Credit ACIP/CDC
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Last May the WHO Recommended Switching To A Monovalent XBB based COVID Vaccine, and the United States expects to have an updated booster available in October. But vaccine uptake over the past year has been highly disappointing (see CDC chart below), particularly for those under the age of 65.
In June the FDA Advisory Committee (VRBPAC) Recommended Fall COVID Shot Based on XBB.1.5, but we've not seen any official guidance released on who should receive them. Presumably those over 65 and immunocompromised individuals, but there may be other groups included as well.
That decision will be made by the CDC after the FDA approves the new formulations.
But today the UK's JCVI (Joint Committee on Vaccination and Immunisation) has released their recommendations which raised the age eligibility (with noted exceptions) to those 65 and older.
First their press release, after which I'll have a brief postscript.
JCVI advises on eligible groups for 2023 autumn booster
The Joint Committee on Vaccination and Immunisation (JCVI) has announced its advice regarding persons who will be eligible for a COVID-19 booster vaccine in autumn 2023.
From:UK Health Security Agency Published 8 August 2023
JCVI’s announcement follows interim advice published in January.
The COVID-19 vaccination programme is now entering its third autumn season. Vaccination helps to protect against severe illness, hospitalisations and deaths from COVID-19.
The advice for this autumn is to offer the vaccine to those at high risk of serious disease and who are therefore most likely to benefit from vaccination.
Specifically, JCVI advises the following groups be offered a COVID-19 booster vaccine this autumn:Further advice on the choice of vaccine products for use this autumn will be provided in due course.
- residents in a care home for older adults
- all adults aged 65 years and over
- persons aged 6 months to 64 years in a clinical risk group, as laid out in the Immunisation Green Book, COVID-19 chapter (Green Book)
- frontline health and social care workers
- persons aged 12 to 64 years who are household contacts (as defined in the Green Book) of people with immunosuppression
- persons aged 16 to 64 years who are carers (as defined in the Green Book) and staff working in care homes for older adults
Professor Wei Shen Lim, Chair of COVID-19 immunisation on the JCVI, said:
The autumn booster programme will continue to focus on those at greatest risk of getting seriously ill. These persons will benefit the most from a booster vaccination.
It is important that everyone who is eligible takes up a booster this autumn – helping to prevent them from hospitalisations and deaths arising from the virus over the winter months.
Dr Mary Ramsay, Director of Public Health Programmes at the UK Health Security Agency (UKHSA), said:
The COVID-19 virus has not gone away and we expect to see it circulating more widely over the winter months with the numbers of people getting ill increasing.
The booster is being offered to those at higher risk of severe illness and by taking up the booster vaccine this autumn, you will increase your protection ahead of winter, when respiratory viruses are typically at their peak.
To optimise protection over the winter months, JCVI advises that the autumn programme should aim to complete vaccinations by early December 2023 ahead of winter, mindful that protection is highest in the first 3 months following vaccination. This will help maximise the potential benefits of the programme.
At the same time, JCVI recognises some need for operational flexibility in relation to when these vaccines will be offered, taking into consideration factors such as vaccine supply.
From autumn 2023, JCVI additionally advises that primary course COVID-19 vaccination for persons who have not had any COVID-19 vaccines before should consist of a single dose of COVID-19 vaccine. Eligibility for primary course vaccination will be the same as for the autumn 2023 booster.
Last year’s autumn booster programme ended on the 20 February 2023. Data up to 12 March showed that 73.2% of people aged 65 to 70 years in England had been vaccinated and this increased in older cohorts rising to 83.7% (just under 2.5 million) in those aged over 80 years.
Data from last autumn’s programme showed that those who received a booster were around 53% less likely to be admitted to hospital with COVID-19 in the 2 to 4 weeks following vaccination, compared to those who did not receive a booster.
NHS England will confirm details on how and when eligible people can access the autumn booster vaccine in due course.
UK Health Security Agency press office
10 South Colonnade
London
E14 5EA
Although we now enjoy varying degrees of immunity against COVID, and Omicron and XBB viruses appear less severe than Delta, our pharmacological options to prevent and treat COVID infection continue to dwindle.
Monoclonal antibodies, which were touted at a `game changer' in 2021, are now exhausted, with the FDA Withdrawing their EUA For Last one: Bebtelovimab last December.
Antivirals like Paxlovid and Veklury and Lagevrio remain the preferred treatments for acute COVID. But as COVID continues to evolve, these treatments are not guaranteed to remain effective.
Last month, in ECDC: SARS-CoV-2 Variant Mutations Conferring Reduced Susceptibility to Antiviral Drugs and Monoclonal Antibodies, we saw there are already mutations showing up in some variants that greatly reduce the effectiveness of our remaining armamentarium:
The mutations found in ORF1ab, namely nsp5:S144A, nsp5:Q189K, nsp5:H172Y, nsp5:E166A, and nsp5:F140A conferred moderate to high reduction in susceptibility to Paxlovid (nirmatrelvir/ritonavir), while nsp12:S861G conferred 25–99-fold reduction in susceptibility to Veklury (remdesivir) (Table 3).
COVID vaccines, which were remarkably effective against a fairly monolithic COVID threat in early 2021, are far less so today given the ever-changing and crowded field of variants (see CDC Nowcast chart below).
While I'll be grateful to get the vaccine this fall, I fully expect be masking up again this fall and winter. Because in the final analysis, prevention is always better than relying on a cure.
