COVID-19: Vaccinations and older people

Position statement
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Authors:
British Geriatrics Society
Date Published:
06 January 2021
Last updated: 
17 March 2021

The first vaccines for COVID-19 have been approved for use in the UK and BGS is pleased to see that older people are being prioritised for access to the vaccine. This page brings together current information on vaccination, including BGS statements, Q&As and useful external links. 

Please note: The situation regarding the COVID-19 vaccine is changing rapidly and we will update this document as and when changes are made to the vaccination programmes. We will review this regularly to ensure we capture changes. However, readers are advised to check www.gov.uk/coronavirus for the latest official UK advice.

Should older people really be prioritised ahead of other age groups?

Yes. Older people have been disproportionately affected by COVID-19 with 90% of deaths occurring in the over 65 age group. They are more vulnerable to the virus than younger population groups and it makes sense to protect the most vulnerable first. COVID-19 is a virus that in many people remains asymptomatic, meaning that younger people in particular could unknowingly pass it on to older more vulnerable people. If those most vulnerable to the virus are vaccinated, the risk of other people passing the virus on to them is greatly reduced. We are pleased to see the vaccination programme expanding this week to include people aged over 70, indicating that good progress is being made. 
 
We are also pleased that NHS and care home staff have been prioritised. They have been on the frontline of this pandemic and it is right that they are provided with protection as a matter of urgency. This will enable them to better do their jobs as they will not need to worry about infecting the vulnerable people they care for. In addition, this will help the NHS and social care systems to operate at capacity as staff will not be off sick or self-isolating as much as they have been over the last few months. It will be important for leaders, such as senior clinicians and care home managers, to lead by example and to be vaccinated when invited. From 11 February eligible frontline social care staff will be able to book their own vaccination appointment at a time and place that is convenient to them using the National Booking Service.
 
We are concerned however that access to vaccines for healthcare professionals has been variable across the country and have called on the Government to ensure that healthcare professionals, and, in particular, those who work with older people, are prioritised for vaccination.

Can people book their own appointments to be vaccinated?

Yes, in some parts of the UK.

In England, the NHS has launched an online booking service for the COVID-19 vaccination. This service is currently available for:

  • People aged over 50
  • Those at high risk from coronavirus (Clinically Extremely Vulnerable)
  • Frontline health and social care workers
  • Those who have a condition that puts them at increased risk (Clinically Vulnerable)
  • Those with a learning disability
  • People who are the main carer of someone at high risk

People who do not fall into one of these categories should wait until the vaccine is rolled out to their age group.

In Northern Ireland an online booking system is operating for the following groups:

  • Those who will be 50 or older on 31 March 2021
  • Those aged 16 and over on 31 March 2021 who are Clinically Extremely Vulnerable and have a shielding letter
  • Those aged 16-17 on 31 March 2021 who have an underlying condition and have a letter from their GP
  • People with a letter from their hospital specialist or GP stating that they are eligible for the vaccine
  • People who have an email or letter from their employer

In Scotland and Wales, people will be contacted directly when it is their turn to receive the vaccine.

Is the NHS ready to roll out a mass vaccination programme on this scale?

The Government has published a Vaccination Delivery Plan outlining how it intends to vaccinate the entire adult population by the autumn of 2021. This is obviously an ambitious plan but vaccinations have already begun on a mass scale across much of the country. It is also worth remembering that the NHS will administer 30 million doses of the flu vaccine this winter and, as such, is used to vaccinating people on a mass scale. The NHS is also trialling new ways of delivering the vaccine such as offering 24 hour vaccine clinics. Since December, over a third of the UK population have received a dose of the vaccine.
 
The UK government has pre-ordered supplies of seven of the most promising vaccines. MHRA approval of further vaccines will be announced over the coming weeks. The third vaccine to be approved is the Moderna vaccine. 
 

News reports have suggested that the AstraZeneca vaccine may increase the risk of blood clots – is this true?

Some European countries have halted the rollout of the AstraZeneca vaccine due to reports of blood clots occurring in people shortly after receiving the vaccine. The numbers of people experiencing a blood clot after receiving the vaccination are lower than the rates of blood clots in the general population and there is no evidence that the two are linked. Around 17 million people have received this vaccine in the UK and Europe and fewer than 40 people have experienced blood clots in the days or weeks after being vaccinated. The MHRA, the UK’s drug regulator, has stated that the AstraZeneca vaccine is safe and encourages people to get vaccinated when they are eligible.

Does BGS agree with 24-hour vaccination centres?

It is important that everyone is able to access the vaccine at a time and place that is convenient to them. For some healthcare workers and others who work unsociable hours or would otherwise be awake, a vaccination in the middle of the night may be convenient and indeed preferable. For others, it will obviously not be convenient. It will be important to ensure that no one, and in particular no older person, is pressured into attending a vaccination appointment at a time that is inconvenient to them or when they would otherwise intend to be asleep.

Does the BGS believe that all older people should be vaccinated?

The BGS believes that it is important for older people to have access to the information they need to make an informed choice about receiving the vaccine. It will not be compulsory for anyone to receive the vaccine, and older people have as much right as anyone else to make that decision for themselves.
 
Older people and those with severe frailty and multiple long-term conditions are at increased risk of dying of COVID and have the most to gain from receiving the vaccine. As such, we would advise that older people do take up the vaccine when offered.

Does the BGS support the delayed second dose of vaccination?

In line with recommendations by the JCVI and the decision by CMOs of the four nations, the BGS supports plans to postpone the second dose of vaccines in favour of vaccinating a greater number of people in the short term. The modelling behind these changes has been well described in a letter signed by all four UK CMOs.
 
Vaccination, in whatever form, is preferable to no vaccination, and those offered the vaccine should not be deterred by the change in schedule.
 
It is imperative that older people and others in the clinically vulnerable category receive the second dose of the vaccine within 12 weeks of the initial dose to ensure sustained and optimal immunity.
 
The BGS has called for the government to ensure that the impact of the changes in the vaccine schedule are carefully and rigorously evaluated.
 

Isn’t there a new vaccine that can be given in one dose? Wouldn’t that be better?

Yes, the pharmaceutical company Janssen, owned by Johnson & Johnson, has developed a vaccine for COVID that can be delivered in a single dose and trials have shown this to be 66% effective (comparable with some of the other vaccines which have been approved). The UK Government has pre-ordered 30million doses of the Janssen vaccine but it will need to be approved by the MHRA before it will be made available in the UK to ensure that the vaccine is considered safe to use. Once approved, it may be significantly easier to deliver this vaccine, particularly to people with limited mobility who would prefer to only visit a vaccination centre once. It may also be easier for people who are unable to leave their homes as a vaccinator will only need to make one visit.

How do we know this vaccine is really safe in older people or people with multiple complex conditions?

The vaccines have been subjected to rigorous testing before being deemed safe for use and effective in protecting against COVID-19.
 
There is very little known about the long-term safety of these vaccines in any population group. The trials have included people with multiple long-term conditions and the vaccines appear safe in this group. We do not however have information about safety in the very old population groups or in those with severe frailty. However, the risk of dying from COVID is very high in those who are very old, have severe frailty or have multiple long-term conditions. This group therefore has the most to gain from receiving a vaccine and the side effects would have to be more common than from any other vaccine for the risks to outweigh the benefits.

What happens if there are unforeseen side effects in older people?

There are always safeguards with any new medication and the MHRA will be carefully monitoring the rollout of vaccines to ensure that any unforeseen side effects are identified as early as possible and appropriate action is taken. The Yellow Card Scheme enables any unforeseen problems with medications and vaccines to be reported as quickly as possible and it has been reported that the MHRA has procured an additional AI system specifically to allow fast reporting of any side effects of the COVID vaccine.

What steps are being taken to ensure that older people and those with limited mobility are able to access vaccination centres?

Vaccination centres will need to be accessible to those with limited mobility, with vaccinations administered in people's own homes for those who are not able to attend a centre. If people are initially invited to a vaccination centre that they are unable to attend, they must have the option of booking another appointment at a more convenient location (such as a GP practice) and this should be made clear to them when they are initially invited.

It is also important for the Government and the NHS to ensure that safe, convenient transport arrangements are in place to enable older people to attend vaccination centres if they do not have friends or relatives who can help with transport.

How logistically difficult will it be to provide the Pfizer-BioNTech vaccine, that has to be kept at -70°C, to people with limited mobility or those living in care homes?

Only the Pfizer-BioNTech vaccine needs to be kept at very low temperatures – other vaccines which have been approved can be kept at normal fridge temperature which may make them easier to administer in a care home environment or in someone’s home.
 
Latest advice from NHS England has advised GPs that they are required to provide the first dose of the vaccination to care home residents by 24 January and that doses of the Oxford/AstraZeneca vaccine should be prioritised for care homes as it is easier to transport and store.
 
Guidance has been issued for care homes that are currently experiencing an outbreak of COVID-19. While initially vaccination was not conducted in these care homes, this has now changed and although there are additional considerations to take into account, guidance now states that staff and unaffected residents should still be vaccinated. It is important that care home managers and leaders lead by example and are vaccinated themselves.

Once an older person has had the vaccine, what next? Will the advice to them be any different?

It will take some time for all those who are considered clinically vulnerable or clinically extremely vulnerable to be vaccinated, although this is now happening at scale across primary and community care.
 
Although vaccination reduces the risk of infection, it does not remove it completely. And COVID-19 remains prevalent. It is therefore important that people should continue to follow the relevant government guidelines even once they have been vaccinated. There is currently no separate advice for such people.
 
It is not currently known how long immunity lasts after receiving the vaccine – it may be that the vaccine has to be readministered every year in a similar fashion to the flu vaccine.
 
As research on the long-term response to the vaccines continues, it will be important for research teams to ensure that studies look specifically at how long the vaccines give protection to older people and especially those in care homes, as these groups were not included in the initial vaccine trials.

Does the BGS support mandatory vaccination for workers or visitors to care homes to ensure that residents are kept safe?

We strongly encourage all staff and visitors, as well as residents, to get the vaccine as it is rolled out to different groups, but we do not support mandatory vaccination.
 
Numerous research studies have identified staff as a significant source of outbreaks in care homes. Reducing the rate of staff infections is essential as we work to prevent care home outbreaks. It has been reported that some social care staff are reluctant to have the vaccine for various reasons. The Department for Health and Social Care has produced a toolkit for employers to use when discussing the vaccine with their staff to encourage uptake.
 
Vaccination is not a substitute for measures on social distancing, PPE and hand hygiene.

What is the logic behind the prioritisation of different groups?

Population groups have been prioritised by the JCVI based on their risk of contracting and dying of COVID-19. This starts with care home residents, NHS and care home staff and those over 80. The prioritisation groups tend to be in descending age brackets with the addition of those who are considered Clinical Extremely Vulnerable or Clinically Vulnerable. 

What is the advice for people who suffer from allergies

Following allergic reactions in two NHS staff members, people who have suffered in the past from severe allergic reactions are now advised not to be vaccinated. The MHRA has issued additional guidance to cover the risk of anaphylaxis including stating that people being vaccinated must now stay at the vaccination centre for 15 minutes after receiving their vaccination for observation and staff overseeing the vaccination process must be trained in recognising anaphylaxis and familiar with resuscitation techniques for patients with anaphylaxis.

Are there any contraindications with the vaccine?

People who are taking warfarin and anti-coagulants should discuss this with their healthcare professionals before receiving the vaccine.
 

What is BGS’s reaction to reported reluctance among those from BAME communities to be vaccinated?

We know that people from BAME communities have been particularly hard hit by the pandemic and it is worrying that these communities appear to be more reluctant than some others to receive the vaccine. It will be important over the coming weeks for the Government to work with community leaders to dispel myths about the vaccine and ensure that everyone making a decision about whether or not to have the vaccine has access to the information they need to make an informed choice.

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