Living on Plague Island

Yesterday the Joint Committee on Vaccines and Immunisation (JCVI) set out proposals for who will be entitled to a free Covid-19 vaccine booster in 2025 and 2026. Whist entitlements to the spring booster remains largely unchanged, there is a very significant proposed narrowing of who will be able to get a vaccine booster in Autumn 2025 and beyond. This has set alarm bells ringing and as usual the JCVI paper is thin on underlying detail. This blog reproduces a letter of complaint that I have today sent to my MP.

What is the JCVI proposing?

The proposals are set out in this document and would restrict access to an Autumn Covid-19 vaccine boost to the following groups:

• those aged 75 plus
• residents of care homes for the elderly
• individuals aged 6 months and over who are immunosuppressed.

This is in contrast to the current Autumn 24 campaign where everyone 65 and over is entitled to a boost plus other clinically at risk individuals (over and above the immunosuppressed) and pregnant women. This was in turn a significant narrowing compared to the Autumn 2023 campaign.

The rationale presented in the document is that:

‘As COVID-19 becomes an endemic disease, and with a move towards standard assessment of cost-effectiveness, the focus of the programme is shifting towards targeted vaccination of the oldest adults and individuals who are immunosuppressed. These are the 2 groups who continue to be at higher risk of serious disease, including mortality’.

Of course there is no evidence that Covid-19 is now an endemic disease and this is alluded to in my letter below.

In my assessment the JCVI document suffers from the flaws that were evident in previous documents which I have discussed before, including lack of transparency about detailed underpinning workings and failure to take into account the wider range of health, social and economic impacts of Covid-19 vaccination. Again this is alluded to in the letter.

We need to fight this one as it is possible that it is in the minds of some on the JCVI that a further narrowing in subsequent years is desirable. This could involve even restricting vaccines to the over 80’s and immunosuppressed over a certain age – 45 perhaps?(I have previously seen indicative JCVI modelling of this particular option ).

Letter of complaint to my MP – 15 November

Here is a copy of the letter I have sent off to my MP

Dear Chris Philp

JCVI proposals on Covid-19 vaccination in 2025 and 2026

I am writing to request that you raise my concerns about the above proposals with the relevant Minister at the Department of Health and Social Care. 

I am very alarmed at the contents of yesterday’s publication from the Joint Committee on Vaccines and Immunisation about Covid-19 vaccination in 2025 and spring 2026. The JCVI propose further restricting access to free vaccines in spring and Autumn 2025. In effect only the over 75’s, care home residents for old people and people who are immunosuppressed would be entitled to a free vaccine in spring and in autumn.  

Under these new rules I would no longer be eligible even though I am 68 years old, suffer several medical conditions and care for my husband who is classified as immunosuppressed (and has failed to mount any significant protective response to previous Covid-19 vaccination) having suffered multiple serious illnesses. We have been semi shielding as a household unit since March 2020. 

If the proposals were to be implemented I would be forced to buy a private vaccine in the Autumn as well as in the Spring (which I do at present as I am not eligible for a spring vaccine). The total cost would be circa £200 p.a. I am in the fortunate position of being able to pay but I am very concerned about those people in my position who can’t pay, and about the resulting consequences for health and wellbeing. 

I believe the proposals laid out by the JCVI are wrongheaded. Indeed, many eminent scientists are in the process of mounting a campaign about the proposals. 

Obvious flaws that I can immediately identify with the JCVI document include the complete lack of clarity about the bespoke model used. There is also a failure to acknowledge that clinically vulnerable individuals are not atoms -they need to interact with those around them, including informal carers, and healthcare staff.  

I believe the scientists will also major on the point that Covid-19 is not, as stated, a stable virus and is, in fact, mutating at an alarming rate. This is a key point when planning for future vaccine campaigns.

There is also an increasing evidence base on the protection that covid-19 vaccines offer against developing Long Covid. As you may be aware Long Covid is a growing problem as revealed by Office for National Statistics data published on 25 April 2024. ONS data also showed a growth in prevalence of long covid between 2023 and 2024. 

It is becoming increasingly recognised, including by several economic consultancies, that Long Covid is costing the British economy tens of billions of pounds p.a., as is sick leave taken by employees due to Covid -19. Treating Covid-19 patients, (including in primary healthcare,) for the immediate illness as well as any subsequent illnesses which we know Covid-19 can result in, will also be costing the NHS billions of pounds. Yet none of these costs are factored into the JCVI analysis. I am happy to provide you with detailed evidence on these points if you wish. 

In summary, I believe the proposals to be deeply flawed and would have detrimental consequences for my household and for many similar households across your constituency. I therefore urge you to raise my points with relevant people in government. 

Yours sincerely

Gillian R Smith

Update 16 November

Once again I received a very timely response from my MP who is now Shadow Home Secretary.

Also last week a paper was published in a MedRxiu platform journal which appears to chime with the willingness to pay approach evident from the JCVI statement. The clinically vulnerable families group have posted an explanatory thread across several social media platforms.  Our overall conclusion is that the over reliance on economic analysis based on very imperfect and partial data is problematic and in my view dangerous. The final part of the thread calls on policy makers to :

• Reverse this dangerous shift towards economic thresholds.  
• Collect better data on Clinically Vulnerable groups. 
•  Centre equity and vulnerability in vaccine decisions, not just cost. 

Update 20 November

Earlier this week the Clinically Vulnerable Families group published an open letter signed by over 50 scientists and front line experts urging the JCVI and the government to reconsider this decision and to align Covid-19 vaccination access with evidence-based public health principles, as supported by the WHO2, as we do for the NHS ‘flu vaccination programme. It points out that:

‘This new guidance not only endangers high-risk groups but also threatens to overburden the NHS and its workforce as Covid-19 continues to circulate throughout the year. Without sufficient vaccination, the frequency and severity of infections among these groups will undoubtedly rise, leading to increased demands on the NHS’.

Also this week, Professors Cruickshank and Pagel published a piece on why withdrawing access to Covid-19 vaccination from pregnant women is a retrograde step not least because vaccinating mothers against Covid-19 helps to protect babies from COVID in the first six months of life.

Update 12 December

On 12 December the DHSC put out a release saying they accepted the advice regarding the Spring 2025 booster programme but that:

‘The government is considering the JCVI’s advice for autumn 2025 and spring 2026 programmes and will respond in due course.‘

This might possibly be good news as it indicates that the government has not simply rubber stamped the advice regarding next Autumns booster programme.

I have also chased a response to my letter with my MP’s office but no reply has been received despite them chasing it with the Department for Health and Social Care.

Update 29 December 2024

There has been no recent progress. However, Sky News ran a long news item today – reported in my blog Happy 2025? In it a former NHS trust chief explains very clearly what is wrong with the highly restrictive approach to vaccination in the UK – namely that this fails to take account of how and to whom Covid-19 spreads. See below.

Update 7 February 2025

I have received a reply to my letter to Chris Philp – copied in below. Essentially it seems that the government is still considering the JCVI advice on Covid-19 boosters for Autumn 2025 and Spring 2026.

Gillian Smith