evidence that boosters are needed and [the] JCVI has understandably not committed itself yet. If a booster is needed, exactly how much benefit would it give and would it justify the resources? 

‘However, there is an equally, if not more, important issue. When, in large parts of the world, there is not enough vaccine to give one dose to the adult population, is it right that we should be using up vaccine in this way? Can we, in all conscience, justify this? There are some people who are at particular risk, where the addition of a booster may make a substantial difference, particularly those who have major problems with their immune system and some occupations. In those cases, it would be entirely justified. But for all adults, at the expense of others for whom there would be much greater benefit?’

This article originally appeared on Medscape, part of the Medscape Professional Network.