How successful was the Spring 2024 Booster Campaign?
This article examines data for the Spring 2024 Covid booster campaign in England to see if any progress was made to improve coverage amongst the eligible groups.
Introduction
Following the successful mass Covid vaccination campaigns in 2021, the Joint Committee on Vaccination and Immunisation (JCVI) transitioned to a booster strategy targeting the most vulnerable groups.
The booster campaigns have focused on high-risk groups, including the elderly, immunocompromised individuals, and health and social care workers who are more exposed to the virus. These campaigns began in February 2022 and occur in autumn and spring to provide seasonal protection.
Each booster campaign can have different eligibility criteria and the only groups who have been offered all five seasonal boosters are the over 75 year olds and immunosuppressed individuals.
This article follows on from an earlier post covering ‘What can we learn from the Autumn 2023 Covid booster campaign’ which can be accessed here. In that post it was seen that whilst booster coverage in the oldest age groups remained relatively high during Autumn 2023, there was a decline with each subsequent campaign. Moreover, the coverage for booster vaccinations among immunosuppressed individuals was alarmingly low at just over 50%. The post concluded with various recommendations to enhance coverage, which will be discussed in this article.
Summary.
The Spring 2024 Covid booster campaign ran from April 15 to June 30, 2024. The campaign was exclusively for individuals aged 75 and above, residents of care homes, and those with compromised immune systems. According to NHS England, approximately 7.3 million people qualify for the Spring campaign in England.
In the past, booster coverage among the oldest age groups was high. However, it has diminished with each successive booster campaign and by the close of the Spring 2024 campaign was only 63% — the lowest recorded for any such effort.
Spring 2024 booster coverage for immunosuppressed individuals is concerningly low, reaching just 36% — again the lowest level recorded. This holds especially true for the youngest ages, ethnic minority groups, and the most deprived communities, which exhibit even lower rates.
Coverage for care homes stands at 68%, slightly higher than other eligible groups, yet it has followed a similar trend of falling to their lowest levels.
The continuing fall in vaccination coverage across all eligible groups is concerning, especially as vaccinations are currently the primary method for proactively managing the Covid pandemic in England.
Booster coverage for the elderly.
This section looks at the elderly which comprise the largest high-risk group eligible for Covid boosters. The following chart, based on data from the recent Winter Infection Survey, shows the risk of being admitted to hospital if you have been infected with Covid by age.
The chart illustrates the increased risk of hospitalisation for individuals aged 75 years and older who contract Covid, which is why age plays a significant role in the booster campaigns. Notably, a significant portion of this group had been vaccinated during the analysis period, suggesting that the risk would have been even higher without the Autumn 2023 booster campaign.
Every booster campaign sets specific and, in some cases, different age criteria for eligibility. This is illustrated in the next chart, which shows age-based coverage throughout the five spring/autumn campaigns which have been run so far.
The chart shows that vaccine uptake increases with age across each booster campaign and is highest in the oldest most vulnerable age group. The data also shows that vaccination coverage is higher among individuals over 75 years old during the autumn campaigns (indicated by green bars) than in the spring campaigns (orange bars).
Finally, there is a noticeable decrease in vaccine coverage in the year following for both autumn and spring campaigns and this led to the recommendation that:
The Spring 2024 booster campaign targeting individuals over 75 years old should address the continuing decline and lower vaccine coverage observed in prior spring campaigns.
Regrettably, the vaccination coverage for the 5.8 million eligible individuals aged 75 and older continued to decline, reaching just 63% by the end of the Spring 2024 booster campaign — the lowest rate of any such effort.
Booster coverage for the Immunosuppressed.
Individuals who are immunosuppressed may have a reduced capacity to combat infections such as Covid. This is due to a weakened immune system, which can be the result of certain health conditions or the use of medications and treatments that suppress immune function.
Individuals with compromised immune systems are categorized as high risk and have qualified for all Covid booster campaigns. However, comparable data has only been made available for the three most recent campaigns, with the summary data presented in the chart below.
In the previous section, we saw that the spring booster campaigns for the over 75 year olds had lower vaccine coverage than the autumn campaigns. This pattern can also be seen for the immunosuppressed group with coverage at the end of the Spring 2024 campaign falling to 36% from 55% at the close of the Autumn 2023 campaign. However, for all booster campaigns the vaccine coverage was relatively low and it’s worth exploring this in more detail.
The first factor to look at is age. The following table shows vaccine coverage by age at the end of the last three booster campaigns, with the Spring 2024 campaign shown to the right of the table.
The table shows a very clear difference in the vaccine coverage by age for the immunosuppressed. The coverage rises with age and is highest for those 65 years and older. Concerningly, all age groups had there lowest coverage levels at the end of the Spring 2024 booster campaign.
The lower coverage seen for the youngest age group led to the recommendation that:
Greater effort needs to be made to reach the younger immunosuppressed in the Spring 2024 booster campaign.
Worryingly the situation has worsened. Coverage for the youngest age groups is very low and at the end of the Spring 2024 campaign only 3% of the 48,000 eligible 5 to 18 year olds had been vaccinated!
Ethnicity is another area where there is a marked disparity in vaccine coverage as shown in the following table.
Here, all ethnic minorities experience significantly lower coverage, with individuals of Bangladeshi or Pakistani ethnicity having the lowest. Once again, all ethnic groups saw a fall in coverage to there lowest levels at the close of the Spring 2024 booster campaign.
Unsurprisingly, those living in the most deprived areas also had the lowest vaccine coverage in the Spring 2024 booster campaign as shown in the next table.
Several factors contribute to the lower vaccination rates among ethnic minorities and the most deprived. These include vaccine hesitancy due to mistrust, the absence of culturally and linguistically tailored information, and challenges in accessing Covid safe vaccination centres.
This led to the recommendation that:
Efforts must persist in identifying and addressing the factors contributing to low vaccination rates among ethnic minorities and the most deprived communities.
Unfortunately, the latest data shows that no progress has been made in this area.
Finally, the vaccine coverage of immunosuppressed individuals has fallen to its lowest levels for each region, as illustrated in the following table. London's vaccine coverage remains significantly lower when compared to other regions
The likely reasons are London's younger demographic and higher levels of ethnic minorities than other regions.
Booster coverage in care homes
This final section covers booster coverage in care homes — the third eligible group for the Spring 2024 campaign. Data for care homes is more limited and only covers the Spring 2023 and 2024 campaigns. The following chart compares coverage in care homes at the end of the last two spring booster campaigns.
Coverage for care homes is relatively high compared to the other eligible groups but have followed a similar pattern in falling to there lowest levels.
In conclusion.
The initial success of the Covid vaccination program has not been maintained in the subsequent booster campaigns. While coverage among the oldest age groups continues to be relatively high, it has diminished with each successive booster campaign.
Booster vaccination coverage for immunosuppressed individuals has also falling with each campaign and is much lower than desired, particularly among the youngest age groups, ethnic minorities, and the most deprived sectors of the population.
The ongoing fall in vaccination coverage across all eligible groups is concerning, considering vaccinations are currently the primary method for managing the Covid pandemic.
As always, if you have any comments or suggestions for topics to cover, please post a message below.
Interesting data. Perhaps I can offer some perspective on the immunocompromised group. I received a donor stem cell transplant in February 2020, and knew that I would have no immunity for at least a year. In the event I did not mount an antibody response to vaccination until my 7th vaccination. Since then my response has continued to improve. I have been part of the 'forgotten lives' group for immunocompromised people and am aware that a substantial portion of the group are permanently immunocompromised due to their primary pathology or to medication taken to control their illness. Many have been advised/ have realised that they have no chance of mounting a useful antibody response to COVID vaccination and have therefore declined further boosters. Indeed I believe that some have been advised against further vaccination by their consultants. The push for this group is for pre-exposure prophylaxis which is available in other countries but does not seem to be a priority for the JCVI.
It's interesting to see this breakdown of the areas where improvement is needed. Here in Northern Ireland we're also told that there has once again been low coverage for immunosuppressed people, but unfortunately the media reports tend to pass quickly over it in tones that veer from vague bafflement to victim-blaming. They always say we are "not taking them up" but never ask why.
The reality - and maybe immunosuppressed people in England have a parallel experience - is that the system has aggressively complicated the process of even finding out a booster is available, much less accessing one: and that's just my experience as someone eager to receive it. I'll tell you my story, because I feel that few commentators realise how torturous the process has become...
After three years of not receiving booster letters from my GP despite my eligibility, I was finally told that some immunosuppressants, despite being on the Green Book list, are not programmed into the algorithm my surgery's computer uses to flag up patients to receive a booster clinic letter. Ustekinumab/Stelara, a biologic used in the NHS for nearly a decade, is one such drug.
So now I have to judge when to contact my GP surgery based on increasingly vague word-of-mouth re: clinics. I used to gauge it based on my mum getting her letter: her age band got the primary vaccines about a month before immunosuppressed under-50s. But now the surgery gets a smaller supply and has stopped writing to patients, even elderly ones.
This spring, it turned out they'd printed an easily missed note on prescriptions to say patients would receive a text message. But my pharmacy collects my prescriptions and delivers my meds, so I don't always receive the paper scrip. And Mum - like many older and disabled people - didn't get the text message as she wasn't using a mobile at the time.
Rang my surgery; it took days to get through as you can no longer reach a person once their daily GP call limit is reached. Due to my age (40s) I got the usual skeptical interrogation re: my eligibility by reception staff, and they said a GP would have to ring me back. He told me both their vaccine clinics had ended: no supply left, and we both googled to figure out where to find a Trust vaccine clinic while he agreed to write me a letter proving my eligibility.
I booked for a clinic at one of our major teaching hospitals via the automated system, and received two confirmations, including one the night before my appointment. But on arrival, I found the ground floor like the Marie Celeste: no staff, just many computers. I explored the building, getting more and more anxious, until upstairs I found an admin clerk who'd been about to leave for the day.
She was baffled too and called a colleague: they eventually worked out that I'd passed a confusing, hastily printed sign downstairs. I'd been told in the email to follow the purple signage, and being autistic and literal, I'd gone past the printout and entered the building, because a more permanent-looking and purple sign had said "Vaccination Clinic". Nobody seemed to have considered that when printing signs, one ought to use clear, unambiguous language, a large font, and the colour patients have been told to look for.
It turned out that, without contacting patients with booked appointments, the vaccine clinic had packed up that very morning and moved to a different hospital on the other side of town. This was because the Encompass team (the NI Health and Social Care system's new integrated computer system, which was rolling out that month), based at the other hospital, had demanded and got the Vaccination Clinic building for their use instead.
I should mention here that at no point had I been given any contact phone number or named person to speak to about the vaccine clinic: there was no such information on the booster clinic booking website, in either of the emails I received confirming my appointment and giving directions to it, or on the poster directing me to the other hospital. If anything, it felt like the Trust actively preferred patients not to have a way of contacting them.
So I'd had an expensive taxi journey to one hospital and now had to have an even more expensive journey to another, on a Saturday, as that was now the only remaining option left - like many disabled people, I don't drive, and I don't know many people who can just ferry me places. As it turned out, taxi access was very difficult, and once I'd got the booster I got distressingly lost trying to find my way back to city landmarks I knew, and ended up in an unsafe situation.
The whole experience was overwhelming, confusing and distressing for me, as an autistic person with medical trauma and a complex medical history that makes avoiding further COVID infection vital (I've already had it once and been unable to access treatment due to poor official communication re: testing). I've done a lot of work a patient advocate, and am normally adept at researching questions of healthcare access and policy, but the situation I found myself in absolutely beat me. I'm dreading what the autumn booster process will be like.
But in the minds of the powerd that be, it's all the fault of immunosuppressed patients for not taking up the offer of a booster...