Pandemic vaccine priority for most at risk

The UK Department of Health announced yesterday that more than 11 million people in England will be targeted first. The priority groups who will be first in line for vaccination against swine flu will include pregnant women, frontline health and social care workers, and everyone in at-risk groups aged over six months.
This follows advice from independent experts on who should be first in line for vaccination.

The Joint Committee on Vaccination and Immunisation reviewed the evidence and advised the Department of Health on the crucial risk groups to be offered vaccination in order to reduce the rate or possibility of serious illness.

The following groups will be prioritised in this order (numbers given are approximate and are for England only):

1.        People aged over six months and under 65 years in current seasonal flu vaccine clinical at-risk groups (about 5 million people).
2.        All pregnant women, subject to licensing conditions on trimesters (about 0.5 million people).
3.        Household contacts of people with compromised immune systems e.g. people in regular close contact with patients on treatment for cancer (about 0.5 million people).
4.        People aged 65 and over in the current seasonal flu vaccine clinical at-risk groups (about 3.5 million people). This does not include otherwise healthy over 65s, since they appear to have some natural immunity to the virus.

Vaccination of frontline health and social care workers (approximately 2 million people) will begin at the same time as the first at-risk group, and will continue for as long as necessary. This group is at increased risk of infection and of transmitting that infection to susceptible patients. Protecting these people will help the NHS workforce to remain resilient and able to treat sick patients.

Preparations continue to be made to extend the programme beyond these initial priority groups, and the Joint Committee on Vaccination and Immunisation will consider this matter further and report back in due course.

Health Secretary, Andy Burnham, said:

"The UK will be one of the first countries in the world to receive a vaccine supply,  thanks to contracts put in place by the Government in advance of the pandemic.

"Ministers from all four nations have today accepted the advice of the Joint Committee on Vaccination and Immunisation on priority groups for H1N1 vaccination.

"We are now working with BMA and NHS organisations to reach a comprehensive swine flu vaccine implementation plan for this first stage of the programme.

"Although the virus has so far proved to be mild in most people, for others it has been more serious.  By vaccinating high risk groups first, we aim to protect those most vulnerable to this virus.

"Our decisions at all times are based on advice from the most eminent specialists, and this will continue to be the case as we go forward."

Details of how the vaccination programme will be delivered are being finalised, but listing the priority groups will enable the NHS and social care sector to plan for the vaccination programme.

Supplies will be delivered as soon as they become available but, due to natural limitations in vaccine production, the groups most vulnerable to this new strain of influenza need to be prioritised.

Licensing

The vaccination programme is expected to begin in the Autumn, subject to the vaccine being licensed by the European Medicines Agency. The EMEA has strict processes in place for licensing pandemic vaccines.  The vaccine will not be used until it is licensed.  Manufacturers anticipate that licenses may be granted in late September or October. Vaccination will commence as soon as possible once licences are granted.

Risk benefit analysis

Experts have advised on the most vulnerable groups and completed thorough risk benefit analyses. The virus has so far disproportionately affected people in the at-risk groups outlined. Therefore, our advice is that these groups would clearly benefit from this vaccine at an early opportunity.

Whilst children are also disproportionately affected by swine flu, the vast majority make a full recovery. As such, the experts do not advise that children, other than those in at-risk groups, should be vaccinated initially.

Next steps

Decisions on vaccinating the wider healthy population will depend on the evolution of the pandemic as well as new and emerging clinical data on the use of the vaccine. This will be kept under close review.

Further operational guidance to the NHS on the roll out of the programme will be made available in the next few weeks. The Department of Health is working with the BMA and NHS organisations to reach a comprehensive swine flu vaccine implementation plan.

People in the priority groups outlined do not need to take any action yet. Further announcements will be made when the vaccination strategy is ready, and people who need a vaccine will be contacted.