Will a two for one on autumn boosters be with us soon?

New research on flu and COVID-19 boosters and what it means for us

Apologies for long gaps between posts but its been a hectic semester with teaching and grant deadlines! Today I wanted to reflect on the plans for the Autumn campaigns which will be announced soon and what that will mean for us.

What lies ahead?

The spring booster campaign in the UK was launched earlier this year targeting clinically more vulnerable groups including older people and those with immunodeficiencies or immunosuppression. In the UK, the autumn schedule has not yet been released and in the UK we will not hear until end of August/early September (JCVI due to announce 31st August). I am not sure why our announcements lag behind other countries and am curious if this impacts procurement and delivery of vaccine campaigns. However, based upon what JCVI have stated, thus far, the offer is likely to shrink further from the already more limited rollout in Autumn 2023. Its also worth stating that vaccine procurement contracts are expected to be in place from 1 September 2024 to 31 March 2026 with the potential to extend by up to twelve months.

What will the vaccines on offer look like? The simple answer is, in the UK at least, we don’t yet know. However, the WHO have recommended a formula targeting the JN.1 group of COVID-19 variants for Autumn. Other variants (KP.2/KP.3, known as FLiRT) are on the scene and may ultimately dominate. Although mRNA vaccines are quick to update for new variants other platforms such as protein based vaccines need a longer lead in time so realistically the vaccines are always going to be a little behind the latest variants. However, there is still enough cross-over in terms of conserved viral features such that the JN.1-induced immune response should still be protective against both. The FLiRT mutations may indicate the virus will go down that route and be the target for later vaccine campaigns.

What vaccines will be likely to be offered?

Several vaccines targeting JN.1 have been trialled in animal models including the Novavax vaccine (which is a protein subunit vaccine) and are ready to go and the FDA have very recently announced these will be used for the Autumn campaign. Novavax showed positive results for antibody and T cell responses and the mRNA vaccines supplied by companies such as Moderna will also be ready by Autumn. As such, it is likely the UK will offer vaccines targeting JN.1. We have previously licenced mRNA and Novavax vaccines but no announcements will likely to be made until Autumn about what the UK will procure. In a recent update FDA have now urged the vaccine manufacturers to if possible target KP.2 lineage. This lineage is a descendant of JN.1 and has overtaken the JN.1 in the States. This lineage is also doing well in the UK so it’s possible we will do the same however protein vaccines like Novavax unlikely to be updated for this in time.

Moderna have recently announced the development of a two-in vaccine that targets both flu AND COVID-19. This vaccine has completed phase three trials in 8000 volunteers and showed enhanced antibody responses to both infections compared with single shots. Currently those elegible for boosters will typically get two shots at once which can cause two temporarily sore arms -and I, for one- would much prefer fewer shots! It will also be more speedy to administer for vaccination clinics as a result. Its worth stating that there are no immunological disadvantages to getting shots that contains multiple targets and several studies have looked at this already nicely summarised here. Sadly the vaccine will not be available until 2025 or 2026 but its an exciting direction of travel for future autumn campaigns.

Vaccine uptake remains a concern.

Vaccines are only effective if people take them up and here I have major concerns. Bob Hawkins shared some analysis recently on the spring booster campaign take up. Its worth noting that several groups particularly ethnic minorities have low take-up. This is a trend that we have consistently seen throughout the pandemic.

It is not just uptake of vaccines targeting COVID-19 that are down. We are seeing a reduction in uptake of many vaccines including measles (MMR) and whooping cough and this has enabled these conditions to re-emerge with devastating outcomes for some. There can be many reasons for this that I have discussed previously so I won’t rehash them here. A recent study showed that misinformation and disinformation have a big negative impact on intent to vaccinate with mainstream news outlets (irrespective of size) having the biggest effect. The impacts of vaccine disinformation can be incredibly long-lasting with a recent survey in the USA revealing that 1 in 4 adults think the MMR vaccine is linked with autism. This is despite Wakefield’s papers being retracted and the work being debunked in a multitude of studies.

Despite the known harms such disinformation does, there seems to be little movement on action to tackle it. Notably in the last week, a paper was published in BMJ Public Health that has led to dangerous renewed vaccine conspiracy theories about COVID-19 vaccines that were magnified on social media and in several newspapers. The actuary Stuart McDonald did a brilliant debunking of just why the study is so flawed in Christina Pagel’s blog and I do urge you to read that. The research funders of the paper have even published a statement distancing themselves from the study. Hopefully the journal will retract the study however the damage may already be done.

Accessibility to vaccinations is a huge issues too. With JCVI likely to recommend further contraction of eligibility to Autumn boosters 9including flu), I am very worried that many in the UK may have to pay for their autumn vaccines now. With some companies touting prices around £100 this will not be a trivial sum for most.

Vaccination is a cornerstone of any effective healthcare system and should be accessible to all- not just the wealthy few.