JCVI statement on the COVID-19 vaccination programme for autumn 2024, 8 April 2024 (2024)

Advice from the Joint Committee on Vaccination and Immunisation (JCVI) on the COVID-19 vaccination programme has continued to adapt as the country has transitioned from pandemic response to recovery. In 2024, the current situation is one of very high levels of population immunity against the SARS-CoV-2 virus and the emergence of new Omicron sub-variants that are not associated with increased disease severity compared with earlier variants.

Advice

The primary aim of the national COVID-19 vaccination programme remains the prevention of severe illness (hospitalisations and deaths) arising from COVID-19. As currently available COVID-19 vaccines provide limited protection against mild and asymptomatic disease, the focus of the programme is on offering vaccination to those most likely to directly benefit from vaccination, particularly those with underlying health conditions that increase their risk of hospitalisation following infection. For autumn 2024, JCVI advises that a COVID-19 vaccine should be offered to:

• adults aged 65 years and over
• residents in a care home for older adults
• 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)

The vaccine should usually be offered no earlier than around 6 months after the last vaccine dose, although operational flexibility around the timing of vaccination in relation to the last vaccine dose is considered appropriate (with a minimum interval of 3 months between doses). More information on operational flexibility will be provided in the COVID-19 chapter of the Green Book.

The committee does not advise an offer of COVID-19 vaccination within the autumn 2024 national COVID-19 vaccination programme for frontline health and social care workers, staff working in care homes for older adults, unpaid carers and household contacts of people with immunosuppression.

JCVI does not consider aspects of occupational health programmes in their cost effectiveness methodology. Health and social care service providers may wish to consider whether vaccination provided as an occupational health programme is appropriate. Ahead of such considerations, health departments may choose to continue to extend an offer of vaccination to frontline health and social care workers and staff working in care homes for older adults in autumn 2024.

Considerations

The following were considerations for the autumn 2024 COVID-19 vaccination programme.

Number needed to vaccinate (NNV)

An estimate of how many individuals need to be vaccinated, by age group, to prevent one hospitalisation, ICU admission, and one death (the number needed to vaccinate) provides a quantified assessment of the potential benefits of population vaccination. This assessment continues to indicate that the greatest benefits are obtained with programmes targeting the oldest age cohorts, especially those with underlying health conditions. Analyses of NNV were used to inform a bespoke cost effectiveness assessment of autumn 2024 vaccination. Further details are provided at appendix A.

Cost effectiveness assessment

A bespoke, non-standard method of cost effectiveness assessment was developed to reflect the ongoing uncertainties around COVID-19 and the availability of pandemic pre-procured COVID-19 vaccines. This cost effectiveness assessment was one of the factors considered by JCVI in the formulation of its advice for autumn 2024. Cost effectiveness was considered by age group and clinical risk group.

Using an estimated item of service fee per vaccine set by NHS England and assuming co-administration with influenza vaccines in autumn 2024, the bespoke cost effectiveness assessment for autumn 2024 indicated that vaccination was likely to meet acceptable cost effectiveness criteria when offered to the following groups:

• all adults aged 70 years and over
• adults aged 65 years and over in a clinical risk group (excluding immunosuppression)
• immunosuppressed individuals aged 15 years and over

Given the high proportion of older adults with underlying health conditions and the higher uptake seen in universal age-based programmes, JCVI considers that for autumn 2024, it is appropriate to offer vaccination to all adults aged 65 years and over. While not a fully incremental assessment as would be standard, this approach is considered appropriate as it reflects the uncertainties in the cost effectiveness assessment estimates.

Further details regarding the cost effectiveness assessment of COVID-19 vaccination in autumn 2024 will be published by the Department of Health and Social Care (DHSC) in due course.This interim non-standard analytical approach to cost effectiveness is specific to COVID-19 and is applicable only during this transition phase of pandemic recovery.

Cost effectiveness analyses indicate that COVID-19 vaccination of clinical risk groups under the age of 65 years is unlikely to be cost effective. However, COVID-19 clinical risk groups as defined in the Green Book (tables 3 and 4) are highly heterogeneous, with the absolute risk of serious disease varying substantially both within and between clinical risk groups. The relative importance of different underlying health conditions in susceptibility to severe complications of COVID-19 may also be changing as population immunity changes. Therefore, for autumn 2024, JCVI considers it appropriate to offer vaccination to all people in a clinical risk group aged 6 months and over. This includes women who are pregnant regardless of their stage of pregnancy, while recognising that the risk of severe COVID-19 in both pregnant women and neonates is currently substantially lower than previously seen in these groups (references 1 and 2).

Those living and working with vulnerable people

In the current era of high population immunity to COVID-19 and all cases due to Omicron sub-lineages of the SARS-CoV-2 virus, additional doses of available COVID-19 vaccines provide moderate protection against severe COVID-19 for a few months (references 3 and 4). However, protection against mild symptomatic infection is much more limited both in terms of peak protection and duration of protection (weeks). While there is an absence of good scientific data on the added protection against transmission of infection from one person to another in the era of highly transmissible Omicron sub-variants, it is expected that any such protection would be extremely limited. Therefore, the indirect benefits of vaccination (vaccinating an individual in order to reduce the risk of severe disease in other people) are less evident now compared with previous years. These considerations informed the advice relating to frontline health and social care workers, staff working in care homes for older adults, unpaid carers and household contacts of people with immunosuppression. A specific cost effectiveness analysis was not undertaken for these cohorts.

Post-COVID syndromes

There remains considerable uncertainty regarding the impact of additional vaccine doses, beyond primary vaccination, on the risk, progression and/or outcome of post-COVID syndromes (reference 5). Long-term sequelae following SARS-CoV-2 infection are highly heterogenous and determining the proportion of cases in which symptoms can be firmly attributed to SARS-CoV-2 infection is complex. The rate of self-reported long-term symptoms following COVID-19 is lower with infection from Omicron sub-lineages of SARS-CoV-2 compared with previous variants (reference 6). Better data is needed on the impact of additional vaccine doses on the occurrence and severity of post-COVID syndromes in the current era of Omicron sub-variants and high population immunity.

Vaccine products for autumn 2024 programme

The cost effectiveness assessment for the autumn 2024 programme considered the unique situation that COVID-19 vaccines have already been pre-procured as part of the government’s pandemic emergency response. There will be sufficient pre-procured COVID-19 vaccine doses, available at no additional cost, to complete the autumn 2024 campaign. Other authorised vaccines which may offer similar protection and would therefore be considered suitable, but which would incur additional costs, are therefore less cost effective.

For the autumn 2024 COVID-19 programme, the following COVID-19 vaccines are advised(please refer to theCOVID-19 chapter of the Green Bookfor more details):

For all individuals aged 18 years and over:

• Moderna mRNA (Spikevax) vaccine. Dose: 50 micrograms
• Pfizer-BioNTech mRNA (Comirnaty) vaccine. Dose: 30 micrograms

For young people aged 12 to 17 years:

• Pfizer-BioNTech mRNA (Comirnaty) vaccine. Dose: 30 micrograms

For children aged 5 to 11 years:

• Pfizer-BioNTech mRNA (Comirnaty) vaccine. Dose: 10 micrograms

For children aged 6 months to 4 years:

• Pfizer-BioNTech mRNA (Comirnaty) vaccine. Dose: 3 micrograms

Novavax Matrix-M adjuvanted COVID-19 vaccine (Nuvaxovid) may be used as a booster dose for persons aged 12 years and above when alternative products are considered not clinically suitable.

HIPRA bivalent COVID-19 vaccine (Bimervax) may be used as a booster dose for persons aged 16 years and above when alternative products are considered not clinically suitable.

Future programmes

Infection with SARS-CoV-2 continues to occur throughout the year. The current trend indicates intermittent waves occurring every few months which are consistently peaking at lower amplitude. Winter remains the period of greatest threat from COVID-19 both in relation to the risk of infection to individuals and the pressures on health systems.

JCVI will continue to review the optimal timing and frequency of COVID-19 vaccination beyond autumn 2024. Transition to a routine vaccination programme will require the COVID-19 programme to meet standard cost effectiveness criteria, in line with other vaccination programmes. Should population immunity to SARS-CoV-2 be maintained, it is anticipated that most people will experience relatively mild symptomatic or asymptomatic infections. In such a scenario, future routine COVID-19 immunisation may be a cost effective intervention for only a relatively small population group who remain at high risk of severe complications from SARS-CoV-2 infection.

References

1. Intensive Care National Audit and Research Centre data (unpublished).
2. Engjom HM, Ramakrishnan R, Vousden N and others. Perinatal outcomes after admission with COVID-19 in pregnancy: a UK national cohort study. Nature Communications 2024, volume 15, article number 3234.
3. Lunt R, Quinot C, Kirsebom F and others. The impact of vaccination and SARS-CoV-2 variants on the virological response to SARS-CoV-2 infections during the Alpha, Delta and Omicron waves in England. Journal of Infection, volume 88, issue 1, January 2024, pages 21 to 29.
4. UK Health Security Agency. National influenza and COVID-19 surveillance report, 22 February 2024 (week 8).
5. Byambasuren O, Stehlik P, Clark J and others. Effect of COVID-19 vaccination on long COVID: systematic review. BMJ Medicine, February 2023, volume 2, issue 1.
6. Office for National Statistics. Self-reported long COVID after infection with the Omicron variant in the UK: 18 July 2022.