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The Joint Committee on Vaccination and Immunisation (JCVI) has published recommendations that all over-50s should be offered COVID-19 booster and flu jab this autumn.
Dr John McCauley, WHO Collaborating Centre for Reference and Research on Influenza, The Francis Crick Institute, said:
“The flu vaccine for the Northern Hemisphere 2022/2023 northern hemisphere winter season was updated from that used in the 2021/2022 season. The components are the same as was used for the Southern Hemisphere 2022.
“Looking at what is circulating in the Southern Hemisphere at present the composition of the flu vaccine looks to be a good correspondence between the components in the vaccine and the viruses currently in circulation in Australia, for example.
“We cannot still be sure that the influenza virus will not undergo further antigenic change (evolution) prior to the start of the NH 2022/2023 season, but we have not seen any evidence for such a change so far.
“The Joint Committee for Vaccination and Immunisation makes recommendations on the nature of the flu vaccines in different age-groups.”
Prof Penny Ward, Independent Pharmaceutical Physician, and Visiting Professor in Pharmaceutical Medicine at King’s College London, said:
“Unsurprisingly today we see JCVI announcing the plan for ‘autumn’ boosters for covid and influenza vaccination among groups considered to be higher risk and healthcare staff that may increase potential for exposure to these infections among the more vulnerable while caring for them. However one might consider whether the JCVI could have acted more promptly to extend the spring booster campaign to individuals under 75 – as has recently been recommended by the ECDC as the continent faces a surge of infections caused by the BA.5 variant. As is, this advice is too late to impact the inevitable increase in hospitalisations we can expect to follow the very high levels of current community infections, although recent naturally acquired infection does offer the merit of boosting immunity among those affected. For those of us that have not experienced naturally acquired infection in the interim, by the time this advice goes live, many will be at least 12 months away from our last vaccination raising the question whether we can expect the same protection observed in studies suggesting increased efficacy for boosters given within 6 months of the last shot. This advice considers only eligibility for vaccination and not the type of vaccine to be used. Given the superior and broader spectrum immunity suggested by the results of recent studies reporting antibody responses to bivalent covid vaccines, it is greatly to be hoped that the UK will use the newer bivalent vaccines to immunise vs Covid. The advice does not consider the potential for early deployment of the RSV vaccine which has recently shown efficacy in older patients. RSV has almost as great an impact as influenza and perhaps some early decisions could be made as to whether there is merit in an early emergency use approval and deployment to get ahead of the RSV wave we can also expect to arrive this winter.
“The JCVI, unlike their sister US Advisory Committee on Immunisation Practice, does not consider the use of treatments or alternatives to vaccination for the prevention of disease. It remains a national scandal that the long acting combination antibody, Evusheld, MHRA approved in February, has not been made available to prevent infection and illness in the immune compromised – most of whom will not respond to vaccination and won’t gain any greater benefit from the proposed winter shot. Evusheld is widely applied outside of the UK to good effect in preventing illness in the omicron era in this high risk population yet it seems the UK is the only country doubting its utility.
“Lastly, we have available antivirals for influenza and for covid. There is existing advice on deployment of antivirals for treatment of influenza in older, higher risk individuals and this advice could be broadened to include the available covid antivirals. This will require access to multiplex testing to ensure the appropriate antiviral is used for the patients illness, although oseltamivir or baloxavir could be coadministered with molnupiravir or nirmatrelvir-ritonavir if covid and influenza are cocirculating. Indeed molnupiravir may be effective against both influenza and covid although the clinical trials planned in influenza were never undertaken, the effectiveness of the dose used for covid could be confirmed by conducting an influenza challenge study if confirmation is needed prior to using it as a single agent for influenza illness.
“If the DHSC is determined to relieve winter pressures it really is time to look at all the options available for the control of respiratory viral infections as we head into winter with a health service getting further behind by the day and no end in sight. We have the tools: we need to find the will to use them.”
(Comment from JCVI member; not a third-party comment) Prof Adam Finn, Professor of Paediatrics, University of Bristol, said:
“The JCVI recommendations for targeted autumn COVID19 and flu vaccine boosters are designed to keep as many people as possible well and out of hospital and to protect the NHS against an expected winter surge in respiratory illness. It’s really important that people come forward to receive these vaccines promptly when invited so that the impact of the programme can be maximised. Although reformulated COVID19 vaccines are expected to be authorised and delivered at some point, the existing vaccines still provide strong boosted protection against severe illness caused by all the virus variants seen to date, so it’s important to get boosted as soon as you can and there’s no sense at all in waiting for a different vaccine and risking leaving it too late.”
Declared interests
Dr John McCauley: “I am the Director of the WHO Collaborating Centre for Reference and Research on Influenza at the Francis Crick Institute, Mill Hill Laboratory.”
Prof Penny Ward: “I am semi-retired, but I am owner/Director of PWG Consulting (Biopharma) Ltd a consulting firm advising companies on drug and device development. Between December 2016 and July 2019 I served as Chief Medical Officer of Virion Biotherapeutics Ltd, a company developing antiviral treatments for respiratory viral diseases. Previous employee of Roche, makers of tocilizumab (anti IL6 antibody) and CMO of Novimmune, makers of empalumab (anti IFN gamma antibody).”
Prof Adam Finn: “AF is a member of JCVI and also does vaccine policy advisory work for WHO. He is Chief Investigator of the Valneva vaccine clinical development programme in the UK. He receives no remuneration for this work over and above his salary from the University of Bristol and has no personal or family financial or intellectual property assets related to this company or any other vaccine developer or manufacturer.
AF is an investigator in several COVID19 vaccine trials and studies including Oxford-AstraZeneca, Pfizer, Janssen and Valneva vaccines and several UK government-funded studies involving more than one vaccine. He is U.K. Chief Investigator Sanofi COVID19 booster vaccine trial. He is an advisor to the UK government as a member of JCVI. He chairs the WHO Euro Technical Advisory Group of Experts and is a member of the WHO Special Advisory Group of Experts Working Group on COVID19 vaccines. He undertakes consultancy work for several vaccine developers. He receives no personal remuneration for any of this work, owns no IP or stocks and shares and is paid only in his role as Professor of Paediatrics at the University of Bristol.”