JCVI statement on the COVID-19 vaccination program for 2023: November 8, 2022
Since the first COVID-19 vaccine was licensed for use in the UK in December 2020, the goal of the COVID-19 vaccination program has been, and continues to be, the reduction of severe illness (hospitalization and mortality) in the population, while protecting the NHS.
As the transition from pandemic emergency response to pandemic recovery continues, the Joint Committee on Vaccination and Immunization (JCVI) has begun to consider the 2023 COVID-19 vaccination schedule. The current era of Omicron is characterized by:
- high levels of population immunity acquired through vaccination and/or natural infection
- lower disease severity compared to infection with previous variants of SARS-CoV-2
During this time, the risk of severe COVID-19 continues to be disproportionately higher in older age groups, nursing home residents, and people with certain underlying health conditions. Compared to the initial phases of the pandemic, much more is now known about SARS-CoV2 infection. However, uncertainty remains about the evolution of the virus, the duration and extent of immunity, and the epidemiology of the infection. These uncertainties limit the immediate development of a routine immunization program against COVID-19.
JCVIInterim advice for planning purposes before 2023 is that:
in fall 2023, people most at risk of severe COVID-19 could be offered a booster dose in preparation for winter 2023-2024
Also, for a smaller group of people (such as older people and people who are immunocompromised), an additional booster dose may be offered in spring 2023.
Emergency vaccine responses may be required should a new variant of concern emerge with clinically significant biological differences compared to the Omicron variant.
JCVI also advises that:
the 2021 booster offer (third dose) for persons 16-49 years of age who are not in a clinical risk group should close in line with the closure of the fall 2022 vaccination campaign[footnote 1]
Healthy people aged 5 to 49 years who develop a new health condition in 2023 that places them in a clinical risk group would be offered primary vaccination and/or a booster vaccination during the next seasonal vaccination campaign, as appropriate. . Vaccination outside these campaign periods would be subject to individual clinical judgment.
The primary course of vaccination against COVID-19 should move, in the course of 2023, towards a more specific offer during vaccination campaigns to protect people at higher risk of severe COVID-19. This would include:
- residents in a residence for the elderly and staff who work in residences for the elderly
- frontline health and social care workers
- all adults age 50 and over
- people aged 5 to 49 years in a clinical risk group, as established in the Green Book
- people between the ages of 12 and 49 who are household contacts of people with immunosuppression
- people between the ages of 16 and 49 who are caregivers, as established in the Green Book
research should be considered to inform the optimal timing of booster vaccinations to protect against severe COVID-19 (hospitalizations and deaths) for groups at different levels of clinical risk
It is estimated that more than 97% of adults in England had antibodies to SARS-CoV-2, either through infection or vaccination, at the end of August 2022 (reference 1). In Great Britain, an estimated 93-99% of children aged 12-15 and 74-98% of children aged 8-11 had antibodies to SARS-CoV-2 at the end of August 2022 ( references 1 and 2). Natural immunity alone provides good levels of protection against severe COVID-19, while the combination of natural and vaccine-induced immunity (hybrid immunity) is associated with even higher levels of protection (references 3, 4 and 5). . This high level of strong population immunity developed over the last 2 1/2 years is under regular monitoring through the UK Health Security Agency (UKHSA) public health surveillance programs.
Not all hospitalizations and deaths attributed to SARS-CoV-2 infection are vaccine-preventable events. Due to the high transmissibility of the Omicron variant, coupled with infection that may be asymptomatic or only mildly symptomatic, individuals requiring hospital care for reasons unrelated to COVID-19 may be coincidentally infected with SARS-CoV-2. Such hospitalizations cannot be prevented by vaccination against COVID-19. Conversely, some highly vulnerable people can develop severe COVID-19 despite being vaccinated; these individuals often have underlying health conditions that also make them highly susceptible to serious illness from other infections. In the UK, during the Omicron era (until week 43 of 2022), the highest rates of hospitalizations were consistently seen in people aged 75 and over, while infection (non-severe illness) rates were high across all ages and especially among younger people (references 6 and 7).
Revised estimates of the number needed to vaccinate (NNV) to prevent one hospitalization during the Omicron era indicate that 800 people aged 70 years or older should receive a booster in autumn 2022 (a fourth dose) to prevent one hospitalization for COVID-19. The corresponding NNV for people from 50 to 59 years old it is 8,000 and for people from 40 to 49 years who are not in a clinical risk group it is 92,500 (Annex 1).
In November 2021, JCVI recommended boosters for healthy adults ages 40-49 due to the epidemiology of the time. With the appearance of the Omicron variant at the end of November 2021, the offer was extended to healthy people aged 16-39 as part of an emergency response (see JCVI Update on advice for vaccinating children and youth against COVID-19 Y UK vaccine response to the Omicron variant: JCVI tip). Since April 2022, uptake of the initial booster dose of the COVID-19 vaccine has been less than 0.1% per week in all eligible people under the age of 50 (Figure 62c in reference 8). Based on current data, keeping the booster offer (third dose) open to these groups is considered of limited continuing value and the overall impact on vaccine coverage is negligible.
Primary vaccination offers have been widely available since 2021. Uptake of these vaccine offers has stagnated in recent months across all age groups (Figure 62a in reference 8). Since early 2022, less than 0.01% of week-eligible persons ages 12 and older received a first dose of the COVID-19 vaccine. A more targeted offer of primary vaccination during vaccination campaign periods will allow these efforts to be more focused and allow for a more efficient use of NHS resources.
Although the COVID-19 vaccination program has been very successful overall, there are some socioeconomic and ethnic groups where vaccination coverage remains lower (reference 6). Addressing health inequalities is a long-term effort that is relevant to all UK immunization programmes. Building trust, and specifically trust in vaccines, requires consistent and determined investments of time, resources, and people. Appropriate and adequate communication should be provided prior to changes to the primary course vaccination offer to optimize uptake among those who are eligible but have not yet accepted the vaccination offer.
Future variants and their impact on epidemiology
Since the virulence of any newly emerging variant cannot be reliably predicted, rapid response measures may be required in the event of substantial changes in population immunity against the dominant circulating variant, including any new variant of interest.
JCVI will keep the epidemiology of COVID-19 under review and provide advice for an emergency response, as needed.
Office for National Statistics (ONS) Latest Information on Coronavirus (COVID-19): Antibodies.
Unpublished data from the UK Health Security Agency.
Protective effectiveness of prior SARS-CoV-2 infection and hybrid immunity against Omicron infection and severe disease: a systematic review and meta-regression.
Risk of SARS-CoV-2 reinfection and hospitalization for COVID-19 in people with natural and hybrid immunity: a retrospective study of total population cohorts in Sweden.
Protection against Omicron (B.1.1.529) BA.2 reinfection conferred by primary or pre-Omicron BA.1 SARS-CoV-2 Omicron among healthcare workers with and without mRNA vaccination: a case-control study with testing negative.
National Influenza and COVID-19 Surveillance Reports: 2022 to 2023 Season.
National Influenza and COVID-19 Surveillance Report: October 27, 2022 (Week 43).