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September 2020

Interim guidance on COVID-19 vaccination



Expert immunisation advisors have drawn up an interim framework for prioritising access to a COVID-19 vaccine, as soon as one is licensed.


While the Joint Committee on Vaccination and Immunisation (JCVI) warns that there are still unknown factors about any potential vaccine, the Government asked it to produce interim advice to allow for forward planning of a national COVID-19 vaccination strategy.


The highest priority group for vaccination will be frontline health and social care workers because they are at the greatest increased personal risk of exposure to COVID-19 infection, and of transmitting infection to susceptible and vulnerable patients.


The next priority for vaccination will be those at increased risk of serious disease and death: current evidence strongly indicates that these risks increase with age, and in those with underlying health conditions.


Priority groups should therefore be:

  • People over the age of 50 (risk increasing with age)
  • People with underlying co-morbidities, including chronic heart, kidney and pulmonary disease, malignancy, obesity and dementia.

The committee warns: ‘There are still important gaps in our understanding of COVID-19 and about a potential vaccine, which may modify [our] advice.


‘There is ongoing work in the UK to refine the identification of those at risk of serious disease and mortality from COVID-19 infection. As well as age and underlying co-morbid conditions, the committee notes that early signals have been identified of other potential risk factors, including deprivation and ethnicity. As more evidence on at-risk groups emerges, this work will inform the review of the composition, and order of priority, of groups for vaccination.’



Areas where there are still insufficient data include:


  • Whether SARS-CoV-2 infection generates immunity against re-infection, and how long such immunity might last
  • The transmission dynamics of the virus in the UK population and the contribution of children to transmission: when more data are available, the committee will consider whether vaccinating those most like to spread the virus can play a part in controlling the pandemic
  • Potentially increased risk of disease and mortality among black and ethnic minority groups, and male gender
  • Geographic variation – increased population density in urban conurbations may increase the risk of infection


Vaccines

Some unknowns regarding potential vaccine(s) include:

  • Whether a safe and effective vaccine can be developed
  • When a vaccine will become available
  • What age groups a vaccine will be licensed for (it’s assumed that it will be initially licensed for use in adults)
  • The dosing schedule (one, two or more doses)
  • The timescale for availability of sufficient doses
  • Effectiveness in different age groups and against infection, serious disease and/or transmission
  • Duration of protection
  • Safety, side effects and contraindications

The JCVI advice states: ‘This is the start of a longer process, and the advice provided at this stage is preliminary and limited in terms of detail. There are a number of unknown factors about any potential vaccines, and there are still important gaps in our understanding of COVID-19. The committee will be keeping its advice under review and as more information becomes available will update its advice.

JCVI. https://www.gov.uk/government/publications/priority-groups-for-coronavirus-covid-19-vaccination-advice-from-the-jcvi/interim-advice-on-priority-groups-for-covid-19-vaccination

Practice Nurse 2020;50(7):8