The Joint Committee on Vaccination and Immunisation (JCVI) has now considered the evidence for Phase 2 of the UK’s COVID-19 vaccination programme.
JCVI has been asked by the Department for Health and Social Care (DHSC) to give its advice on the optimal strategy to further reduce mortality, morbidity and hospitalisation from coronavirus (COVID-19) disease. Evidence suggests an age-based approach remains the most effective way of reducing death and hospitalisation from COVID-19.
For Phase 2, modelling studies also indicate the speed of vaccine deployment is the most important factor in maximising public health benefits against severe outcomes. After groups 1 to 9 in Phase 1, people aged 40 to 49 years are at highest risk of hospitalisation, with the risk reducing the younger you are. Prioritisation will therefore continue in the following order, once all at-risk groups in Phase 1 have been offered at least one dose of the vaccine:
- all those aged 40 to 49 years
- all those aged 30 to 39 years
- all those aged 18 to 29 years
The committee agreed that mass vaccination targeting occupational groups would be more complex to deliver and may slow down the vaccine programme, leaving some more vulnerable people at higher risk unvaccinated for longer. Operationally, simple and easy-to-deliver programmes are critical for rapid deployment and high vaccine uptake. JCVI strongly advises that people promptly take up the offer of vaccination when they are offered.
Professor Wei Shen Lim, COVID-19 Chair for JCVI, said:
"Vaccinations stop people from dying and the current strategy is to prioritise those who are more likely to have severe outcomes and die from COVID-19. The evidence is clear that the risk of hospitalisation and death increases with age. The vaccination programme is a huge success and continuing the age-based rollout will provide the greatest benefit in the shortest time, including to those in occupations at a higher risk of exposure."
Dr Mary Ramsay, Head of Immunisations at Public Health England (PHE), said:
"Delivering a vaccination programme on this scale is incredibly complex and the JCVI’s advice will help us continue protecting individuals from the risk of hospitalisation at pace. The age-based approach will ensure more people are protected more quickly. It is crucial that those at higher risk – including men and BAME communities – are encouraged to take the vaccine, and that local health systems are fully engaged and reaching out to underserved communities to ensure they can access the vaccine."
While many have been able to work at home during the pandemic, some occupations are not compatible with home working and cannot be undertaken without interaction with other people. In these circumstances individuals may be exposed to SARS-CoV-2. These include workers who have public facing roles, or who work in close contact with co-workers. Commuting to a workplace using public transport constitutes a potential additional risk of infection.
JCVI has reviewed data to understand the association between occupation and the risk of exposure to SARS-CoV2, the risk of COVID-19 disease and the risk of COVID-19 related severe outcomes, including mortality.
The evidence indicates that certain occupations have a higher risk of exposure, and these are more likely to be occupations involving frequent contact with multiple other people in enclosed settings. These encompass the elementary occupations, manufacturing, processing and those working in the caring, leisure and a broad range of service occupations. Where increased risk of serious disease is evident, this is considered likely to be associated with a combination of various risk factors for exposure and poorer outcomes including: older age, an overrepresentation of certain underlying health conditions in those undertaking certain jobs, socio-economic deprivation, household size and inability to work from home. Occupational risk associated with poorer outcomes from COVID-19 has predominantly affected men aged 40 to 49 years (please see annex A for more details).
Delivery of a programme targeting occupational groups is recognised to be operationally complex given a number of key factors:
- robust data on the infection exposure risk for every occupational group, or in every occupational setting, are not available
- occupation is not routinely recorded within primary care records and these records may not be up-to-date
- advice to target certain occupations could be considered discriminatory towards those in occupations where no data are available or that are not accurately listed within primary care records
- workplaces that may be associated with higher exposures to infection may include individuals from multiple occupational groups
Overall, JCVI considers that an operationally simple, age-based programme starting with those aged 40 to 49 years is the optimal way to protect individuals, working in jobs with a potentially higher risk of exposure to SARS-CoV2, from severe disease related to COVID-19.
When will phrase two start?
The next phase will start as soon as the first one is over. Everyone over 50 should get their offer by 15th April, so phrase two will likely start in April.
Why haven’t any groups like shop workers/teachers/police officers been prioritised?
The JCVI did not want to single out any occupational group because of the unfairness. One of the great things about the scheme the JCVI constructed our advice around those that are risk of getting severe complications from Covid. It is overall aim to save as many lives and possible.
The JCVI think the right thing to do is to make sure that we minimise the amount of people who die, by using that by using the vaccine most effectively and age is still the predominant risk factor for severe illness or death due to Covid- more so that any risk from the work environment.
One of the many difficulties with occupational status is that it's not very well recorded or not completely recorded in primary care records- many people do not have their job on their GP records. We know the age-based programme is simple and works very well and that's why it seemed sensible to continue with that keeping an eye on speed, as speed of deployment is the important factor.
Teachers/police officers/shop workers over the age of 50 or those with underlying illnesses, will have already got the vaccine or will be getting in the coming weeks.
Did the JCVI even consider teachers to be prioritised?
Yes, the JCVI did looked at these groups very carefully and found that in terms of workplace exposure risk teachers actually have a much lower occupational exposure risk that those working in the catering industry for example. The exposure risk for teacher is relatively small because they have ventilation in classrooms. In fact, the data shows that teachers are no more likely to catch Covid at than any other member of the population who goes to work.
What about police officers?
While some police officers do sometime come into close contact with Covid-19, the ONS data on the occupations with the highest rates of death begin with restaurant and catering establishment managers/proprietors, following onto metal working & machine operatives, food/drink process operatives and chefs.
A lot of police officers work outside in a ventilated environment, a lot of police officers were behind desk with no exposure is so there are patches within each occupation. To reiterate the point any police officer over the age of 50 will be immunised and then any police officer then is between 40 & 49-year-old group will be offered the vaccine.
We know locally in Essex, many Police have already been called to take missed vaccination slots at local hospital and vaccine hubs.
What about those with a learning disability?
The JCVI has already announced those on the GP learning disability register should be prioritised for a Covid vaccine.
People with a "severe or profound" learning disability in England & Wales were already in priority group six for the coronavirus vaccine, along with unpaid carers for those with disabilities and the elderly. All adults with Down's Syndrome have already been offered a jab, in priority group 4.
The NHS is being asked to work with local authorities to identify other adults, in residential care or receiving support to live in the community, who are severely affected by a learning disability and may not be registered, but who should be offered a vaccine.