Updated Covid-19 vaccination guidance

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5 December 2020

Clinically extremely vulnerable individuals prioritised for Covid-19 vaccine

Adults who are ‘clinically extremely vulnerable’ (those that have been previously asked to shield) will now receive a Covid-19 vaccination sooner following the publication of new guidance on priority from the UK Joint Committee on Vaccines and Immunisation (JCVI). This does not include immunosuppressed and immunocompromised people.

The new guidance replaces withdrawn guidance from 25 September. The JCVI appear to have considered a great deal more evidence over the two months since their previous guidance was published, this includes the specifics of the Pfizer/BioNTech vaccine and the two strategies of ‘direct protection’ (vaccinating those most at risk) and ‘transmission reduction’ (vaccinating enough of the population to reduce the travel of the virus through the community). There does not appear to be enough evidence to take the ‘transmission reduction’ approach now, because they cannot prove that being vaccinated makes an individual less likely to to pass the condition on to others.

Genetic Alliance UK collaborated with Angelman UK, Contact, Disabled Children’s Partnership, Muscular Dystrophy UK, Neurological Alliance, and Spinal Muscular Atrophy UK on a letter to the Joint Committee on Vaccines and Immunisation on 19 November. In this letter we called for the committee to take account of both the clinical impact of Covid-19 and the social impact of restrictions to protect us from Covid-19 on our community. We hope that this letter contributed to the considerations that led to the higher prioritisation for our community.

New vaccination priority order

The new priority order (with positive changes relevant to our community in bold) is:

1. Residents in a care home for older adults and their carers.
2. All those 80 years of age and over and frontline health and social care workers.
3. All those 75 years of age and over.
4. All those 70 years of age and over and clinically extremely vulnerable individuals.
5. All those 65 years of age and over.
6. All individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality. Other groups at higher risk, including those who receive carer’s allowance, or those who are the main carer of an elderly or disabled person, should also be offered vaccination alongside this group.
7. All those 60 years of age and over.
8. All those 55 years of age and over.
9. All those 50 years of age and over.

Pregnant women should not be prioritised for the time being, on the basis that there is no data as yet on the safety of COVID-19 vaccines in pregnancy, either from human or animal studies.

Vaccination for children

Priority level four does include some children, but not all clinically extremely vulnerable children – ‘only those children at very high risk of exposure and serious outcomes, such as older children with severe neuro-disabilities that require residential care, should be offered vaccination.’

The basis for this is that there is not sufficient data for the vaccine to be considered safe enough for the benefits to outweigh the risks for children. The guidance leaves the option of individual parent-clinician decision-making: ‘Clinicians should discuss the risks and benefits of vaccination with a person with parental responsibility, who should be told about the paucity of safety data for the vaccine in children aged [under] 16 years.’

Vaccination for people with underlying health conditions

People over the age of 16 living with the following conditions will be at priority level 6:

– Chronic respiratory disease, including chronic obstructive pulmonary disease (COPD), cystic fibrosis and severe asthma.
– Chronic heart disease (and vascular disease).
– Chronic kidney disease.
– Chronic liver disease.
– Chronic neurological disease including epilepsy.
– Down’s syndrome.
– Severe and profound learning disability.
– Diabetes.
– Solid organ, bone marrow and stem cell transplant recipients.
– People with specific cancers.
– Immunosuppression due to disease or treatment.
– Asplenia and splenic dysfunction.
– Morbid obesity.
– Severe mental illness.

Vaccination for immunosuppressed and immunocompromised people

The guidance states: ‘[m]any individuals who are clinically extremely vulnerable will have some degree of immunosuppression or be immunocompromised and may not respond as well to the vaccine.’

The advice is for these people to continue to shield and not to take the vaccine yet. The guidance also discusses people living with immunosuppressed and immunocompromised people, but concludes that ‘at this time there are no data on the size of the effect of Covid-19 vaccines on transmission.

Evidence is expected to accrue during the course of the vaccine programme, and until that time the committee is not in a position to advise vaccination solely on the basis of indirect protection. Once sufficient evidence becomes available the committee will consider options for a cocooning strategy for immunosuppressed individuals, including whether any specific vaccine is preferred in this population.’

Vaccination questions that still need to be answered

How will we get notified when it is our turn? Some of our community fell through the cracks with shielding letters – could the same happen again?
Will we be told when priority level 4 vaccinations begin?

Please let us know of any other questions that you think need answering by emailing covid-19@geneticalliance.org.uk .
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