Publication approval reference: C1279
- ICS leads
- CCG Accountable Officers
- NHS Foundation Trust and Trust Chief Executives
- Local Authority Chief Executives
- All COVID-19 vaccination sites
- All GP practices
- All Community Pharmacies
- Chairs of ICS
- CCG Chairs
- Chairs of NHS trusts and foundation trusts
- NHS Regional Directors
- NHS Regional Directors of Commissioning
Friday 7 May 2021
We are writing to you following today’s updated independent Joint Committee on Vaccination and Immunisation (JCVI) guidance in relation to the use of the AstraZeneca vaccine for some people aged under 40:
The updated guidance from JCVI states:
‘JCVI’s advice is based on the available data on the current epidemiology, benefit-risk profile by age, modelling predictions on future disease trends and the current forecast on vaccine supply. Given the risk (albeit extremely rare) of these adverse events associated with the AstraZeneca (AZD1222) vaccine, the current control of COVID-19 in the UK, model predictions of the potential scale and timing of a future wave, and promising forecasts for the availability of vaccines in the UK, JCVI agreed its advice should be updated.
JCVI advises that, in addition to those aged under 30, unvaccinated adults aged 30 to 39 years who are 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 (AZD1222) vaccine, where possible and only where no substantial delay or barrier in access to vaccination would arise.
For those under 40 years who are of older age, male, obese (BMI above 30), from certain ethnic minority backgrounds or experiencing socio-economic deprivation, the risks of acquiring and/or suffering complications of COVID-19 are higher. Every effort should be made to remove barriers to accessing vaccination in those individuals.
For those aged 18 to 29 years the precautionary advice for a vaccine preference is stronger, reflecting a gradient in the benefit-risk balance with age.’
All vaccination sites should now take the following actions:
- All those who have received a first dose of the AstraZeneca vaccine should continue to be offered a second dose of AstraZeneca vaccine, irrespective of age. The second dose will be important for longer lasting protection against COVID-19.
Therefore, everyone (excluding exception set out below) who has received a first dose of AstraZeneca and are due to receive their second dose, no further action is required and these appointments should continue.
MHRA are clear that the only individuals who should NOT have a second dose of AstraZeneca are:
- Patients who have experienced major venous and/or arterial thrombosis occurring with thrombocytopenia following vaccination with any COVID-19 vaccine should not receive a second dose of COVID-19 Vaccine AstraZeneca.
Adults under 40 without underlying health conditions that are currently eligible for the vaccine:
- JCVI guidance states ‘in addition to those aged under 30, unvaccinated adults aged 30 – 39 years who are 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.
For these recipients who have yet to receive a COVID-19 vaccination and are scheduled to receive a dose of AstraZeneca, the following actions will now need to be taken:
- For those who have a first dose appointment at a site booked through the National Booking Service, we will make every effort to nationally contact these people to make them aware of the new guidance. All sites should prepare to have individual conversations with these people coming for their appointments about the risks and benefits of continuing to receive the AstraZeneca vaccine or alternatively being directed to book into an appointment to receive an alternative vaccine if they choose to. This means all vaccination sites will need to put immediate measures in place to ensure that regulated healthcare professionals are available to support these conversations. Information for the public will be published by PHE on their website shortly.
- The National Booking Service will temporarily not allow further people under 40 without an underlying health condition to book an appointment. This includes frontline eligible health and social care worker booking through the self-elective route. The National Booking System will be amended in the coming days to allow people to book into specific vaccine appointments in line with JCVI guidance.
- Those booked via a local booking system should align with this approach and if, following a conversation with a clinician, an individual chooses to go ahead with the AstraZeneca vaccination, local health systems should ensure arrangements are in place for that person to have their appointment or be booked into one.
- For those who already have a first dose appointment for a Moderna or Pfizer-BioNTech vaccination, no further action is needed.
If an individual chooses to have another vaccine:
- PCN-led Local Vaccination Services, working with system partners including Hospital Hubs, should rebook this individual in a clinic offering the Pfizer-BioNTech vaccine over the coming weeks. Guidance on how to access additional Pfizer-BioNTech vaccine has been previously communicated.
- For Hospital Hubs, any available Pfizer-BioNTech doses should be offered as first doses.
- Local health systems should also consider putting arrangements in place to ensure that people are able to be locally booked into appointments in a National Booking Service site that offers the Pfizer-BioNTech vaccine and/or the Moderna vaccine (for people aged 18 and over).
- The National Booking System will be amended in the coming days to allow people to book into specific vaccine appointments in line with JCVI guidance.
Following the JCVI advice that women who are pregnant or think they are pregnant should continue to be offered the Pfizer-BioNTech or Moderna vaccine, dependent on age and clinical risk, we wrote to you on 17 April advising on next steps. Local services should have arrangements in place to invite pregnant women to be vaccinated in a timely way, in line with the latest eligible cohorts. NHS Digital will be amending the National Booking Service in the coming days to allow pregnant women to book into specific vaccine appointments in line with JCVI guidance:
For those who have contraindications or conditions that require special precautions
For those who have contraindications or conditions that require special precautions for use of the AstraZeneca vaccine, continue to follow the MHRA information for UK healthcare professionals: https://www.gov.uk/government/publications/regulatory-approval-of-covid-19-vaccine-astrazeneca/information-for-healthcare-professionals-on-covid-19-vaccine-astrazeneca – then do as follows:
- Ensure that everyone who presents for vaccination is asked about additional risk factors, using the above guidance. If they are at increased risk, they should have a discussion about the benefit and risks to them of receiving the AstraZeneca or another vaccine with a clinician.
- If, following a conversation with a clinician, an individual chooses to go ahead with the AstraZeneca vaccination, vaccination sites should make this option available.
- If an individual chooses to have another vaccine, the NHS will put appropriate arrangements in place:
- PCN-led Local Vaccination Services, working with system partners including Hospital Hubs, vaccination clinics and community pharmacies should rebook this group at clinics offering Pfizer-BioNTech vaccines over the coming weeks
- For Hospital Hubs, any available Pfizer BioNTech doses should be offered as first doses.
- Local health systems should also consider putting arrangements in place to ensure that people are able to be locally booked into appointments in an NBS site that offers the Pfizer-BioNTech and/or the Moderna vaccine (for people aged 18 and over).
- The National Booking Service will be amended in the coming days to allow people to book into specific vaccine appointments in line with JCVI guidance.
Thank you for your continued efforts. We remain, as ever, hugely grateful for everything that you are doing to make the NHS delivery of this programme the success that it is.
Dr Emily Lawson | NHS Chief Commercial Officer and SRO
Professor Stephen Powis | National Medical Director
Dr Nikki Kanani | Medical Director for Primary Care