What lessons can we learn from the Autumn Booster Campaign?

This article examines data for the Autumn 2023 Covid booster campaign in England to see what went well and identifying opportunities to improve ahead of the Spring 2024 booster campaign.

Summary.

The undoubted success of the initial Covid vaccination campaign resulted in a high level of coverage in those over 50 years old who were at greatest risk. However, younger age groups, ethnic minorities, and the most deprived were less well vaccinated.

Subsequent booster campaigns targeted those most at risk, including the elderly, individuals who are immunosuppressed, and healthcare workers with higher exposure to the virus.

Although booster coverage among the oldest age groups continues to be high, it has diminished with each successive booster campaign.

Booster vaccination coverage for immunosuppressed individuals is concerningly low, barely exceeding 50 percent. This holds especially true for the youngest ages, ethnic minority groups, and the most deprived communities, which exhibit even lower rates.

Finally, booster uptake among NHS staff is low, with less than one in three having received the Autumn 2023 Covid booster.

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The initial vaccination campaign.

On December 8, 2020, Margaret Keenan became the first individual outside of clinical trials to receive a Covid vaccine, marking the start of the UK's vaccination program. Initially, the vaccine course required two doses, which were offered to everyone aged 18 and over. In the latter half of 2021, the vaccination program expanded to include individuals over the age of 12. Following the emergence of the Omicron variant, a third dose was made available to all adults in December 2021. Vaccines were made available for clinically vulnerable children aged 5 to 11 starting December 15, 2021.

The following interactive chart shows the vaccine coverage by age for the first three doses offered.

The initial campaign's remarkable success was largely due to the rapid deployment, particularly among the elderly and more vulnerable groups. Vaccine coverage was highest among those over 50 years old, though it slightly decreased with each campaign. For the 18 to 49-year age group, coverage significantly fell with the third dose to just under 50 percent.

The weakness of the initial campaign was that the very youngest age groups, having had limited eligibility, consequently had the lowest coverage. Also vaccine coverage for some ethnic minorities and the least deprived was lower.

The following table shows that, among adults aged 18 and over, Covid vaccine coverage for the full course of three doses was significantly lower for Black, Pakistani, and Bangladeshi individuals compared to other ethnic groups.

The next chart shows that adults living in the most deprived areas were significantly less likely to have received three doses by the end of the initial Covid vaccination campaign.

In the following sections, we will see that the same disparities continue and, in some cases, intensify with the subsequent booster campaigns.

Finally, a report by the Kingsfund Charity summarised deployment of the third dose to the immunocompromised as follows.

For many of the UK’s 500,000 immunocompromised people, who are at particularly high risk from Covid, the third dose rollout felt less a national triumph and more a Kafkaesque nightmare.

The report pinpointed three main factors contributing to the poor performance that required attention: inadequate communication, the lack of a national registry for those who are immunosuppressed, and insufficient accountability regarding the interests of immunocompromised individuals within the NHS and Government.

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The booster campaigns.

After the initial three doses, Covid booster vaccinations were offered to extend protection and lower the risk of severe illness. The booster campaigns concentrated on the high-risk groups and health and social care workers who have a higher exposure to the virus. These campaigns, which started in February 2022, take place in autumn and spring to offer seasonal protection.

The rest of the article delves into data from booster campaigns, specifically concentrating on the insights gained from the most recent campaign.

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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 show 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 over 65 who contract Covid which is why age place 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 four spring/autumn campaigns which have been run so far.

Similar to the initial vaccination program, vaccine uptake increases with age across each booster campaign and is highest in the oldest most vulnerable age group. However, the data shows a decline in vaccine coverage in the subsequent year for both the autumn (represented by green bars) and spring (represented by orange bars) booster campaigns. Finally, the vaccination coverage among those over 75 years old is greater for the autumn campaigns compared to the spring ones.

The Spring 2024 booster campaign targeting individuals over 75 years old should address the lower vaccine coverage observed in prior spring campaigns.

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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 four Covid booster campaigns. However, comparable data has been made available only for the most recent two 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. However, for both booster campaigns the vaccine coverage was relatively low and its worth exploring this in more detail.

The first factor to look at is age and the following chart shows a very clear difference in the vaccine coverage by age for the immunosuppressed.

While the number of immunosuppressed individuals rises with age and is high for those over 65 years old, vaccination coverage among the youngest age groups remains worryingly low. Just 8 percent, or 4,180, of the eligible population aged 5 to 18 years that totals 50,864, have been vaccinated.

Greater effort needs to be made to reach the younger immunosuppressed in the Spring 2024 booster campaign.

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. Again this represents an opportunity to improve with the Spring 2024 campaign.

Unsurprisingly, those living in the most deprived areas also had the lowest vaccine coverage in the Autumn 2023 booster campaign as shown in the next chart.

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 vaccination centres.

Efforts must persist in identifying and addressing the factors contributing to low vaccination rates among ethnic minorities and the most deprived communities.

Finally, London's vaccine coverage is significantly lower when compared to other regions, as illustrated in the following table.

The likely reasons are London's younger demographic and higher levels of ethnic minorities.

Improving vaccine coverage in London could greatly advance the overall protection of immunocompromised individuals throughout England.

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Booster coverage for Health and Social Care workers.

The last significant group eligible for Covid boosters are health and social care workers, who are at increased risk of virus exposure. The following table shows that only 31 percent of eligible NHS England staff received the Autumn 2023 vaccination.

Fewer than one in three NHS staff in England received the Autumn 2023 Covid booster, with London showing the lowest uptake rates. The heightened exposure of under-vaccinated NHS staff to the virus is concerning and could lead to higher rates of absence due to sickness.

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In conclusion.

The initial success of the Covid vaccination program has not been completely 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 is lower than desired, particularly among the youngest age groups, ethnic minorities, and the most deprived sectors of the population.

The uptake of Covid booster vaccinations among the NHS workforce is concerningly low, especially considering their higher exposure to the virus.