Independent report

Joint Committee on Vaccination and Immunisation (JCVI) interim statement on the COVID-19 vaccination programme for autumn 2022

Published 20 May 2022

Advice

The Joint Committee on Vaccination and Immunisation (JCVI) recognises that there is considerable uncertainty with regards to the likelihood, timing and severity of any potential future wave of COVID-19 in the UK. Despite the known uncertainties in the year ahead, winter will remain the season when the threat from COVID-19 is greatest for individuals and for health communities.

As with the 2021 autumn COVID-19 booster programme, the primary objective of the 2022 autumn booster programme will be to augment population immunity and protection against severe COVID-19 disease, specifically hospitalisation and death, over winter 2022 to 2023. With the transition towards endemicity, or ‘living with COVID-19’, it is anticipated that the protection of the most vulnerable people in society will continue to be of primary importance.

The following advice should be considered as interim and for the purposes of operational planning for autumn 2022.

The JCVI’s current view is that in autumn 2022, a COVID-19 vaccine should be offered to:

• residents in a care home for older adults and staff working in care homes for older adults
• frontline health and social care workers
• all those 65 years of age and over
• adults aged 16 to 64 years in a clinical risk group^{[footnote 1]}

Vaccination of other groups^{[footnote 1]} of people remains under consideration within JCVI’s ongoing review.

Considerations

Throughout the pandemic, COVID-19 has disproportionately affected those in older age groups, residents in care homes for older adults, and those with certain underlying health conditions, particularly those who are severely immunosuppressed.^{[footnote 2]} In cohorts who have received primary course COVID-19 vaccination, older age continues to be the most important factor associated with severe COVID-19.^{[footnote 3]}

In contrast to the high certainty regarding the association of age with COVID-19, there are several important uncertainties related to vaccines, vaccine science and COVID-19 epidemiology which complicate planning for an autumn booster programme:

• the duration of protection against severe disease and mortality provided by vaccine-induced immunity, natural immunity or hybrid (combinations of vaccine-induced and natural) immunity
• the timing, size, and severity of future waves of infection in the UK
• the likely emergence of new variants of concern and what characteristics such variants might display, including any vaccine escape features
• the efficacy of updated variant-specific, as well as non-matched, vaccines and their availability in the UK by autumn 2022

Vaccine effectiveness

The current booster programme continues to provide high levels of protection against severe COVID-19 across the population. The latest data from the UK Health Security Agency (UKHSA) indicates that in adults over the age of 65 years, vaccine effectiveness against hospitalisation with the Omicron variant is about 77% 15 weeks after a booster. Vaccine effectiveness against more severe outcomes of COVID-19, such as the need for admission to an intensive care unit (ICU), is higher still. People who are unvaccinated account for a disproportionately large fraction of those who require ICU care for severe COVID-19.

Updated data from the COV-BOOST trial indicate that a fourth dose of COVID-19 vaccine is generally well tolerated and provides a measurable increase in vaccine-induced immunity (unpublished). A study in Israel found that a fourth COVID-19 mRNA dose restored antibody levels to peak post-third dose levels.

The duration of immunity against severe COVID-19 after booster vaccination is not known. Although some waning in immunity can be anticipated, the degree of loss in protection and over what period of time remains to be determined. Estimates vary according to viral variant. Furthermore, natural infection occurring after vaccination, can boost immune responses, extending the duration of immunity.

Future variants and vaccines

The vaccines currently used in the UK vaccination programme were developed against the original SARS-CoV2 strain and how well these vaccines will protect against severe disease caused by future variants is uncertain. Trials of variant-specific vaccines are ongoing. However, these vaccines are based on currently circulating variants and their efficacy against new variants cannot be predicted.

Natural immunity following infection with SARS-CoV2 is an important component of immunity that will increase in relevance as more people are exposed to and recover from SARS-CoV-2 infection. The combination of natural and vaccine-induced immunity (hybrid immunity) can provide increased strength and breadth of immunity, and potentially improve protection against future variants.^{[footnote 4] [footnote 5]}

Being prepared

Although the Omicron variant is associated with a less severe illness compared to Delta, the virulence of any new emergent variant cannot be reliably predicted.^{[footnote 6]} Given the uncertainties, outlined above, planning for the autumn 2022 COVID-19 programme should include sufficient resilience and flexibility to permit a proportionate response to a range of possible future scenarios. Rapid response measures may be required to manage the unfolding epidemiology of COVID-19 and/or if there are substantial changes in the degree of vaccine-induced protection against the dominant circulating variants.

1. Further detail regarding the definitions of ‘clinical risk groups’ and ‘other groups’ is under review. ↩ ↩²

2. BMJ (2020), 371. Living risk prediction algorithm (QCOVID) for risk of hospital admission and mortality from coronavirus 19 in adults: national derivation and validation cohort study. ↩

3. BMJ (2021), 374. Risk prediction of COVID-19 related death and hospital admission in adults after covid-19 vaccination: national prospective cohort study. ↩

4. The New England Journal of Medicine (2022). Protection against SARS-CoV-2 after COVID-19 vaccination and previous infection. ↩

5. The New England Journal of Medicine (2022). Effectiveness of the BNT162b2 vaccine after recovery from COVID-19. ↩

6. Nature Reviews Microbiology (2022). Antigenic evolution will lead to new SARS-CoV-2 variants with unpredictable severity. ↩