Briefing – Vaccine Prioritisation

Vaccination policy has been decided nationally, based on evidence-based advice from the independent Joint Committee on Vaccination and Immunisation (JCVI), and is very closely managed. Councils do not have local discretion over the decisions and priorities made.


Summary

1. We thought that it would be helpful to explain the rationale behind the way that people are being prioritised to receive COVID-19 vaccinations. We know that this is a matter of considerable interest to elected members.

2. Vaccination policy has been decided nationally, based on evidence-based advice from the independent Joint Committee on Vaccination and Immunisation (JCVI), and is very closely managed. Councils do not have local discretion over the decisions and priorities made. Instead, councils local role is to accurately identify those residents and staff who  meet the clear national criteria set nationally and to help those people to access the COVID-19 vaccination.

Joint Committee on Vaccination and Immunisation (JCVI) priority cohorts for vaccination

3. The JCVI advises that: 

3.1. “…the first priorities for any COVID-19 vaccination programme should be the prevention of COVID-19 mortality and the protection of health and social care staff and systems. Secondary priorities could include vaccination of those at increased risk of hospitalisation and at increased risk of exposure, and to maintain resilience in essential public services.” (UK Joint Committee on Vaccination and Immunisation.

4. The national vaccination programme is currently focused on, “the prevention of COVID-19 mortality and the protection of health and social care staff and systems”.

5. JCVI evidence strongly indicates that the single greatest risk of mortality from COVID-19 is increasing age, and that the risk increases exponentially with age. This is reflected in the priority cohorts for vaccination identified by the JCVI.  Across England, nine cohorts are being sequentially invited for vaccination, with vaccination of the first four groups listed below well underway across the country.

6. It is estimated that taken together, these at-risk groups account for 99 per cent of all deaths from COVID-19 to date.  The percentage of deaths attributed to priority cohorts 1-4 account for 88 per cent of all deaths.

7. The vaccination of frontline health and social care staff providing close and regular care to people clinically vulnerable to COVID-19 is currently underway is in order to protect them and the ‘health and social care systems’ that they support. Guidance has been issued jointly by the LGA, ADASS and NHS England to ensure local authorities with the process of identifying those serving in a number of roles in our diverse social care sector they are eligible for vaccination; this includes all care workers in this category, whether or not they provide care on behalf of the council. 

8. View the guidance below:

9. Vaccinating frontline social care workers

10. Once those in priority cohorts 1-9 have been vaccinated, the vaccination of the remaining adult population will begin. The process for prioritising this remaining group has not yet been outlined. Local agencies may prepare information about their staff to be ready when the call for this comes, but national policy is clear that this should not be taken as a sign of imminent call-up for vaccination. To get the vaccination people will need to be registered with their GP. 

11. It will likely take until late spring 2021 to offer the first dose of vaccination to the JCVI priority groups 1 to 9, with estimated cover of around 27 million people in England and 32 million people across the UK.

12. JCVI advice is that that the age-based programme they have set out will be most likely to maximise rapid delivery and greatest uptake in those at the highest risk. Within the guide set out by the JCVI framework, implementation should also involve flexibility in vaccine deployment at a local level with due attention to:

12.1.    mitigating health inequalities;
12.2.    vaccine product storage, transport and administration constraints; and
12.3.    exceptional individualised circumstances.

Table: Number of people in each cohort for vaccination under JCVI priorities

1

Residents in a care home for older adults and their paid carers

0.7m

2

All those 80 years of age and over and frontline health and social care workers

6m

3

All those 75 years of age and over

1.9m

4

All those 70 years of age and over and clinically extremely vulnerable individuals (not including pregnant women and those under 16 years of age)

3.7m

5

All those 65 years of age and over

2.4m

6

All individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality, and unpaid carers

6.1m

7

All those 60 years of age and over

1.5m

8

All those 55 years of age and over

2.0m

9

All those 50 years of age and over.

2.3m

 

Clinically extremely vulnerable (people who are shielding)

13. Many of those who are clinically extremely vulnerable to COVID-19 are in the oldest age groups and will be among the first to receive vaccine. Data from the first wave in the suggests the overall risk of mortality for clinically extremely vulnerable younger adults is estimated to be roughly the same as the risk to persons aged 70 to 74 years. Given the level of risk seen in this group as a whole, JCVI advises that persons aged less than 70 years who are clinically extremely vulnerable should be offered vaccine alongside those aged 70 to 74 years of age.

Persons with underlying health conditions

14. There is good evidence that certain underlying health conditions increase the risk of morbidity (disease) and mortality from COVID-19. The JCVIs advice is to offer vaccination to those aged 65 years and over, followed by those in clinical risk groups aged 16 years and over (Priority Group 6). The main health risks which indicate increased vulnerability to COVID-19 are groups identified by the JVCI committee are set out below:

14.1.     chronic respiratory disease, including chronic obstructive pulmonary disease (COPD), cystic fibrosis and severe asthma
14.2.     chronic heart disease (and vascular disease)
14.3.     chronic kidney disease
14.4.     chronic liver disease
14.5.     chronic neurological disease including epilepsy
14.6.     Down’s syndrome
14.7.     severe and profound learning disability
14.8.     diabetes
14.9.      solid organ, bone marrow and stem cell transplant recipients
14.10.    people with specific cancers
14.11.    immunosuppression due to disease or treatment
14.12.    morbid obesity
14.13.    severe mental illness

Carers

15. Other groups at higher risk, including those who are in receipt of a carer’s allowance, or those who are the main carer of an elderly or disabled person whose welfare may be at risk if the carer falls ill, should also be offered vaccination alongside the priority groups.

Teachers and other occupations 

16. Occupational prioritisation could potentially form part of a second phase of the programme, which would include healthy individuals from 16 years of age up to 50 years of age, subject to consideration of the latest data on vaccine safety and effectiveness.

17. There have been calls for teachers, police, fire and other frontline workers to be moved up the queue. We understand business lobby groups, unions and other bodies are understood to have submitted their bids for where employees should rank in the priority order among the under-50s.

18. Evidence published by the Office National Statistics (ONS) said COVID-19 death rates for teachers and educational professionals were not statistically significantly raised, compared with rates for the wider working population. While teachers do get sick and die from COVID-19, it remains unclear whether they were picking up the infection through general community transmission or in the classroom.

19. It has been reported by Cabinet sources to The Daily Telegraph that Ministers are discussing a “jabs at work” plan to help vaccinate nearly 30 million younger adults once vaccinations have been offered to the vulnerable and elderly.  We understand Ministers are also discussing roving vaccination teams would going to places of work to ensure that the correct groups of people were being inoculated, and to speed up the rollout.

20. During the first week of February the following was confirmed;

20.1. Nadhim Zahawi, the vaccines minister, told MPs that phase two could include; “targeted vaccination of those at high risk of exposure and/or those delivering key public services. This could include first responders, the military, those involved in the justice system, teachers, transport workers, and public servants essential to the pandemic response.”
 20.2. Boris Johnson, the Prime Minister, also pledged that in the second wave of jabs “we want to get down to all key workers who come into regular contact with others who may be exposed to the virus”.
 20.3. A senior Number 10 source stressed that no decisions had been taken about the second rollout, saying: “The JCVI is looking at the next stage and analysing evidence around what we do after we have vaccinated the one to nine. The basis of our approach based on their advice so far is that we should vaccinate those people in the order that they are most likely to end up in hospital or dying from coronavirus.”

Vaccine wastage

21. At the end of every day, vaccine teams report there may be a very small number of doses, typically fewer than ten, which have not been used due to the non-attendance of those booked for vaccination. They cannot be re-sealed or re-frozen in the case of the Pfizer vaccine.  Wasting the vaccine is not acceptable and vaccination centres have been encouraged to use leftover doses to vaccinate people available at very short notice, focusing on those in priority groups, including health and social care workers, wherever possible. 

22. In public health terms we should be clear that:

22.1. Vaccinating small numbers of people helping out at vaccine centres is part of vaccinating people engaged in frontline health and care work because of their roles in supporting vaccine delivery;
22.2. This is good stewardship of vaccine which would otherwise be wasted; 
22.3. It will contribute to the overall aims of vaccination strategy;
22.4. This does not constitute an “alternative” or “additional” phase of vaccination; and
22.5. All vaccination sites should have a reserve list so they can call people at short notice.

Further reading

UK COVID-19 vaccines delivery plan