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Speaking during a visit to a hospital in Milton Keynes on Tuesday, the Secretary of State for Health said we are “waiting for the final advice from JCVI…and when we get that advice we will be able to start the booster programme, but I anticipate it will begin in early September, so I’m already making plans for that.”
Prof Jonathan Ball, Professor of Molecular Virology, University of Nottingham, said:
“It’s important to make a decision soon, as the NHS needs to prepare if a booster programme is rolled out. Our recent work has shown that additional exposure – in our studies through natural infection rather than immunisation – can increase antibody levels that are more effective at neutralising infection of key variants of concern, such as the beta variant, which was first identified in South Africa.
“Whilst we do not understand what protective immunity looks like, it may well be that this additional increase in antibody potency and breadth offers more protection to vulnerable people, especially as vaccine immunity wanes over time. We could wait, and monitor vaccine effectiveness and only respond if signals suggest that the vaccines are starting to fail. This is the decision that policy makers will have to decide. From a personal perspective, we know that there are millions of unvaccinated people around the world, and it is important to end vaccine apartheid. However, if the UK stockpiles are tricky to shift, because of coldstore problems for example, then leaving them in freezers instead of putting them into the arms of UK vulnerable people wouldn’t make much sense to me.
“Maximising levels of immunity may also reduce the likelihood of infection and transmission in vaccinated people, and therefore reduce further evolution of the virus.
“Finally, I do not see this as the thin end of the wedge and setting a precedent for annual boosters. This could easily be a one off, just to give vulnerable people’s immune systems an additional lift. In future, constant exposure to the virus as it circulates is likely to achieve the same immune boost in less vulnerable people.”
Dr Gail Carson, Deputy Chair of the Global Outbreak Alert & Response Network (GOARN), University of Oxford, said:
“There are 193 countries in the world according to the United Nations and 10 of them (5%) have 75% of all the COVID-19 vaccine doses. The UK is one of the 10 countries in that privileged position. However, with a world population of ~ 7.7 billion, just over half of the world’s population is in the low and middle income countries. Yet just over 17% of COVID-19 vaccine doses have been administered in the LMICs. This is inequity. There is more to do to help even this up and save lives.
“The WHO have made their position clear with the goal to vaccinate an increasing proportion of the people in LMICS by September and more by mid-2022. There is a prioritised approach to vaccinate the health care workers, those most at risk first in the whole world, the pandemic is a global crisis. Meanwhile, doctors and nurses in those countries are still dying from COVID-19 as they remain unvaccinated and so do most of the populations they care for. We can help reduce the deaths, the severe illness, the oxygen shortage and the mourning around the world now if we delay some of the third vaccine doses this Autumn to have a greater impact elsewhere. But still keep collecting the data to inform decisions about when a third vaccine dose or booster dose is required in the different at risk groups.
“The policy makers have a decision to make soon with regard to a third dose/a booster dose programme. One key piece of information to consider as outlined by the UK SAGE paper – International vaccination: Potential impact on viral evolution and UK public health, Clifford et al from July 2021, is what influences the risk of new variant development and transmission resulting in infection. The authors outline and reference clearly the uncertainty and gaps around the evidence base however, they do consistently mention that if virus prevalence in the whole world is low, then the risk of new variants is lower. Let’s vaccinate more people in the world by sharing more vaccine doses, at least in the short term until manufacturing can match demand.
“The Head of Immunisation at WHO Geneva, Dr Kate O’Brien spoke recently to esteemed journalist Helen Branswell and shared her thought that the consideration of booster programmes for COVID-19 as premature. That if countries go ahead with booster or a third dose programme early Autumn 2021, how do they walk back from that policy position if we later find out, based on evidence, that vaccine induced immunity lasts for longer? Meanwhile, we know for sure that unvaccinated people will continue to die in other parts of the world. The strain on the global vaccine pool will be significant if a number of countries go ahead this Autumn with such programmes, leaving yet again those less fortunate than us who have not received even one vaccine dose to suffer from ongoing waves of SARS-CoV-2 in countries with weaker health care systems, and at increased risk of high transmission resulting in new variants. The global context needs to be considered and as University of Oxford’s Professor Pollard made clear this week, stockpiled COVID-19 vaccines should be sent to the places in the world where they would have the greatest impact now.”
Dr David Elliman, Consultant Paediatrician, Great Ormond Street Hospital, said:
“I actively support vaccinations in general and the COVID vaccination in particular. The vaccination programme is something of which we can rightly be proud.
“However, I would have some concerns if we were on a path to roll out the vaccine to groups that will have much less to gain from the vaccine than those already offered it. I mean those below 16 years old and those who have already had two doses. There seems to be a universal scientific acceptance that the more virus that is circulating globally, the more likely that variants of concern will arise and that one or more of these will be less susceptible to the vaccine. In addition, from an ethical standpoint, before we roll out the vaccine to those at lesser risk in this country, we should ensure that those at greater risk in other parts of the world have had the opportunity to be immunised. This is far from the case at present. Not only would this be a more moral approach, but it would be to our long term benefit – enlightened self interest.
“I hope the government will think more broadly about this issue, rather than adopting a short-sighted selfish approach. If the UK were the first country to make a positive decision to delay roll out to those groups less at risk and, instead, send the vaccine to the countries who need it more, not only would this make the UK stand out as a caring country, but others may follow suit and do the same. And in the long run it would be in our own interests.”
Comment sent out 10/08/2021:
Prof Stephen Evans, Professor of Pharmacoepidemiology, London School of Hygiene & Tropical Medicine, said:
“If the Secretary of State for Health is quoted correctly when he says “when we get that advice we will be able to start the booster programme”, then it sounds to me like he has already made up his mind, though as he is also quoted as saying, “we are waiting for the final advice from JCVI” and I look forward to hearing what they advise and I hope that will be taken into consideration.
“JCVI will give very careful consideration to the available scientific data and I would respect their advice. They have a UK-wide remit but this is a global pandemic; there is a major shortage of vaccines for even first doses in much of the world. In spite of what some say, our giving third doses of vaccines that could be given as first doses elsewhere in the world is a decision with moral implications. It may also be true that depriving other countries of first doses by the UK using a third jab could result in those countries having variants that are even more likely to escape the vaccine that delta, and they will eventually reach us. The virus does not respect borders.
“So the first scientific question is, do we have evidence that there is a need for a third dose booster? The real need is not to reduce the number of mild cases, though their impact should not be minimised, but rather to reduce hospitalisations and deaths among those who have had two doses already. We have some evidence that some immunocompromised people are not protected by two doses but it is by no means certain that they would substantially increase their chances of being protected by a third dose. We are likely to need non-vaccine strategies to protect them, including drug treatments.
“For most people, it would seem that a third dose of one of the existing vaccines would not offer any notable improvement in their protection and some will continue to get Covid even after a third dose. There is uncertainty in this and the situation could change. No Covid vaccines are 100% effective at preventing all infections, but we have no evidence that there is now a strong surge in hospitalisations or deaths among those who have had two doses (there will be such cases but the question is whether their absolute numbers are more than expected given vaccine dose coverage).
“Resources should probably be devoted to ensuring that as many people as possible are given two doses. The latest ONS survey data suggests that some of the groups (ethnic minorities, those in poorer areas) who are least likely to be vaccinated are those at most risk of the serious consequences of Covid disease; this is tragic.
“So, other than for very small sub-groups, the argument that there is a strong need for a third dose has not been made clearly under current conditions.
“Assuming that there is an argument for a need (though such is not clear at the moment) that JCVI is able to identify, will a third dose of an existing vaccine meet that need? In general the answer seems to be “no”. If “tweaked” vaccines become available which are targeted at the newer variants, possibly beta and delta, then a third dose with one of those new vaccines might give greater protection at a population level. There would be an opportunity cost to spending a lot on third doses of the existing vaccines. It would almost undoubtedly be better to await a modified version that could offer significant gains in protection.
“Whether it is morally right to give marginal gains to the UK population at the expense of poorer countries not having even one dose for their vulnerable population is the question. It requires major moral leadership for politicians to make that kind of decision.
“As noted, there are small groups for whom a third dose may be beneficial but it will be important to both identify them and be sure that the third dose really does bring benefit rather than just assuming it.”
https://www.bbc.co.uk/news/topics/cywd23g0gn0t/sajid-javid
All our previous output on this subject can be seen at this weblink:
www.sciencemediacentre.org/tag/covid-19
Declared interests
Prof Jonathan Ball: “Receives funding to develop next generation Covid19 vaccines.”
Prof Stephen Evans: “No conflicts of interest. I am funded (one day per week) by LSHTM. They get funding from various companies, including Astra Zeneca and GSK but I am not funded by them, I have no involvement in obtaining funding from them and I am not an investigator on any grants obtained from them. I am the statistician to the ‘meta-Data Safety and Monitoring Board’ for CEPI. I am paid for my attendance at those meetings and will be paid expenses for travel if that occurs. I am a participant in the Oxford/Astra Zeneca trial, and on 13th January 2021 learnt I had received the active vaccine.”
None others received.