R.Recent headlines have noted that Covid may be returning, but, as tired as we all are of this annoying virus, the truth is that it never went away. Unlike viruses like the flu, there is no evidence that Covid has adapted to a seasonal pattern. Its constant presence means that it has many opportunities to accumulate new mutations that continue to make it worrying.
While we can limit the likelihood of exposure by improving ventilation or wearing masks, vaccination remains an important cornerstone of protection. That’s why plans to offer vaccine boosters in the fall are really important. The Joint Committee on Vaccination and Immunization (JCVI) has the difficult task of making decisions on the UK’s booster plans. Factors such as the susceptibility of the population and the severity of the infection are generally considered, but this fallthe JCVI “has begun to include cost-effectiveness considerations in the development of its advice.”
This has meant that, while the autumn 2022 booster program was aimed at over-50s for both flu and Covid, this autumn we will see a more limited supply of both vaccines. Only over-65s, carers, frontline healthcare workers and clinically vulnerable people will be eligible for free boosters. Flu vaccines should be available for purchase by the public, but, as of now, Covid vaccines will not be. The main effect of reducing the eligible group is that everyone over 50 who was previously eligible will now be at least a year away from their last booster.
This very small vaccine supply raises the question: what was considered in the cost-effectiveness analysis? A cost-benefit analysis of doses administered versus hospitalizations and excess deaths is clearly vital; But what if we consider the cost of lost work days, reduced school attendance, and new cases of long Covid? Not only that, but also the enormous devastation experienced by those fighting serious illnesses and the burnout of frontline workers in an overstretched NHS.
The JCVI statement indicates that it considers there is too much uncertainty about the significance of post-Covid syndromes, and these were not taken into account in the cost-benefit analysis. This is quite surprising given the numerous scientific studies that have shown the impact of long Covid on health. An estimate 2 millions People in the UK are living with long Covid, of whom around 700,000 developed the condition in the so-called “mild” Omicron era. There has also been accumulating evidence of increased risks of long-term diseases, such as Autoimmune diseases, Diabetes type 1 and cardiovascular disease after Covid infection. Each subsequent reinfection with Covid represents a risk of post-Covid conditions, and reinfections in those who already have long Covid can worsen their symptoms and affect their overall recovery. All this risk can be significantly reduced through vaccination.
In addition to the health risks, there is another issue: the more infections we have in a population, the greater the opportunity the virus will have to continue mutating. Vaccination can, to some extent, reduce this. Unfortunately, fewer preventative measures have caused the virus to develop a series of mutations, such as EG.5 (Eris) and the BA.2.86 (also known as pyrola) variants. In particular, BA.2.86 has acquired more than 30 mutations, including some that will help it evade our immune system.
The appearance of this variant has caused a change in the planned reinforcement schedule: it has been went ahead from October to start across the UK within the next few weeks. While welcome, this move, along with confusing messages about the fees paid to GPs for administering vaccines and when they should be administered, has caused Chaos in GP surgeries. In England.
Since BA.2.86 was identified, researchers have been working apace to understand how immunoevasive it is. New data arrives almost daily from researchers around the world. BA.2.86 appears to be better at dodging our immune system, but it appears that antibodies against the XBB variants (which circulated earlier this year) provide the best protection. This is great news for the US, which announced earlier this year that its booster program would use an XBB variant as the basis for its vaccine, but what about the UK? Just a few days ago, the Medicines and Healthcare products Regulatory Agency (MHRA) announced that it had approved a vaccine which points to Omicron XBB.1.5. This is excellent news, but with vaccination set to begin next week, it is unlikely that the Omicron XBB.1.5 vaccine will be rolled out in time for use. Published plans indicate that the UK will maintain existing stocks, including the bivalent Original/Omicron BA.4-5 vaccines. While they will offer some protection and are certainly much better than no vaccine, they are predicted to be less effective against BA.4.5. However, they will continue to protect against other circulating variants.
Annual booster programs are expensive and difficult to implement, and public compliance with the Covid program is already declining, with only 40% of eligible people in London taking up the spring booster offer. Funding for vaccination campaigns and education has been reduced, and misinformation is rife on social media. It is important to help people make informed decisions about vaccines.
It is also notable that countries like the United States are investing in research to develop solutions, such as nasal vaccines, which can provide longer lasting protection. A longer-term approach that considers education, greater investment in vaccine development and the risks of the long-term impacts of Covid would be a welcome development for the UK.
