Joint Committee on Vaccination and Immunisation

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Joint Committee on Vaccination and Immunisation
Agency overview
Formed1963 (1963)
Jurisdiction England, Wales, and Scotland
Agency executive
Website www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation

The Joint Committee on Vaccination and Immunisation (JCVI) is an independent expert advisory committee that advises United Kingdom health departments on immunisation, making recommendations concerning vaccination schedules and vaccine safety. It has a statutory role in England and Wales, and health departments in Scotland and Northern Ireland may choose to accept its advice.

Contents

History

The committee was established in 1963, having been until then an advisory board for polio immunisation. [1] It gained statutory status as the Standing Advisory Committee on Vaccination and Immunisation, a non-departmental public body [2] advising the Secretary of State for Social Services and the Secretary of State for Wales, under the National Health Service (Standing Advisory Committees) Order 1981. [3]

Since the devolution of government powers to Wales, the JCVI continues to advise Welsh ministers. [1] For England, the Health Protection (Vaccination) Regulations 2009 require the Secretary of State for Health to implement the committee's recommendations regarding national immunisation programmes. [2] The committee has no statutory role in Scotland or Northern Ireland, [1] although the Scottish Parliament takes JCVI advice because it has not formed an alternative body. In 2015 a petition was presented to the Scottish Parliament to depart from JCVI advice because the petitioner felt that the chair of the JCVI was not observing the Nolan Principles. [4] Petitioner had contacted Nicola Sturgeon during her time as Health Minister, and nine years later had decided to petition as a last resort for his proposal to form a body "similar if not the same as Norway's model". [5]

Following the government's review of public bodies that completed in 2012, the JCVI was reconstituted as a departmental expert committee, although its statutory status under the 1981 order continues. [6]

Roles and responsibilities

The JCVI has a responsibility to provide high quality and considered advice and recommendations to the UK Health Ministers. This includes giving advice on recommendations on matters of both a 'routine' nature and also on any specific or special matters that Ministers may request. In formulating any advice and recommendations, the Committee must take into account the need for and impact of vaccines, the quality of vaccines and the strategies to ensure that their greatest benefit to the public health can be obtained from the most appropriate use of vaccines.[ citation needed ]

JCVI members meet and report as one Committee, usually three times a year. Its recommendations, as accepted by the secretaries of state, are published in "Immunisation against infectious diseases", commonly referred to as The Green Book which provides guidance to clinicians, [1] and also through other routes as necessary (e.g., the Chief Medical Officer letters). [7]

Membership

In June 2018, the JCVI chair was Professor Andrew Pollard of the Oxford Vaccine Group in the Department of Paediatrics at the University of Oxford. [7]

The chair of the COVID-19 subcommittee is Wei Shen Lim, a consultant respiratory physician and honorary professor of medicine at Nottingham University Hospitals NHS Trust. [8] [9]

The current members' names and affiliations are published online [7] although year of appointment is not stated. According to the published code of practice, [1] appointments are normally of three years' duration. In accordance with the Code of Practice issued by the Commissioner for Public Appointments, members cannot serve on the Committee for more than 10 years. [1]

A previous chairman, Andrew Hall, was appointed Knight Bachelor in the 2013 Birthday Honours. [10]

Notable work

Position on MMR (1988 onwards)

The JCVI "expressed concern" about giving triple vaccines to children with a personal or family history of convulsions, but considered it appropriate to proceed with a planned introduction of the MMR vaccine in October 1988, including two products containing Urabe strain. After the start of the mass MMR immunisation programme, additional evidence that the strain was linked with viral meningitis surfaced in a number of countries, and by 1990, many had withdrawn products containing it. [11] In November 1992, it was withdrawn in the UK, following the publication of government-sponsored research which confirmed a high incidence of transitory mild meningitis. [12] Since that time, government agencies have acted to prevent the importation of single vaccines containing this strain. [13]

In late 2000, Andrew Wakefield published what he said were his concerns in the journal Adverse Drug Reactions and Toxicological Reviews , based on his interpretation of early studies of MMR — none of which were actually critical of the vaccine. The article was reviewed in January 2001 by the JCVI, which unequivocally rejected Wakefield's claims, with government agencies publishing a detailed rebuttal. [14] In 2010, Wakefield was struck off by the General Medical Council for fabrication of results and failure to declare a financial interest in the importation of single strain vaccines. [15]

Position on thimerosal (2001)

As is the case in the United States and many other countries, the mercury-based additive thimerosal, previously thought necessary for multi-dose vials of vaccines such as the DPT shot, has largely been phased out. According to the JCVI, it has been shown that the amount of mercury in the blood of children receiving thimerosal-containing vaccines is well below levels that may be "associated with any toxic effects." Reports reviewed by the JCVI contended that mercury exposure in the UK immunisation programme was low. However, in 2001, JCVI endorsed recommendations to remove the preservative, stating: "even though there is no evidence of toxicity, as a precautionary measure, thiomersal should be phased out over time...". [16]

COVID-19 vaccines (2020–2024)

During the COVID-19 pandemic, in autumn 2020 the committee gave advice to the recently formed Vaccine Taskforce on the groups of people that should be prioritised for vaccination, giving regard to health inequalities. [17] [18] Their advice was refined in December of that year. [19]

On 6 April 2021, Maggie Wearmouth of the JCVI said "in a personal capacity" that the vaccine roll-out should be slowed "in younger people" to maintain public trust and confidence, after the committee had discussed concerns over a possible link between the Oxford–AstraZeneca vaccine and a rare type of blood clot. [20]

The next day in a press conference, the JCVI stated that it "believes healthy young people aged 18 to 29 should be offered the Pfizer-BioNTech or Moderna vaccines instead of the AstraZeneca jab" because of the risk of CVST blood clots. [21] The press conference was offered by the "chair of the JCVI" (sic) Wei Shen, who said "every country has to take their own decision based on their own population, the scale of the pandemic, the values of its people and the quantity of vaccines." The JCVI had judged safety evidence from the MHRA and Public Health England in coming to its decision. Adam Finn, a member of the JCVI, said on BBC Breakfast that "it was possible doses of the Moderna jab could be reserved for young people... We are seeing another vaccine coming in (Moderna), and further vaccines are approaching licensure, and I know that the UK has made contracts for quite a wide range of different vaccines. As time goes forward we will have much more flexibility about who can be offered what." [22]

The updated advice from the JCVI was published on 13 April 2021, stating "it is preferable for adults aged 18 to 29 years without underlying health conditions that put them at higher risk of severe COVID-19 disease, to be offered an alternative to the AstraZeneca COVID-19 vaccine, if available". [23] On 7 May the applicable age range was extended to 18–39. [24]

In February 2022, JCVI recommended a further booster dose for the most vulnerable people, to be given around six months after their previous dose. Those eligible were in three categories: aged 75 and over, residents in care homes for older adults, and immunosuppressed people aged 12 and over. [25]

The initial JCVI recommendation for a booster programme in autumn 2022 (published as interim advice in May) included everyone aged 65 and over, selected workers and care home residents, and people in clinical risk groups aged 16 and over. [26] In July, their final recommendations for the autumn programme were widened to include people aged 50 and over, residents and staff in care homes for older adults, front-line health and social care workers, unpaid carers, people aged 5 to 49 in clinical risk groups, and household contacts aged 5 to 49 of those who are immunosuppressed. [27] Refinements to the advice in August included the addition of the first approved bivalent vaccine from Moderna, although the committee found it would give only a marginally higher immune response, and stated that timeliness was more important than the type of vaccine. [28] A second bivalent vaccine from Pfizer-BioNTech was later added to the recommendations for the Autumn 2022 programme. [29]

For the 2023 spring programme, JCVI recommended booster doses for people aged 75 and over, all residents in care homes for older adults, and everyone aged 5 and over who is immunosuppressed. [30] The recommendation for the 2023 autumn booster set the general age cut-off at 65, and again included care home residents and front-line health and social care workers. Lower age limits were adjusted: six months for clinical risk groups, 12 for household contacts of people with immunosuppression, and 16 for carers and care home staff. [9]

For spring 2024, doses were again recommended for those aged 75 and over, residents in care homes for older adults, and immunosuppressed people aged 6 months and over. [31]

For young people

In late July 2021, the JCVI advised that all 16- and 17-year-olds should be given a first dose of the Pfizer-BioNTech vaccine, with advice on a second dose expected to be given in the future; this advice was published by the government on 4 August. [32] Two doses were already available for certain at-risk people aged 16 and over. Those aged 12 to 15 with specific underlying health conditions were already eligible for two doses of the same vaccine, and the new advice extended this to children who are household contacts of immunosuppressed people. [33] In December 2021, this recommendation was expanded to certain at-risk children aged 5–11, [34] and two doses were recommended for all children aged 12–17. [35] In February 2022, the JCVI advised that two doses of Pfizer-BioNTech vaccine should be offered on a "non-urgent" basis to parents of all 5–11-year-olds. [36] [37]

Around July 2021, some medical commentators raised concerns that the committee had not taken into account all risks to children, particularly long COVID, and pointed out that other countries – including the United States – were already vaccinating everyone aged 12 and over. [38]

See also

Related Research Articles

<span class="mw-page-title-main">MMR vaccine</span> Any of several combined vaccines against measles, mumps, and rubella

The MMR vaccine is a vaccine against measles, mumps, and rubella, abbreviated as MMR. The first dose is generally given to children around 9 months to 15 months of age, with a second dose at 15 months to 6 years of age, with at least four weeks between the doses. After two doses, 97% of people are protected against measles, 88% against mumps, and at least 97% against rubella. The vaccine is also recommended for those who do not have evidence of immunity, those with well-controlled HIV/AIDS, and within 72 hours of exposure to measles among those who are incompletely immunized. It is given by injection.

<span class="mw-page-title-main">DPT vaccine</span> Combination vaccine

The DPT vaccine or DTP vaccine is a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis, and tetanus. The vaccine components include diphtheria and tetanus toxoids and either killed whole cells of the bacterium that causes pertussis or pertussis antigens. The term toxoid refers to vaccines which use an inactivated toxin produced by the pathogen which they are targeted against to generate an immune response. In this way, the toxoid vaccine generates an immune response which is targeted against the toxin which is produced by the pathogen and causes disease, rather than a vaccine which is targeted against the pathogen itself. The whole cells or antigens will be depicted as either "DTwP" or "DTaP", where the lower-case "w" indicates whole-cell inactivated pertussis and the lower-case "a" stands for "acellular". In comparison to alternative vaccine types, such as live attenuated vaccines, the DTP vaccine does not contain any live pathogen, but rather uses inactivated toxoid to generate an immune response; therefore, there is not a risk of use in populations that are immune compromised since there is not any known risk of causing the disease itself. As a result, the DTP vaccine is considered a safe vaccine to use in anyone and it generates a much more targeted immune response specific for the pathogen of interest.

The Medicines and Healthcare products Regulatory Agency (MHRA) is an executive agency of the Department of Health and Social Care in the United Kingdom which is responsible for ensuring that medicines and medical devices work and are acceptably safe.

The Therapeutic Goods Administration (TGA) is the medicine and therapeutic regulatory agency of the Australian Government. As part of the Department of Health and Aged Care, the TGA regulates the quality, supply and advertising of medicines, pathology devices, medical devices, blood products and most other therapeutics. Any items that claim to have a therapeutic effect, are involved in the administration of medication, or are otherwise covered by the Therapeutic Goods Act 1989, the Therapeutic Goods Regulations 1990, or a ministerial order, must be approved by the TGA and registered in the Australian Register of Therapeutic Goods.

<span class="mw-page-title-main">Vaccination schedule</span> Series of vaccinations

A vaccination schedule is a series of vaccinations, including the timing of all doses, which may be either recommended or compulsory, depending on the country of residence. A vaccine is an antigenic preparation used to produce active immunity to a disease, in order to prevent or reduce the effects of infection by any natural or "wild" pathogen. Vaccines go through multiple phases of trials to ensure safety and effectiveness.

<span class="mw-page-title-main">Booster dose</span> Additional administration of vaccine

A booster dose is an extra administration of a vaccine after an earlier (primer) dose. After initial immunization, a booster provides a re-exposure to the immunizing antigen. It is intended to increase immunity against that antigen back to protective levels after memory against that antigen has declined through time. For example, tetanus shot boosters are often recommended every 10 years, by which point memory cells specific against tetanus lose their function or undergo apoptosis.

A vaccination policy is a health policy adopted in order to prevent the spread of infectious disease. These policies are generally put into place by State or local governments, but may also be set by private facilities, such as workplaces or schools. Many policies have been developed and implemented since vaccines were first made widely available.

<span class="mw-page-title-main">Oxford–AstraZeneca COVID-19 vaccine</span> Viral vector vaccine for prevention of COVID-19 by Oxford University and AstraZeneca

The Oxford–AstraZeneca COVID‑19 vaccine, sold under the brand names Covishield and Vaxzevria among others, is a viral vector vaccine for the prevention of COVID-19. It was developed in the United Kingdom by Oxford University and British-Swedish company AstraZeneca, using as a vector the modified chimpanzee adenovirus ChAdOx1. The vaccine is given by intramuscular injection. Studies carried out in 2020 showed that the efficacy of the vaccine is 76.0% at preventing symptomatic COVID-19 beginning at 22 days following the first dose and 81.3% after the second dose. A study in Scotland found that, for symptomatic COVID-19 infection after the second dose, the vaccine is 81% effective against the Alpha variant and 61% against the Delta variant.

Nicola Mary Turner is a New Zealand public health advocate who is a Professor at the University of Auckland and Medical Director of the Immunisation Advisory Centre, an organisation that advises the New Zealand medical profession and the New Zealand Government. She has contributed to advisory committees for the New Zealand Ministry of Health, is a spokesperson for the Child Poverty Action Group and works in general practice. Much of her research and outreach has focused on improving immunisation coverage and closing equity gaps for the national schedule vaccine delivery in New Zealand and she has commented publicly on these issues during COVID-19 in New Zealand.

Helen Aspasia Petousis-Harris is a New Zealand vaccinologist and associate professor in the Department of General Practice and Primary Health Care at the University of Auckland. She has been involved in research related to vaccination in New Zealand since 1998, with her main areas of focus being vaccine safety and effectiveness. Petousis-Harris has had a variety of lead roles in New Zealand and international organisations that focus on vaccination and is a regular media spokesperson in this field, especially during the COVID-19 pandemic.

<span class="mw-page-title-main">COVID-19 vaccination in the United Kingdom</span> Immunisation against COVID-19

The COVID-19 vaccination programme in the United Kingdom is an ongoing mass immunisation campaign for coronavirus disease 2019 (COVID-19) during the COVID-19 pandemic in the United Kingdom.

<span class="mw-page-title-main">COVID-19 vaccination in Australia</span> Ongoing COVID-19 vaccine program in Australia

The general COVID-19 vaccination in Australia program began on 22 February 2021 in response to the COVID-19 pandemic, with the goal of vaccinating all willing people in Australia before 2022. Front-line workers and aged care staff and residents had priority for being inoculated, before a gradual phased release to less-vulnerable and lower-risk population groups throughout 2021. The Therapeutic Goods Administration (TGA) approved four vaccines for Australian use in 2021: the Pfizer–BioNTech vaccine on 25 January, the Oxford–AstraZeneca vaccine on 16 February, Janssen vaccine on 25 June and the Moderna vaccine on 9 August. Although approved for use, the Janssen vaccine was not included in the Australian vaccination program as of June 2021.

<span class="mw-page-title-main">COVID-19 vaccination in the Republic of Ireland</span> Immunisation plan against COVID-19

The COVID-19 vaccination programme in the Republic of Ireland is an ongoing mass immunisation campaign that began on 29 December 2020 in response to the COVID-19 pandemic in the Republic of Ireland. Ireland's vaccination rollout has been praised as one of the most successful rollouts in the world and was ranked number one in the European Union in terms of its percentage of adult population fully vaccinated, and was also ranked number one in the EU for the number of booster vaccines administered.

<span class="mw-page-title-main">COVID-19 vaccination in Canada</span> COVID-19 vaccination programme in Canada

COVID-19 vaccination in Canada is an ongoing, intergovernmental effort coordinated between the bodies responsible in the Government of Canada to acquire and distribute vaccines to individual provincial and territorial governments who in turn administer authorized COVID-19 vaccines during the COVID-19 pandemic in Canada. Provinces have worked with local municipal governments, hospital systems, family doctors and independently owned pharmacies to aid in part, or in full with vaccination rollout. The vaccination effort in full is the largest such immunization effort in the nation's history. The vaccination effort began December 14, 2020, and is currently ongoing.

The National Advisory Committee on Immunization is an advisory body that provides the Government of Canada with medical and scientific advice relating to human immunization.

The Australian Technical Advisory Group on Immunisation (ATAGI) is a technical advisory group of the Australian Government. As part of the Department of Health, ATAGI provides advice to the Minister of Health on the immunisation program of Australia and related matters, including the strength of evidence pertaining to existing, new, and emerging vaccines.

The COVID-19 vaccination campaign in Quebec is an ongoing provincial effort to distribute and administer vaccines against COVID-19.

<span class="mw-page-title-main">COVID-19 vaccination in Singapore</span> Plan to immunize against COVID-19

The COVID-19 vaccination in Singapore is an ongoing immunisation campaign against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), in response to the ongoing pandemic in the country. Singapore has a very high vaccination rate, with more than 92% of its total population having completed their vaccination regimen.

Anthony Harnden is Professor of Primary Care, General Practitioner and Fellow of St Hugh's College at Oxford University. He is also director of graduate studies for the Nuffield Department of Primary Care Health Sciences and sits on the General Medical Council, which is responsible for the regulation of all UK doctors and UK medical schools. He is also editorial advisor for the British Medical Journal. Harnden "has been the General Practitioner member of the Joint Committee of Vaccination and Immunisation (JCVI) since 2006 and Deputy Chairman since 2015."

<span class="mw-page-title-main">The Green Book (immunisation guidance, UK)</span> Book about vaccination

Immunisation against infectious disease, popularly known as The Green Book, provides information on vaccines for vaccine-preventable diseases. It acts as a guide to the UK's vaccination schedule for health professionals and health departments that give vaccines in the United Kingdom.

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