Due to a combination of naturally acquired and vaccine-derived immunity in the population (hybrid immunity), COVID-19 is now a relatively mild disease for the vast majority of people. This ongoing increase in population immunity permits the development of a more targeted programme aimed at those at higher risk of developing serious COVID-19 disease.

Current trends in COVID-19 epidemiology indicate that COVID-19 has not yet settled into a stable pattern of clear seasonality. Infection with SARS-CoV-2 continues to occur throughout the year, with winter being the period of greatest threat from COVID-19 - both in relation to the risk of infection and the pressures on health systems, including the NHS. >JCVI will continue to review the optimal timing and frequency of COVID-19 vaccination beyond spring 2024.

For all routine vaccination programmes, JCVI is required to assess the cost-effectiveness of a programme to ensure that money spent on the programme would not be better spent on other interventions in the NHS. As the UK moves towards routine procurement and delivery of COVID-19 vaccination, cost-effectiveness will become a major determining factor in future advice pertaining to the COVID-19 vaccination programme. Based on the most recent cost-effectiveness assessment, it is anticipated that any autumn 2024 campaign would likely be smaller than previous autumn COVID-19 campaigns.

Currently available COVID-19 vaccines provide good protection against severe COVID-19 disease (hospitalisation and mortality) (reference 4). However, protection against asymptomatic or mild COVID-19 due to currently circulating highly transmissible SARS-CoV-2 variants is only modest and of short duration. The value of COVID-19 vaccination as a means to reduce transmission of infection from one person to another is accordingly limited. These factors will influence the value of future routine COVID-19 vaccination for groups such as healthcare workers and household contacts of immunosuppressed individuals.

Please refer to the Green Book for more details.

Advised for use in adults aged 18 yea­rs and above:

• Moderna mRNA (Spikevax) bivalent Original ‘wild-type’/Omicron BA.1. Dose: 50 micrograms

• Moderna mRNA (Spikevax) Original ‘wild-type’ vaccine. Dose: 50 micrograms

• Pfizer-BioNTech mRNA (Comirnaty) bivalent Original ‘wild-type’/Omicron BA.1 vaccine. Dose: 30 micrograms

• Pfizer-BioNTech mRNA (Comirnaty) ‘wild-type’ vaccine. Dose: 30 micrograms

Advised for use in persons aged 12 to 17 years:

• Pfizer-BioNTech mRNA (Comirnaty) bivalent Original ‘wild-type’/Omicron BA.1 vaccine. Dose: 30 micrograms

• Pfizer-BioNTech mRNA (Comirnaty) ‘wild-type’ vaccine. Dose: 30 micrograms

Advised for use in persons aged 5 to 11 years:

• Pfizer-BioNTech mRNA (Comirnaty) ‘wild-type’ vaccine paediatric formulation. Dose 10 micrograms. Available for ‘off-label’ use as a booster dose (currently UK approved for primary course vaccination in children aged 5 to 11 years)

Exceptional circumstances:

• Novavax Matrix-M adjuvanted wild-type vaccine (Nuvaxovid), dose 5 micrograms (Spike protein) with 50 micrograms adjuvant, may be used ‘off-label’ as a booster dose for persons aged 18 years and above when no alternative clinically suitable UK-approved COVID-19 vaccine is available (see the Green Book)

In the previous advice published on 15 August it was noted that the Pfizer-BioNTech mRNA bivalent vaccine was under assessment by the Medicines and Healthcare products Regulatory Agency (MHRA). This assessment has now been completed and the vaccine authorised for use as a booster in this age group as of 2 September 2022.

The COVID-19 vaccine will reduce the chance of you becoming severely unwell from COVID-19 this spring and summer. It may take a few days for your body to build up some extra protection from the dose. Like all medicines, no vaccine is completely effective. Some people may still get COVID-19 despite having a vaccination, but any infection should be less severe.