The overall news about how Covid-19 has affected the UK so far this year has been relatively positive: although we have still had a lot of hospitalisations and deaths from Covid and flu, figures are lower in England and Wales, Scotland and Northern Ireland compared with the same period last year. News is also coming in about the next few rounds of Covid vaccine boosters. It seems that while countries such as the US and France have made vaccines available to anyone who wants them, the UK will probably continue restricting free access to select groups, and may reduce access further in the future.
The spring booster campaign will be, as expected, more restricted than the recent autumn campaigns – targeting adults aged 75 and over, older people in care homes and children and adults who are immunosuppressed. The Joint Committee on Vaccination and Immunisation (JCVI), which makes recommendations to government, says it is using a “bespoke, non-standard method of cost-effectiveness assessment” to inform priorities moving forward, but full details of its analysis are not available yet (the JCVI said material for its spring campaign will be published “in due course”). Looking ahead at the coming rollouts, and reading between the lines, it seems likely the number of groups offered boosters will continue to shrink.
The 2023 autumn rollout already saw a much-reduced offer compared with previous years, and the JCVI notes that autumn 2024 will probably be even smaller. Reading through the latest JCVI statement, its major focus appears to centre on risk of hospitalisation from severe infection, or death. Clearly severe disease is a major and important consideration, but should other factors be taken into account? For instance, children are less likely to develop severe disease, but there is a large benefit to vaccinating them.
A recent study in four Nordic countries showed vaccines reduced hospitalisations by more than 70% among children aged 12 to 17. And of course, children can also develop long-term impacts even from mild Covid-19 infection. Despite this, vaccines for children in the UK were only given a limited offer and are no longer widely available (unless they are clinically vulnerable), and it seems likely this position will hold. This makes the UK an outlier, as many other wealthy countries recommend vaccination for children. In England, almost 90% of five- to 11-year-olds are unvaccinated.
The JCVI’s analysis considers the impacts of hospitalisation, but does not include the impacts of long Covid as part of its calculations. About 65 million people worldwide are estimated to have long Covid (symptoms persisting four or more weeks), and the condition often presents severe symptoms that can affect many different organs, causing cardiovascular, respiratory and neurological problems. We know vaccination helps protect against long Covid, but we are still seeing new cases, so it’s uncertain how long protection persists from previous vaccinations.
In the UK, an estimated 80,000 people have left employment owing to long Covid, and the cost of healthcare provision for people with long Covid is high and only increases over time. Despite the obvious social and economic costs, it seems neither living with long Covid nor its effect on the economy will be considered.
Continuing to narrow the number of people offered vaccines in the UK also makes little sense given that the government already negotiated the purchase of millions of doses of Covid vaccines, to be delivered in stages between 2021 and 2024. Vaccines were bought under this agreement on the understanding that there would be sufficient coverage for people over the age of 50 and other clinically vulnerable groups. With the vaccine offer shrinking and low uptake in certain groups, there is an excess of unused vaccines that will expire shortly. It has been estimated by the UK Health Security Agency that it expects to write off £229m worth of vaccines that we are committed to buy, or already hold, that ultimately won’t be used.
It is not known whether the value of these vaccines, versus the cost of delivery and rollout, was considered when determining which age groups to offer vaccines to during 2023 and 2024. The pre-purchasing approach has tied us to certain makers and types of vaccine, and it is not clear if there is a long-term plan to develop vaccines that may provide more long-lasting protection. But for the moment, if we are going to throw vaccines away, why not expand the age groups eligible?
There is some good news for those in England and Scotland who want Covid-19 vaccines, as they can finally look to buy doses privately. However, unlike the flu vaccine, which costs about £20, the likely price per dose will be £45. The cost of vaccinating a whole family could therefore quickly spiral into hundreds of pounds. We are in a cost of living crisis with many struggling to afford to eat or heat their homes. People who are poorer tend to be in more insecure work, and are most at risk of contracting Covid-19 at work, so would benefit significantly from vaccination.
There are already many barriers to vaccination campaigns, including low trust and convenience of vaccine access – cost shouldn’t be added to them. The most recent boosters in the US and many European countries have been free for all, but the UK is already moving to a place where vaccines become the preserve of those who are wealthiest.
The original commitments the UK made to vaccinate everyone against Covid-19 have had variable reach depending on age and demographic, but have still prevented untold amounts of death and suffering. At the moment, most adults in the UK under the age of 65 will be one or more years away from their last booster. I don’t mean to diminish the important and voluntary work the JCVI does, or any budgetary constraints it faces regarding vaccine rollouts, but it is crucial that it provides much greater transparency around its costing calculations, so that there can be a public conversation about how best to use the vaccines we have, as well as what lies ahead in the future.
Sheena Cruickshank is an immunologist and professor in biomedical sciences and public engagement at the University of Manchester
