The new guidance has not changed the list of priority groups for vaccination (see below). However, as reported earlier on Wednesday, the committee is now recommending that as many people in the high risk groups as possible be vaccinated with a first dose of either the Oxford/AstraZenca or Pfizer/BioNTech vaccine.
The JCVI has also updated its advice for breastfeeding women, saying that they should also now be offered the vaccine.
The committee said that while there was no known risks associated with pregnant or breastfeeding women receiving non-live vaccines there was ‘insufficient evidence to recommend routine use of COVID-19 vaccines during pregnancy’.
However, it said it was now advising that vaccination should be considered for pregnant women where ‘the risk of exposure to SARS-CoV2 infection is high and cannot be avoided, or where the woman has underlying conditions that put them at very high risk of serious complications of COVID-19.’
‘In these circumstances, clinicians should discuss the risks and benefits of vaccination with the woman, who should be told about the absence of safety data for the vaccine in pregnant women,’ the guidance added.
For breastfeeding women the guidance says that ‘the developmental and health benefits of breastfeeding should be considered along with the woman’s clinical need for immunisation against COVID-19, and the woman should be informed about the absence of safety data for the vaccine in breastfeeding women.’
Either of the two approved vaccines can be considered for use in pregnant or breastfeeding women.
The guidance has also been updated to say that women do not need to avoid pregnancy after vaccination – previous guidance had suggested women should try to avoid conceiving for three months after receiving the vaccine.
12-week gap between doses
Those who are vaccinated will now receive their second dose between 3 and 12 weeks later for the Pfizer/BioNTech jab and between 4 and 12 weeks later for the Oxford vaccine, according to the updated JCVI advice.
A statement from the four UK CMOs on Wednesday 30 December said that in practice this meant that most people would have their second dose of either vaccine nearer the 12-week mark in order to ensure as many people as possible were protected against the virus.
The CMOs said that while efficacy was optimised after two doses of the vaccine had been administered ‘both offer considerable protection after a single dose, at least in the short term’.
‘At this stage of the pandemic prioritising the first doses of vaccine for as many people as possible on the priority list will protect the greatest number of at risk people overall in the shortest possible time and will have the greatest impact on reducing mortality, severe disease and hospitalisations and in protecting the NHS and equivalent health services,’ the statement said.
‘Operationally this will mean that second doses of both vaccines will be administered towards the end of the recommended vaccine dosing schedule of 12 weeks. This will maximise the number of people getting vaccine and therefore receiving protection in the next 12 weeks.’
Updated JCVI advice
The updated JCVI guidance says that skipping the second dose of the vaccine ‘is not advised’ because ‘the second dose may be important for longer lasting protection, however exact durations of protection are currently unknown.’
However it added: ‘Evidence from Phase 3 trials indicate high levels of protection against serious disease and death from around two weeks after the first dose.’
Current advice from Public Health England is that people should receive the same vaccine for their second dose, although it does allow for a different jab to be administered if the first vaccine is unavailable.
The JCVI has estimated that vaccinating all the priority groups covered by this stage of the programme would cover around 99% of preventable deaths from COVID-19.
JCVI priority groups
- Residents in a care home for older adults and their carers
- All those 80 years of age and over, and health and social care workers
- All those 75 years of age and over
- All those 70 years of age and over, and individuals deemed clinically extremely vulnerable (shielded patients)
- All those 65 years of age and over
- Adults aged 18 to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality
- All those 60 years of age and over
- All those 55 years of age and over
- All those 50 years of age and over