Publication approval reference: C1355
- All GP practices
- All CCGs
- All Directors of Public Health
- All Directors of Children’s Services
- All NHS trust and foundation trust Chief Executives
- NHS Regional Directors of Commissioning
- All CCG Chairs
- All ICS and STP leads
- All Local Authority CEOs
- NHS Regional Directors
22 July 2021
We are writing to you following Monday’s updated independent Joint Committee on Vaccination and Immunisation (JCVI) guidance in relation to COVID-19 vaccinations for children and young people:
The guidance states:
“A small number of children and young people with underlying chronic conditions are at increased risk of serious COVID-19 disease.
JCVI advises that children and young people aged 12 years and over with specific underlying health conditions that put them at risk of serious COVID-19, should be offered COVID-19 vaccination.
Government advisers are currently reviewing evidence on the risk of COVID-19 in children and young people considered clinically extremely vulnerable. Once this review has reported, the finding will be considered by JCVI and will inform further guidance.
At the current time, children 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 (PMLD), 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 Green Book, should continue to be offered COVID-19 vaccination.
Further details regarding other specific underlying health conditions for which an offer of COVID-19 vaccination is advised will be provided in the Green Book: Immunisation against infectious disease.
Persons who are immunosuppressed are at higher risk of serious disease from COVID-19 and may not generate a full immune response to vaccination.
JCVI advises that 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.
Clear information on the potential risks and benefits of vaccination should be provided to the child and those with parental responsibility prior to vaccination.
Until more data become available, JCVI does not currently advise routine universal vaccination of children and young people less than 18 years of age. JCVI will keep this advice under review as more safety and effectiveness information become available on the use of COVID-19 vaccines in children and young people.
The health benefits in this population are small, and the benefits to the wider population are highly uncertain. At this time, JCVI is of the view that the health benefits of universal vaccination in children and young people below the age of 18 years do not outweigh the potential risks.
Operationally, it is considered reasonable to allow a lead-in time to offer vaccination to those children who are within three months of their 18th birthday to ensure good uptake of vaccine in newly-turned 18 year olds.”
The vaccination of eligible children and young people will require a system-based approach, involving the NHS, Local Authorities and other local partners. Integrated Care Systems working with vaccination providers and regional teams should now develop an operational plan that covers the following areas.
To note, the national protocol and Patient Group Direction (PGD) for the Pfizer BioNTech Covid-19 vaccine are being updated to reflect the new JCVI advice. In the meantime until they are updated and in line with PHE advice, the current protocols and PGD do already allow some flexibility for patients to be called for vaccination before their 18th birthday. This means that ‘18’ in the existing protocol and PGD can in present circumstances be interpreted as including 17 year olds within 3 months of their 18th birthday, where this is necessary to support high vaccine uptake. Children aged 12-15 in the groups specified by JCVI can only be vaccinated using a PSD until the documents are updated.
A. Children and young people aged 12 years and over with specific underlying health conditions that put them at risk of serious COVID-19 and Children and young people aged 12 years and over who are household contacts of persons (adults or children) who are immunosuppressed
Delivery plans must ensure:
- Children are offered a first dose vaccination before returning to school in September. Therefore, it is expected that first dose vaccinations for eligible children aged 12-15 to be operational from w/c 23 August at the latest with invitations issued in advance.
- The ability to vaccinate children aged 12-15 using an appropriate mix of PCN led Vaccination services; Hospital Hubs; and School Aged Vaccination and Immunisation Services.
- All eligible children should receive a consistent offer of COVID-19 vaccination that promotes access, minimises journey times and recognises the complex needs of children identified as requiring vaccination, recognising home visits may be suitable for some children.
- Arrangements are in place to vaccinate children in secure accommodation or residential care.
- Many of these children will be in contact with hospital and Local Authority services and will benefit from opportunistic vaccination in a specialist setting where children and their parents are able to discuss their individual needs. Systems should work with Acute and Community Trusts and Local Authority teams to undertake opportunistic vaccination if possible and where supply allows at the earliest opportunity.
- PCN Groupings will require indemnity to vaccinate these children. A contractual agreement will be put in place nationally which will follow shortly pending appropriate engagement with professional bodies.
B. Children who are within three months of their 18th birthday
Delivery plans must ensure:
- Existing local COVID-19 vaccination delivery models can be used for the vaccination of children who are within three months of their 18th birthday.
- That systems note and can develop the additional workforce and training requirements necessary to vaccinate this group, as soon as operationally feasible. Further guidance will follow on specific requirements.
- Nationally, we are developing the capability for the national call / recall process to invite all eligible individuals to book their appointment through the National Booking System. Local systems may already be in a position where they can begin to offer vaccination in advance of NBS going live. Where workforce and training requirements are in place, supply and capacity allows, we would encourage vaccination at the earliest opportunity.
- To support delivery, we will update the general practice and community pharmacy service specifications following discussion and engagement with the professional bodies.
We are working with stakeholder groups, including patient representative groups, to ensure that families are provided with appropriate information and the opportunity to access specialist advice where necessary.
We are committed to ensuring that all adults have been offered the opportunity to be vaccinated. This means the focus must remain on doing everything we can to ensure as many people as possible, especially those 18-29 year olds who have not yet come forward, receive their first dose, as well as maintaining an unrelenting focus on second dose delivery throughout the summer months.
In line with the updated Green Book guidance second dose vaccinations should not be offered earlier than 8 weeks. Local systems and delivery sites should continue to ensure the dosing interval aligns with the latest JCVI guidance and that an interval of 8 to 12 weeks between doses of all the available COVID-19 vaccines is observed.
Together we have delivered in England a proven vaccine programme safely, comprehensively and at scale. We know your remarkable endeavours to date are enormously appreciated and will continue to be so.
Professor Sir Keith Willett | National Director for the COVID Vaccine Deployment Programme
Dr Nikki Kanani | Medical Director for Primary Care
Eleanor Kelly | LA CEO advisor