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CMOs to review Covid jabs for all 12-15s after JCVI stops short of recommendation


12-15s


The UK’s chief medical officers (CMOs) are set to review universal Covid vaccination for 12-15s after the JCVI stopped short of recommending expanding the rollout to all healthy children in the age group.

The JCVI has today recommended that the list of underlying health conditions making 12-15s eligible for vaccination should be expanded, but said it did not recommend a universal offer.

However, the Government has said that health ministers have now asked their CMOs to review the decision, taking into account other aspects that are outside the remit of the JCVI.

In a statement released this afternoon, Public Health England (PHE) announced that the JCVI has advised that vaccination should be expanded to include more children aged 12-15, including those with sickle cell disease or type 1 diabetes.

It said that the JCVI has also advised that the ‘health benefits’ to healthy 12-15s of vaccination are ‘marginally greater than the potential known harms’ but that the Government should ‘seek further input from the CMOs on the wider impacts’, including the impact on schools.

The four UK health ministers have today written to their CMOs asking them to begin assessing the ‘broader impact’ of universal Covid vaccination for this age group, PHE said.

It added: ‘They will now convene experts and senior leaders in clinical and public health to consider the issue. They will then present their advice to ministers on whether a universal programme should be taken forward.’

Health secretary Sajid Javid said that the Government will today expand the vaccination offer to more 12-15s with underlying conditions, as recommended by the JCVI, and that ministers will consider further CMO advice before making a decision on universal vaccination for 12-15s ‘shortly’.

In a background briefing attended by Pulse, JCVI chair of Covid immunisation Professor Wei Shen Lim said that around 200,000 additional teenagers are expected to be covered by today’s cohort expansion.

He added that they should be offered the Pfizer vaccination, in line with other eligible teenagers in the age group.

In a statement, the JCVI said: ‘A precautionary approach was agreed given the very low risk of serious disease in those aged 12 to 15 years without an underlying health condition that puts them at increased risk.’

It added that while there is ‘increasingly robust’ evidence of an association between mRNA Covid vaccines and myocarditis, this is a ‘very rare adverse event’.

It concluded: ‘Overall, the committee is of the opinion that the benefits from vaccination are marginally greater than the potential known harms but acknowledges that there is considerable uncertainty regarding the magnitude of the potential harms. 

‘The margin of benefit, based primarily on a health perspective, is considered too small to support advice on a universal programme of vaccination of otherwise healthy 12 to 15-year-old children at this time.’ 

Longer-term data on potential adverse reactions ‘may allow for a reconsideration of the benefits and harms’ but this data ‘may not be available for several months’, it said.

It added that it is ‘not within [the JCVI’s] remit’ to make ‘in-depth consideration on wider societal impacts including educational benefits’ beyond health benefits and risks and that the Government ‘may wish to seek further views’ from the CMOs.

PHE reiterated that the health secretary ‘has asked the NHS to put preparations in place to roll-out vaccinations to 12 to 15 year olds, should it be recommended by the CMOs’ – and that parental or carer consent will be sought.

The health secretary previously said that the jabs would be administered by school vaccination teams, as well as at other locations including GP vaccination sites, to ensure full coverage across the country.

So far, only those with certain health conditions or who live with someone clinically vulnerable have been offered the vaccine in the 12-15 age group.

The news comes as 16-17-year-olds were offered their first Covid vaccine dose last month, with more than 620,000 – 50% of the cohort – having taken up their first jab so far.

Click to complete relevant paediatrics CPD modules on Pulse learning

JCVI advice

Previously, JCVI advised that children with severe neuro-disabilities, Down’s Syndrome, underlying conditions resulting in immunosuppression, profound and multiple learning disabilities (PMLD), severe learning disabilities or who are on the learning disability register, should be offered COVID-19 vaccination.

Following consideration of the updated data, JCVI advises that the offer of a course of COVID-19 vaccination should be expanded to include children aged 12 to 15 years with the following:

  • haematological malignancy
  • sickle cell disease
  • type 1 diabetes
  • congenital heart disease
  • other health conditions as described below under ‘COVID-19 clinical risk groups for children aged 12 to 15 years’ (these health conditions reflect the basket of diagnoses used in the RCPCH and NHSE analyses mentioned above).

COVID-19 clinical risk groups for children aged 12 to 15 years

Chronic respiratory disease:

Includes those with poorly controlled asthma that requires continuous or repeated use of systemic steroids or with previous exacerbations requiring hospital admission, cystic fibrosis, ciliary dyskinesias and bronchopulmonary dysplasia.

Chronic heart conditions:

Haemodynamically significant congenital and acquired heart disease, or milder heart disease with other co-morbidity.

Chronic conditions of the kidney, liver or digestive system:

Includes those associated with congenital malformations of the organs, metabolic disorders and neoplasms, and conditions such severe gastro-oesophageal reflux that may predispose to respiratory infection.

Chronic neurological disease:

Includes those with:

  • neuro-disability and/or neuromuscular disease including cerebral palsy, autism, epilepsy and muscular dystrophy
  • hereditary and degenerative disease of the nervous system or muscles, or other conditions associated with hypoventilation
  • severe or profound and multiple learning disabilities (PMLD), Down’s syndrome, or those on the learning disability register
  • neoplasm of the brain

Endocrine disorders:

Includes diabetes mellitus, Addison’s and hypopituitary syndrome.

Immunosuppression:

Immunosuppression due to disease or treatment, including:

  • those undergoing chemotherapy or radiotherapy, solid organ transplant recipients, bone marrow or stem cell transplant recipients
  • genetic disorders affecting the immune system (for example, deficiencies of IRAK-4 or NEMO, complement disorder, SCID)
  • those with haematological malignancy, including leukaemia and lymphoma
  • those receiving immunosuppressive or immunomodulating biological therapy
  • those treated with or likely to be treated with high or moderate dose corticosteroids
  • those receiving any dose of non-biological oral immune modulating drugs – for example, methotrexate, azathioprine, 6-mercaptopurine or mycophenolate
  • those with auto-immune diseases who may require long term immunosuppressive treatments

Asplenia or dysfunction of the spleen:

Includes hereditary spherocytosis, homozygous sickle cell disease and thalassemia major.

Serious genetic abnormalities that affect a number of systems:

Includes mitochondrial disease and chromosomal abnormalities.

Source: JCVI