Living on Plague Island

My previous post, Submission to the Treasury on forthcoming budget and spending review was highly critical of the plans for the 2024 Covid-19 Autumn booster campaign, particularly the further narrowing of entitlement to a free vaccine, including the exclusion of informal carers and household members of the clinically vulnerable.

However, one of the issues that was unclear from the revisions to the Green Book published on 2 August 2024 is the type of vaccine that will be given. Fortunately, following extensive lobbying this issue has been clarified and resolved. It has been confirmed that the most up to date vaccine will be administered to those eligible for an Autumn booster.

The Autumn 2024 campaign

Following the publication of plans for the Autumn booster campaign on 2 August it had been feared that those receiving the boost would receive what are essentially ‘old’ vaccines. The JCVI document included the statement ‘There will be sufficient pre-procured COVID-19 vaccine does, available at no additional cost , to complete the Autumn 2024 campaign’.

The statement was ambiguous in terms of what ‘pre procured’ meant. In particular, we know there is a lot of stock in fridges and the fear was we would be given old vaccines from previous campaigns despite the fact that the new JN.1 vaccines had already been approved for use in the UK. Fears were further fuelled by the fact that the DHSC did not immediately respond to various lobbying targeted at Andrew Gwynne, Minister for Public Health, including from the Clinically Vulnerable Families group.

This is important because the virus appears to be mutating at an increasing pace. Although vaccine manufacturers have struggled to keep up to match vaccines to the strand of virus in circulation at any point in time, the consensus amongst scientists is that the latest available vaccines (this is the JN.1 vaccines at the current time) are best. Indeed, this all brought back memories of the Autumn 2023 campaign when those given the vaccine in September received an old vaccine which was subsequently found to be less effective than the vaccine administered from 2 October 2023.

Good News

The good news is that on 16 September 2024 the DHSC published an update, including revisions to the green book. This states clearly that those receiving the booster will receive the new JN.1 vaccines.

This is what the revised guidance says:

For all vaccine doses, including additional doses for those with severe immunosuppression, the age-appropriate advice below should be followed, regardless of the vaccine received as a primary dose or for previous boosters.

Eligible adults aged 18 years or over (including residents aged over 65 years in care homes for the elderly)

– a 0.3ml dose (30mcg) of Pfizer BioNTech COVID-19 vaccine (Comirnaty® JN.1) –

a 0.5ml dose (50mcg) of the Moderna COVID-19 vaccine (Spikevax® JN.1)

Eligible children and young adults aged 12-17 years

– a 0.3ml dose (30mcg) of Pfizer BioNTech COVID-19 vaccine (Comirnaty® JN.1)

Pfizer BioNTech vaccine is the preferred vaccine for children due to a slightly lower reported

rate of myocarditis.

Eligible children aged 5-11 years

– a 0.3ml (10mcg) dose of Pfizer BioNTech paediatric COVID-19 vaccine (Comirnaty® 10 JN.1)

Pfizer BioNTech vaccine is the preferred vaccine for children due to a slightly lower reported rate of myocarditis.

    Chapter 14a – 36

COVID-19 – SARS-Cov-2

Chapter 14a – COVID-19 – SARS-CoV-2 16 September 2024

Eligible children aged 6 months – 4 years

– 0.3mL (3mcg) dose of Pfizer BioNTech infant COVID-19 vaccine (Comirnaty® 3 JN.1). A second dose may be required for those that had not been previously vaccinated.

Pfizer BioNTech vaccine is the preferred vaccine for children due to a slightly lower reported rate of myocarditis.

Vaccination of those in whom mRNA vaccines are unsuitable requires an individual clinical judgement (see section on immunisation in those with a history of allergy).

Concluding Comments

This is a significant victory as the changes to the wording of various parts of the document suggest that something different was originally planned possibly reflecting the view known to be held in certain bodies that all vaccines offer a similar level of protection. Indeed, the issues may not have been fully explained to new ministers, though we don’t know this for sure!

The booster programme is due to start on 3 October 2024. We expect every eligible adult to receive one of the following: a 0.3ml dose (30mcg) of Pfizer BioNTech COVID-19 vaccine (Comirnaty® JN.1) or a 0.5ml dose (50mcg) of the Moderna COVID-19 vaccine (Spikevax® JN.1).

We do not expect any operational problems in ensuring that this happens but I will post regarding any issues arising that I hear of. In the meantime, and given recent history, it might be worth checking that you will be receiving one of the 2 approved vaccines listed above before going to the vaccination centre.