Letter from the JCVI to the Health and Social Care Secretary on further considerations on phase 1 advice: 1 March 2021
Published 11 March 2021
Applies to England
© Crown copyright 2021
This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gov.uk.
Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.
This publication is available at https://www.gov.uk/government/publications/letter-from-the-health-and-social-care-secretary-on-covid-19-vaccination-phase-1-advice/letter-from-the-jcvi-to-the-health-and-social-care-secretary-on-further-considerations-on-phase-1-advice-1-march-2021
From:
JCVI Secretariat
133 to 155 Waterloo Road
London SE1 8UG
To:
Rt Hon Matt Hancock MP, Secretary of State for Health
1 March 2021
Dear Secretary of State,
Re: Advice on COVID-19 vaccination – further considerations on phase 1 advice from the Joint Committee on Vaccination and Immunisation (JCVI)
JCVI have been reviewing correspondence and commentary on the first phase of the programme. I wanted to update you on the latest position from JCVI on a number of key areas which are set out below.
Homelessness
People experiencing homelessness and rough sleeping have a higher risk of poorer outcomes of COVID-19 compared to the general population. This population group have high rates of undiagnosed co-morbidity and poor health outcomes and reduced access to healthcare, including primary care.
Almost half of this population are, in practice, unable to access primary care, through a combination of either being unregistered or no longer based near where they are registered. These risks are compounded by challenges in adhering to recommended physical distancing and infection prevention control measures, along with often poor symptom recognition or disclosure and barriers in engaging with contact tracing activities.
Due to current restrictions, many thousands of people who experience rough sleeping have been accommodated in emergency accommodation. This provides a unique opportunity to in-reach vaccination to a population that is otherwise often unable to access basic healthcare. JCVI is aware that some areas have taken local decisions to prioritise this highly vulnerable group alongside group 6, and this approach is considered to fall within the operational flexibility advised by the Committee.
Having noted that many homeless individuals are likely to have underlying health conditions which would place them in group 6 of the first phase of the programme and that these conditions are likely to be under-diagnosed or incompletely recorded in primary care records,
JCVI advises that local teams exercise operational judgment and consider a universal offer to people experiencing homelessness and rough sleeping, alongside delivery of the programme to priority group 6, where appropriate.
It is recognised that an NHS number is an important element of the vaccination programme to ensure quality care and appropriate monitoring and surveillance. However, this requirement systematically excludes a vulnerable group of the population. The Committee understands that the first dose of vaccine may be offered without the need for an NHS number or registration with general practice, but timely provision of the second dose is challenging without registration and the ability to call back individuals.
Given the high efficacy of the first dose, JCVI is of the view that these groups should be offered the first dose even where registration is not possible. Every effort should be made to offer the second dose in a timely manner, though as this is an operational matter JCVI cannot comment further on how this may best be achieved.
As many people experiencing homelessness are likely to be offered the AstraZeneca vaccine, optimal timing of the second dose is 8 to 12 weeks after the first dose. Local decision making should be undertaken on whether a shorter schedule may be offered in cases where the individual is unlikely to return for receipt of the second dose at 12 weeks, and where they may be lost to follow-up.
JCVI recognises the benefit of access to stable accommodation with respect to the timely delivery of two doses of the COVID-19 vaccine, and asks that those responsible for considering the provision of accommodation for people experiencing homelessness take the benefits in delivery of the COVID-19 vaccination programme into account in their decision making.
Prison workers, prisoners and detained estates
JCVI has received correspondence which asks that prison officers be considered the same as social care workers, and therefore be in priority group 2 of the first phase of the COVID- 19 vaccination programme. Additionally, JCVI has been asked to consider the programmatic benefits of operational flexibility in delivery of the programme to those residing in detained settings.
Prevention of mortality is the key aim of the first phase of the COVID-19 vaccine programme, and in most cases the requests fall outside of this aim.
Most prison officers will be working with younger adults and will individually be at a low risk of mortality. Those prison officers at high individual risk of mortality will be targeted for vaccination in the first phase of the programme. While we recognise that prison officers may be sources of transmission in a COVID-19 outbreak in prison settings, we do not yet know the extent of the impact of COVID-19 vaccines on transmission, and vaccination solely for the prevention of transmission is not currently advised.
A small number of prison officers will work closely with a number of individuals who are clinically vulnerable to COVID-19 due to their age, the presence of underlying health conditions or both. Such officers will often work in specialist detention facilities for older prisoners or for those with underlying physical or psychiatric conditions. While these prison officers will be working with individuals vulnerable to COVID-19, they are not considered have the same level of risk of exposure as health and social care workers.
In accordance with JCVI’s advice on operational flexibility, in order to minimise vaccine wastage in delivery of the programme, where vaccine remains unused following an offer of vaccination to those in detained settings, such vaccine could reasonably be offered to prison officers. This is an issue of policy, and therefore JCVI asks that DHSC consider this before advising NHSE.
With regard to detainees, JCVI recognises that in such closed settings there may be an increased risk of transmission due to the high concentration of individuals, and there may be difficulty in maintaining social distancing. This may apply to prisons and immigration detention centres, or mental health facilities where individuals may be held under relevant mental health legislation. After considering this in detail, the Committee agreed that it would be difficult to advise additional prioritisation of detainees above the wider population based on the potential increased risk of exposure in a detained setting alone.
The disproportionate proportion of persons from disadvantaged communities in detained settings underlines the impetus for good vaccine uptake to provide protection against COVID-19. Every effort should be made to ensure persons in detained setting are offered vaccination in line with the offer to persons in the wider community, with appropriate support to promote high vaccine uptake.
Extended schedule
JCVI has received substantial comment on their advice that first and second doses of the AstraZeneca and Pfizer-BioNTech vaccines may be given with an interval of up to 12 weeks.
JCVI has reviewed its advice against the latest available evidence, taking into account the current epidemiology of COVID-19 in the UK and the roll-out of the vaccination programme. The Committee remain committed to a 2-dose schedule for both Pfizer-BioNTech and AstraZeneca vaccines. JCVI continues to place a high priority on promoting rapid, high levels of vaccine uptake among vulnerable persons.
Available data indicate high efficacy from the first dose of both Pfizer-BioNTech and AstraZeneca vaccines, and the committee continues to advise that delivery of the first dose to as many eligible individuals as possible should be prioritised over delivery of a second vaccine dose. This should maximise the short-term impact of the programme.
The second dose of the Pfizer-BioNTech vaccine may be given between 3 to 12 weeks following the first dose. Published data indicate that the booster response to the second dose of the AstraZeneca vaccine improves as the interval between doses increases. Given these data, JCVI now advise that the second dose of the AstraZeneca vaccine should be given between 8 and 12 weeks after the first dose.
JCVI advises that the second vaccine dose should be with the same vaccine as for the first dose. Switching between vaccines is not currently advised.
Yours sincerely
Professor Wei Shen Lim
Chair (COVID-19) of the Joint Committee on Vaccination and Immunisation
Cc: Jonathan Van-Tam (DCMO) and Mary Ramsay (Head of Immunisation – PHE)