Coronavirus (COVID-19): vaccine deployment plan: update - July 2021

Ongoing clinical advice

Latest recommendations from the Joint Committee on Vaccination and Immunisation, the Chief Medical Officer and national protocols

JCVI advice

The JCVI has issued advice on a number of topics since the publication of the last deployment plan. This illustrates the highly dynamic nature of the programme and the need to pivot to align with emerging clinical advice.

Advice has included: 

• COVID-19 vaccine and adults living with adults who are immunosuppressed, 29 March 2021
• use of the AstraZeneca COVID-19 vaccine, 8 April 2021
• COVID-19 vaccination for pregnant women, 16 April 2021
• COVID-19 vaccine for people ages under 40, 7 May 2021
• mitigation of the impact of B1.617.2 variant, 14 May 2021
• potential COVID-19 booster vaccine programme (interim advice), 30 June 2021
• vaccinating children and young people under 18, 19 July 2021

JCVI’s publications and statements on COVID-19 are available on the UK Government’s website.

Chief Medical Officer letters

Following consideration of JCVI advice, Scottish Ministers have set out the policy position for the vaccination programme in Scotland via a series of letters issued by the Chief Medical Officer (CMO). CMO letters have covered topics such as:

• update in response to concerns raised in some European nations about a potential link between rare blood clots and the AstraZeneca COVID-19 vaccine, 19 March 2021
• Moderna vaccine rollout, 1 April 2021
• change in recommended use of AstraZeneca vaccine, 8 April 2021
• update on use of AstraZeneca and JCVI advise on 18 years and over, 7 May 2021
• need to accelerate vaccines for those over 50 and that second dose should be brought forward from 12 weeks to 8 weeks, 18 May 2021

The CMO letters are published on the NHS website.

Vaccine protocols

The national protocols for each vaccine reflect the most up to date clinical and regulatory information. New protocols are also developed for each new vaccine that becomes available. Protocol updates since the last deployment plan have included:

• 20 April 2021
  • inclusion – update to include those requiring different second dose to first dose when clinically indicated
  • exclusion – update to include those bone marrow and peripheral blood stem cell donors  guidance
  • frequency section - update to remove advice that second dose should be same as second dose

• 24 May 2021
  • frequency – updated to include the JCVI advice to bring forward second dose from 12 weeks to 8 weeks

• 2 June 21
  • approved vaccinators – update to include Military General Duties Vaccinators (to speed up roll out)

In addition to these there were the following updates to individual protocols:

• AstraZeneca: warning on use for adults under 40 years following a review of safety data, 20 April 2021
• Pfizer: inclusion - all eligible adults over 16 in line with JCVI recommendations on or before 31 July 2021, 24 June 2021

Further information on national protocols for the supply and administration of COVID-19 vaccines to individuals in accordance with the national COVID-19 vaccination programme is available online.

Vaccination of children and young people

We continue to roll out the vaccination programme in Scotland guided by advice from the JCVI, which advises all four nations across the UK on vaccine deployment and prioritisation.

On 19 July 2021, the JCVI provided advice on the vaccination of children and young people under 18 years of age.

JCVI guidance does not advise routine universal vaccination of children and young people under 18 years of age. It states it will keep this advice under review as more safety and effectiveness information becomes available on the use of COVID-19 vaccines in children and young people. It is important to note that the JCVI have considered the clinical risks to children of vaccinating them at this time. They have therefore been clear that, based on the evidence currently available, the potential benefits of vaccination do not outweigh the risks for the majority of children and young people. However, JCVI does recommend vaccination for three key groups of children and young people under 18 years of age:

• children aged 12 to 15 years of age with severe neuro-disabilities, Down’s Syndrome, underlying conditions resulting in immunosuppression, and those with profound and multiple learning disabilities, severe learning disabilities or who are on the learning disability register are considered at increased risk for serious COVID-19 disease and should be offered COVID-19 vaccination
• young people aged 16 to 17 years of age who are at higher risk of serious COVID-19, as currently set out in the COVID-19 Green Book, chapter 14a, should continue to be offered COVID-19 vaccination in line with the current programme approach
• children and young people aged 12 years and over who are household contacts of persons (adults or children) who are immunosuppressed should be offered COVID-19 vaccination on the understanding that the main benefits from vaccination are related to the potential for indirect protection of their household contact who is immunosuppressed

We will continue to work with all relevant stakeholders to effectively deliver this emerging clinical advice provided by the JCVI.

Vaccine safety

The MHRA is the UK agency response for the approval of clinical trials in the UK and responsible for temporary authorisation for supply and marketing authorisation (licences) for new medicinal products.

All our decision making in responding to COVID-19 is guided by the latest scientific evidence from the Scientific Advisory Group for Emergencies (SAGE), advice from Health Protection Scotland and our Chief Medical Officer. In addition, the JCVI provides advice on immunisation to all UK Health Departments, including on the efficacy and safety of vaccines.

The safety of all vaccines and medicines is monitored by MHRA on a UK-wide basis. This includes reports from the Yellow Card Scheme which allows health professionals and patients across the UK to flag up suspected adverse reactions to any vaccine or medicine, as well as reports from worldwide use and ongoing scientific evidence.

Concerns about the safety of vaccines are not taken lightly. The MHRA keeps the safety of all vaccines under close and continual review. They would take appropriate regulatory action if new evidence emerged calling into question the safety of any vaccines currently in use in Scotland.

Safety remains paramount in our vaccination programme and we will continue to follow JCVI advice in deploying vaccines in Scotland. We maintain a consistent approach wherever it is appropriate to do so across the four nations.

Use of AstraZeneca in under 40s

In May, the JCVI advised that unvaccinated adults aged 30 – 39 years not in a clinical priority group at higher risk of severe COVID-19 disease, should be preferentially offered an alternative to the AstraZeneca COVID-19 vaccine where possible, and only, where no substantial delay or barrier in access to vaccination would arise. This advice came following a review of the safety data in relation to the use of the AstraZeneca vaccine and the extremely rare adverse events of concurrent thrombosis (blood clots) and thrombocytopenia (low platelet count) following vaccination with the first dose of the AstraZeneca COVID-19 vaccine. This followed advice in April recommending those under the age of 30 should be offered an alternative to the AstraZeneca vaccine, if available.  

Everyone who has received their first dose of the AstraZeneca vaccine safely should receive their second dose as this gives greater and longer lasting protection against the virus. The benefits of using AstraZeneca continue to outweigh the risks for most age groups providing protection against the harm from COVID-19. It remains crucial that everyone who is offered a vaccination takes up the offer.

Reducing the time between first and second doses

Following an increase in prevalence of the Delta variant across the UK, we brought forward the schedule for second doses from 12 to 8 weeks in line with JCVI advice. This is because the emerging evidence suggests that a first dose of the vaccine may not offer the same protection against this variant as it does against some earlier strains of the virus. Analysis published by Public Health England in May, shows two vaccine doses are highly effective at preventing hospitalisation from the Delta variant (96 and 92% effective for Pfizer and AstraZeneca respectively). PHS is also conducting analysis to estimate vaccine effectiveness in preventing COVID-19 infection in Scotland. Offering second doses more quickly may therefore maximise protection. As outlined above though, JCVI do not routinely recommend reducing the dose schedule lower than eight weeks.

From 21 June 2021, all health boards began to routinely schedule all second doses 8 weeks after first doses as standard. In addition to this, we are using social media and other channels to encourage individuals who have an appointment scheduled for beyond 8 weeks to go online or call the helpline to request that their appointment is rescheduled in line with the eight-week schedule. From 5 July all mainland health boards have offered drop-in facilities for all those eligible to receive a first dose of the COVID-19 vaccine but who have not received a first dose yet, and second doses for those who have waited more than eight weeks since their first dose.

Pregnancy and breastfeeding

We continue to follow JCVI advice on vaccination of pregnant women. The JCVI updated its advice in April to state that pregnant women should be offered the COVID-19 vaccine at the same time as the rest of the adult population, based on their age and clinical risk group. Pfizer and Moderna vaccines are currently the preferred vaccines for pregnant women of any age who are attending for their first dose. Anyone who has already started vaccination and is offered a second dose whilst pregnant should have a second dose with the same vaccine, unless they had a serious side effect after the first dose. COVID-19 vaccines offer pregnant women the best protection against the virus, which can be serious in later pregnancy for some women.

Pregnant women should discuss the risks and benefits of vaccination with their clinician, including the latest evidence on safety and which vaccine they should receive. The JCVI advises that women who are breastfeeding may be offered any suitable COVID-19 vaccine. Further information on pregnancy, breastfeeding, fertility treatment and the coronavirus can be found on the NHS Inform website, and information on vaccine uptake in pregnant women is available on the PHS website.

Households of severely immunosuppressed people

The JCVI had advised that prioritisation alongside group 6 is given to those who are over 16 years of age and living with severely immunosuppressed adults in order to further protect those severely immunosuppressed adults who may not make an effective response to vaccination themselves. Following JCVI advice on children and young people under 18 published on 19 July, we will continue to work with all relevant stakeholders to consider that advice and respond accordingly. Severe-immunosuppression includes conditions such as those with blood cancer, HIV or those on treatment including chemotherapy. Adults who are severely immunosuppressed have a weaker immune system, meaning they are less able to fight infections naturally. These individuals are more likely to have poorer outcomes following COVID-19 infection and recent evidence suggests that they may not respond as well to the COVID-19 vaccine as others. There is growing evidence that the COVID-19 vaccines may reduce the chance of someone who has been vaccinated transmitting the virus.

To ensure we reach all adult household contacts of adults who are severely immunosuppressed, we have broadened this offer to adult household contacts of adults on the shielding list. The interim JCVI advice on a potential COVID-19 booster programme this autumn is that adults aged 16 years and over who are immunosuppressed should be offered a COVID-19 booster vaccination alongside the annual seasonal flu vaccination from September. We look forward to receiving the JCVI’s final advice on the potential COVID-19 booster programme in due course.