Independent report

JCVI statement on the COVID-19 vaccination programme for autumn 2023 - update 7 July 2023

Published 30 August 2023

Advice

The Joint Committee on Vaccination and Immunisation (JCVI) has previously advised who would be offered a COVID-19 booster vaccine in autumn 2023. This includes:

• residents in a care home for older adults
• all adults aged 65 years and over
• persons aged 6 months to 64 years in a clinical risk group, as defined in tables 3 and 4 of the COVID-19 chapter of the Green Book
• frontline health and social care workers
• persons aged 12 to 64 years who are household contacts, as defined in the Green Book, of people with immunosuppression
• persons aged 16 to 64 years who are carers, as defined in the Green Book, and staff working in care homes for older adults

JCVI met on 20 June 2023 to review COVID-19 vaccine products which may be available for use in the autumn 2023 programme. JCVI reviewed data on vaccines which are available, or in development, from Pfizer-BioNTech, Moderna, Sanofi-GSK and Novavax. JCVI advises the following principles for vaccine deployment in autumn 2023:

1. The priority of the autumn programme should be for eligible individuals to be offered a booster vaccine dose to increase their immunity against severe COVID-19 (hospitalisation and death) ahead of winter 2023 to 2024. As optimal protection is achieved in the first 3 months of vaccination, there is an advantage in those at highest risk of severe COVID-19 receiving vaccination closer to the period of maximum pressures in the NHS, provided the vaccine programme can be largely completed by early December 2023.
2. Subject to UK regulatory approval, the latest COVID-19 variant vaccines which are available will become the preferred vaccines for the autumn 2023 programme, prioritised for use in persons at higher individual clinical risk of severe COVID-19; that is adults aged 75 years and over, residents in a care home for older adults, and individuals who are immunosuppressed. For autumn 2023, the latest variant vaccines that are likely to be cost-effective for this cohort are mRNA COVID-19 variant vaccines, as these vaccines have been pre-procured (see ‘Considerations’ below for further details).
3. The currently approved and available bivalent Original/Omicron BA.4-5 mRNA COVID-19 vaccines (Cominarty and Spikevax) are considered appropriate for younger age groups and other eligible groups. These vaccines and the AS03-adjuvanted monovalent beta-variant vaccine (VidPrevtyn Beta) are also suitable for use in persons 75 years old and over as an alternative to support operational flexibility in delivery, for example for domiciliary delivery in care homes.
4. Where substantial delays might be incurred in deploying the latest UK-approved COVID-19 vaccine by December, the principle of timeliness should take priority over the choice of vaccine.
5. Individuals offered vaccination should be advised that timely boosting is desirable to increase and update protection over the winter. Therefore, it is advised that individuals take up the offer when it is received, irrespective of which booster vaccine is offered.
6. Vaccines should be offered at least 3 months after the previous vaccine dose, although operational flexibility may be applied to maximise timely delivery of the autumn programme and in consideration of individual circumstances. For consistency across the programme, this interval also applies to second primary doses for eligible individuals.
7. Where operationally expedient, COVID-19 and influenza vaccines may be given concurrently. It is not the intention of JCVI that the autumn 2023 COVID-19 vaccine programme should disrupt deployment of the annual influenza vaccination programme. Both programmes are important for individual and public health. JCVI supports offering vaccinations to younger people at the start of the campaign to facilitate alignment of the influenza and COVID-19 programmes in older individuals such as to optimise protection in the populations most at risk during the expected seasonal increase in influenza.

Considerations

Since the emergence of the initial Omicron variant in November 2021, the SARS-CoV-2 variant landscape has been dominated by its descendent lineages. Currently, Omicron XBB sub-lineages are the most prevalent in England, accounting for 90% of sequenced episodes between 24 April 2023 and 30 April 2023. Globally, Omicron XBB sub-lineages also dominate. Previous SARS-CoV-2 variants of concern (pre-Omicron variants) are no longer being detected in circulation.

In June 2023, the United States Food and Drug Administration (FDA) and the European Medicines Agency (EMA) recommended that the strain composition for 2023 to 2024 COVID-19 vaccines be updated to a monovalent XBB-lineage. JCVI has reviewed data from studies undertaken by manufacturers on monovalent XBB-lineage vaccines. These studies suggest that XBB-lineage vaccines elicit neutralising antibodies against XBB variants and are immunogenic against currently circulating Omicron XBB variants. These studies were not designed to determine the amount of additional protection against severe disease provided by XBB-lineage vaccines over currently available COVID-19 vaccines.

Real-world observational studies indicate that bivalent Original/Omicron BA.4-5 mRNA vaccines continue to be effective at preventing hospitalisation, severe disease and death due to COVID-19. Preliminary data from the UK Health Security Agency (UKHSA) evaluating the autumn 2022 COVID-19 programme indicates that the effectiveness of the bivalent Original/Omicron BA.1 mRNA vaccines against hospitalisation were similar for Omicron sub-lineages XBB.1.5, BQ.1 and CH.1.1 (UKHSA, unpublished).

The AS03-adjuvanted monovalent beta-variant vaccine (VidPrevtyn Beta) was comparable to mRNA bivalent Original/Omicron BA.4-5 vaccine in immunogenicity studies (COVAIL study, Porton, unpublished).

The choice of vaccine products for autumn 2023 has been determined based on available data on vaccine safety, effectiveness and immunogenicity, logistical factors, programmatic deliverability and a bespoke cost-effectiveness assessment. The cost-effectiveness assessment included in its considerations the current unique situation of COVID-19 vaccines that have already been pre-procured as part of the government’s pandemic emergency response; there will be sufficient COVID-19 vaccine doses, including mRNA vaccines targeted against the latest Omicron variant, pre-procured and available at no additional cost to complete the autumn 2023 campaign. Other vaccines which may offer similar protection, but which would incur additional costs, are expected to be less cost-effective within the bespoke cost-effectiveness assessment compared to pre-procured Omicron-variant mRNA COVID-19 vaccines.

JCVI will keep these considerations under review as new data emerges and new vaccine products become available.

Vaccine products for autumn 2023 programme

Please refer to the COVID-19 chapter of the Green Book for more details.

Advised for use in adults aged 75 years and over:

• Moderna mRNA (Spikevax) bivalent Original/Omicron BA.4-5 vaccine. Dose: 50 micrograms
• Moderna mRNA monovalent XBB vaccine (subject to licensure)
• Pfizer-BioNTech mRNA (Comirnaty) bivalent Original/Omicron BA.4-5 vaccine. Dose: 30 micrograms
• Pfizer-BioNTech mRNA monovalent XBB vaccine (subject to licensure)
• Sanofi/GSK AS03-adjuvanted monovalent beta variant (VidPrevtyn Beta) booster vaccine authorised for adults. Dose: 5 micrograms (spike protein)

Advised for use in adults aged 18 to 74 years:

• Pfizer-BioNTech mRNA (Comirnaty) bivalent Original/Omicron BA.4-5 vaccine. Dose: 30 micrograms
• Pfizer-BioNTech mRNA monovalent XBB vaccine (subject to licensure)
• Moderna mRNA (Spikevax) bivalent Original/Omicron BA.4-5 vaccine. Dose: 50 micrograms
• Moderna mRNA monovalent XBB vaccine (subject to licensure)

Advised for use in people aged 12 to 17 years:

• Pfizer-BioNTech mRNA (Comirnaty) bivalent Original/Omicron BA.4-5 vaccine. Dose: 30 micrograms
• Pfizer-BioNTech mRNA monovalent XBB vaccine (subject to licensure)

Advised for use in people aged 5 to 11 years:

• Pfizer-BioNTech mRNA monovalent XBB vaccine paediatric formulation (subject to licensure)

Advised for use in people aged 6 months to 4 years:

• Pfizer-BioNTech mRNA monovalent XBB vaccine infant formulation (subject to licensure)

Further considerations

When mRNA COVID-19 vaccines are not considered clinically suitable, Sanofi/GSK AS03-adjuvanted monovalent beta variant (VidPrevtyn Beta) booster vaccine is a suitable alternative for adults aged 18 years and over.