Balancing Autumn's Vaccination Priorities: COVID-19 and Influenza Updates

Dr Stuart Scott - Chief Medical Officer, TAC Healthcare

This autumn's influenza and COVID-19 vaccination program has been brought forward due to public health concerns arising from a new highly mutated COVID-19 variant (BA.2.86) spreading in the UK. Currently, the number of reported cases is increasing globally; however, reported cases do not accurately represent infection rates due to reduced testing and reporting globally.

Within the UK over the summer, those patients with respiratory infections who were tested found that 1 in 20 were discovered to have COVID-19, while almost 1 in 3 had Rhinovirus. In Scotland, there has been an observed significant increase in COVID-19 in wastewater samples, suggesting a significant community prevalence of COVID-19 infection.

At present, there is no suggestion that this new variant causes more severe disease, but the number of mutations in this variant compared with previous variants warrants a certain degree of caution.

This year, the COVID-19 booster has been limited to:

• residents in a care home for older adults
• all adults aged 65 and over
• people aged six months to 64 years in a clinical risk group
• frontline health and social care workers
• people aged 12 to 64 who are household contacts of people with weakened immune systems
• people aged 16 to 64 who are carers, and staff working in care homes for older adults
  

Last autumn, individuals aged over 50 were offered an extra dose, but this year this has been changed to those aged 65 and over.

Influenza vaccine remains a significant risk, and compared with the current knowledge of COVID-19 variants, it may cause more significant illness. NHS influenza vaccination is being offered to:

• all adults aged 65 and over in England, Wales, and Northern Ireland, and aged 50 or over in Scotland
• people aged six months to under 65 years in clinical risk groups
• pregnant women
• all children aged two or three years old on August 31, 2023
• school-aged children (from Reception to Year 11)
• people in long-stay residential care homes
• carers in receipt of carer's allowance, or those who are the main carer of an elderly or disabled person
• close contacts of immunocompromised individuals
• frontline care workers
  

Influenza vaccine is also available through many employers or privately; at present, COVID-19 vaccination is only available through the NHS.

Further reviews of measures implemented during the pandemic are beginning to be published, including a major review of the effectiveness of non-pharmaceutical interventions (NPIs) by the Royal Society. An NPI is any public health measure that does not include a vaccine or a drug, and at the start of the pandemic, no drugs or vaccines were available to contain the spread of COVID-19.

The Royal Society report covered six categories of NPI:

• Masks and face coverings
• Social distancing and 'lockdowns'
• Test, trace, and isolate
• Travel restrictions and controls across international borders
• Environmental controls
• Communications
  

The report covers six evidence reviews, examining each of the NPIs individually, and examining observational data on COVID-19 from three of the small number of regions where cases associated with domestic transmission were first identified in early 2020 and were subsequently contained at very low numbers for approximately the first 18 months of the pandemic. These regions were Hong Kong, New Zealand, and South Korea.

There is clear evidence from studies conducted during the pandemic that the stringent implementation of packages of NPIs was effective in some countries in reducing the transmission of COVID-19. There is also evidence for the effectiveness of individual NPIs, although, especially as the pandemic progressed and the virus became more transmissible, NPIs became less effective in controlling the transmission of COVID-19.

The report concludes that for a virus primarily transmitted through respiratory means, such as COVID-19, controlling the virus required a clear plan for the application of combinations of NPIs to buy time for the development, evaluation, and implementation at scale of specific treatments and vaccines. Therefore, the implementation of NPIs will be crucial in future pandemics when therapeutics and vaccines are not yet accessible.