COVID-19 Vaccination Prioritisation for Vulnerable Groups – meeting report
On 9 December 2020, Lord Lansley, Vice-Chair of the APPG on Vulnerable Groups to Pandemics, hosted the APPG webinar on COVID-19 Vaccination Prioritisation for Vulnerable Groups to discuss issues in the prioritisation and delivery of vaccines for vulnerable groups, and tandem health measures to support vulnerable groups through COVID-19 and future pandemics. The meeting took place just a day after the first COVID-19 vaccines were delivered for vulnerable patients in selected hospitals.
The APPG invited guests and its members to discuss data on the impact on vulnerable groups through COVID-19, the projected impact of the vaccine, and plans for its delivery among vulnerable groups. The first speaker, Professor Robert Read, a member of the Government’s advisory Joint Committee on Vaccination and Immunisation (JCVI), provided insight into guidance on COVID-19 vaccination for vulnerable groups. He was encouraged by the results of the recently introduced Pfizer’s vaccine, and noted the advice on COVID-19 vaccination remains dynamic and fluid as new data on mortality through COVID-19, and from ongoing vaccine trials, continues to be received. Some of the key features of the development of the JCVI’s guidance were the following:
- Age has been the “chief single influencer” of mortality, though data has shown a higher risk of mortality among clinically extremely vulnerable (CEV) groups, particularly those with cardiopulmonary or immune system conditions, leading to their prioritisation in band 4, behind people age 75+. The absolute risk of those aged 65+ was identified as higher than the “bulk” of people with underlying conditions.
- The JCVI identified a simpler, age-based programme, rather than a disease-based programme, as quicker and easier to deliver in view of existing age-based vaccination programmes, and that 70 percent population coverage with a highly effective vaccine is needed to stop transmission.
- Initial data on the Pfizer vaccine shows its efficacy in preventing death, but not necessarily in reducing transmission; the JCVI thus primarily aimed to prevent mortality, and by derivation hospitalisation, using the Pfizer vaccine. The Pfizer vaccine’s effect on transmissibility continues to be examined and the JCVI may reprioritise the contacts of vulnerable groups if the vaccine reduces infectivity, this way protecting immunocompromised patients unable to receive the vaccine.
- The current JCVI recommendation is to deploy the AstraZeneca vaccine in the medium term, and that the focus with this vaccine may be to reduce circulation, as initial data suggests the AstraZeneca vaccine can reduce the transmissibility of the virus.
- Through the initial vaccination phase, the JCVI will monitor uptake, with a focus on inequalities; monitor safety and efficacy, and the impact on transmission; and consider options for the next phase, including occupational vaccination and the wider vaccination of the population.
Dr Richard Vautrey, a GP in Leeds and current Chair of the British Medical Association’s GP Committee, reassured participants that on 15 December, GPs will be engaged to deliver vaccines from over 200 GP sites. CCGs have prioritised delivery according to GPs’ readiness to deliver vaccines, and according to which regions have poor health profiles. GPs in initial groups of 7 or 8 will deliver vaccines in one centre, with the aim of expanding delivery to individual practices and ultimately of delivering vaccines to care home residents in their domicile. Non-vaccination primary care services will be reprioritised while GPs work on rotation on vaccine delivery.
During the discussion, participating patient groups including Cystic Fibrosis Trust, Action for Pulmonary Fibrosis, Cancer52, Asthma UK, Primary Immunodeficiency UK (PID UK), and Blood Cancer UK, and a 24-year-old patient representative with Hodgkin’s Lymphoma, called for clear public health messaging on the safety of vaccines and for continuous guidance in tandem with ongoing vaccination to support clinically extremely vulnerable (CEV) patients who may still need to shield.
Patient charities representing patients with primary immunodeficiency conditions asked what can be advised for those unable to get vaccinated. It was advised that “antibody cocktails” could be used to provide passive immunity as antibodies persist for a long time after injection. Monoclonal antibodies may serve as an alternative to a vaccination programme for vulnerable groups who cannot be vaccinated due to their immunodeficiency.
Following this timely and relevant discussion, the APPG members agreed on the following areas which need further clarification during COVID-19 vaccine deployment for vulnerable groups:
- The need for a communication strategy to encourage high-risk groups to be vaccinated as vaccine hesitancy remains within those groups;
- The extension of vaccination prioritisation to family members and carers of vulnerable groups;
- Whether one or more vaccines would be more suitable to some CEV people than another;
- Whether and how patients may be allowed to choose which vaccines to take;
- Whether CEV patients with underlying conditions, regardless of their age, should be prioritised for vaccination in band 4 instead of band 6.
The minutes of the meeting are available here : DOWNLOAD