Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what (1) evidential basis, and (2) rationale, the Joint Committee on Vaccination and Immunisation used to determine that family members of, and carers for, people in the clinical risk groups identified in the Green Book are not recommended to receive COVID-19 booster vaccinations.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
In November 2022, the Joint Committee on Vaccination and Immunisation (JCVI) provided interim advice which indicated that in autumn 2023, persons at higher risk of severe COVID-19 could be offered a booster vaccine dose in preparation for winter 2023 to 2024. As it was interim advice, the JCVI report does not contain any evidential basis for proposed cohorts. Final advice on who will be advised to receive COVID-19 boosters in autumn 2023 will be provided in due course. The considerations for any future decisions will be referenced in JCVI reports and meeting minutes.
In February 2023, JCVI provided advice for the spring 2023 COVID-19 vaccination programme. As a precautionary measure, JCVI advised a spring booster dose for the most vulnerable in the population, as a proportionate response: those over the age of 75 years, residents in a care home for older adults, and those over five years of age who are immunosuppressed. These groups were chosen as they continue to be at highest risk of severe COVID-19.
Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government what are their reasons for implementing restrictions on the spring 2023 COVID-19 booster programme; and what factors were considered in determining the eligibility criteria for the booster programme.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
As with all vaccination programmes in the United Kingdom, the decision on which groups are eligible for a particular vaccination programme is only made following careful consideration of the groups most at risk of illness, severe illness, or death because of infection. For COVID-19, the primary aim of the vaccination programme continues to be the prevention of severe disease, both in hospitalisation and mortality, arising from COVID-19.
Therefore, in February 2023, the Joint Committee on Vaccination and Immunisation (JCVI) provided advice for the spring 2023 COVID-19 vaccination programme. As a precautionary measure, JCVI advised a spring booster dose for the most vulnerable in the population, as a proportionate response: those over the age of 75 years, residents in a care home for older adults, and those over five years of age who are immunosuppressed.
Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, following the decision by the Joint Committee on Vaccination and Immunisation that family members of, and carers for, people in the clinical risk groups are not recommended to receive COVID-19 booster vaccinations, what steps they are taking to protect people in clinical risk groups from contracting COVID-19.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
As set out in the Written Ministerial Statement titled ‘Approach to Managing Covid-19’ on 30 March 2023, in 2023/24 the Government will maintain a range of capabilities to protect those at higher risk of severe illness from COVID-19. Given the continued effectiveness of vaccines and improved treatments, for most people there is a much lower risk of severe illness compared to earlier in the pandemic.
We will therefore continue to encourage people to take up the vaccines to which they are entitled, and we will continue to fund and provide COVID-19 testing, to manage outbreaks in some high-risk settings and to enable access to treatments for those who are eligible. We will also maintain essential COVID-19 surveillance activities in the community, primary and secondary care, and in high-risk settings. Additionally, we will retain proportionate capability for testing in the event of a COVID-19 wave or variant that results in a significant increase in pressure on the National Health Service.
Vaccination does not significantly limit transmission, so there is no strong reason to prioritise vaccination for carers of those who are at high risk of severe illness.
Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government whether the minutes of the Joint Committee on Vaccination and Immunisation meeting that set out the clinical risk groups for the COVID-19 vaccination programme in Spring 2023 will be made available to the public.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The minutes of the meeting of the Joint Committee on Vaccination and Immunisation, which discussed which groups would be eligible for the precautionary COVID-19 booster programme of spring 2023, will be made publicly available through the GOV.UK website in due course.
Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by Lord Markham on 1 March (HL5824), which body will assume responsibility for ensuring that the immunocompromised will continue to be treated as a priority after the disbanding of the Antivirus and Therapeutics Taskforce, and its related programme and strategy boards.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
In line with the Government’s strategy of living with COVID-19, as of 31 March 2023 the Antiviral and Therapeutics Taskforce has been stood down. The treatment of COVID-19 patients will continue to be overseen by National Health Service and will operate in line with evidence-based recommendations from the National Institute for Health and Care Excellence, following the established processes in this area.
The welfare of immunocompromised patients remains a priority, hence the enhanced protections we continue to offer, including the recently announced spring booster vaccinations, free lateral flow tests and guidance in addition to COVID-19 treatments.
Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by Lord Markham on 14 March (HL5699), and as set out in the attachment to the Written Answer NICE nMABs appraisal committee paper, what assessment they have made of the finding that the prioritised list of people with conditions for which it may be clinically advantageous to receive neutralising monoclonal antibodies prophylaxis numbers 1.8 million.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The Independent Advisory Group (IAG) chaired by Prof. Iain McInnes was commissioned by the Department to consider which cohorts should be eligible for treatment for COVID-19. The report was published on 30 May 2022 and has defined the cohort of patient eligible for neutralising monoclonal antibodies and antivirals treatments for COVID-19. In May, our estimate was that this cohort totals around 1.8 million patients in England.
The IAG was also commissioned to consider the cohorts that would potentially be eligible for COVID-19 prophylaxis (PrEP). This report formed part of the National Institute for Health and Care Excellence Single Technology Appraisal considerations into Evusheld as prophylaxis. Whilst estimates have been made as to the total size of this cohort, it is unclear who would be prioritised within these groups should a prophylactic treatment become available. An update to this PrEP IAG report will be published on GOV.UK in due course.
Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by Lord Markham on 7 February (HL4942) which confirmed that the expert working group established specifically to review Evusheld pre-exposure prophylaxis only met twice, the last meeting being on 19 May 2022, why the parliamentary Written Answers provided from that date until 4 July 2022 refer to asking clinicians to advise on the most appropriate option; and what other advice was being received during this period.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The National Expert Working Group is one of the sources of clinical opinion to develop clinical policies. During this period the RAPID C-19 cross-agency group was also set up to review COVID-19 therapies in response to the pandemic. They would consider evidence and analysis from a number of sources, including the Prophylaxis Oversight Group and the UK Health Security Agency. In addition, the Therapeutics Clinical Review Panel considered evidence for COVID-19 risk to help prioritise cohorts for prophylaxis. This informed thinking within the Department and was subsequently shared with the National Institute for Health and Care Excellence. These groups continued to consider emerging evidence, including published evidence from independent researchers and evidence from the company, after the last meeting of the Expert Working Group.
Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by Lord Markham on 7 March 2023 (HL5695), to which body the recommendations on the relevant cohorts for COVID-19 therapeutics are to be made, as discussed by the Chair of the Therapeutics Clinical Review Panel on 2 February; and whether the preparation of these recommendations included reviewing details within the report Qcovid 4 - Predicting risk of death or hospitalisation from COVID-19, published in August 2022.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The Therapeutics Clinical Review Panel met on 31 January 2023 to review most recent evidence on COVID-19 risk, including the National Institute for Health and Care Research rapid study on those who remain vulnerable to poor outcomes from COVID-19 despite vaccination. Advice is then provided to the four United Kingdom Chief Medical Officers. The evidence considered by the Panel was also shared with the National Institute for Clinical Excellence.
Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answers by Lord Markham on 2 February (HL4910), 8 February (HL4944) and 7 March (HL5695 and HL5938), why the Therapeutics Clinical Review Panel (TCRP) did not review the report Qcovid 4 - Predicting risk of death or hospitalisation from COVID-19, published in August 2022, when it met in January; why this report was not provided by the TCRP to the National Institute for Clinical Excellence; and when the TCRP will meet to review this report.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The Therapeutics Clinical Review Panel met on 31 January 2023 to review the most recent evidence on COVID-19 risk, including QCovid 4. The evidence considered by the Panel was shared with the National Institute for Health and Care Excellence (NICE). The report entitled QCovid 4 - Predicting risk of death or hospitalisation from COVID-19 is also in the public domain in an online-only format and available to NICE.
Asked by: Lord Mendelsohn (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask His Majesty's Government, further to the Written Answer by Lord Markham on 7 February (HL4941), what standards are set for governance and reporting by (1) RAPID C-19, and (2) other Department of Health and Social Care committees; how they are audited against this standard; and how regularly that auditing takes place.
Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)
The Research to Access Pathway for Investigational Drugs (RAPID C-19) is a multi-agency initiative, each with their own expertise. RAPID C-19 is operated in line with the interim process, full details can be found on the RAPID C-19 page on the National Institute for Health and Care Excellence website in an online-only format.
The focus will be on bodies that have directly informed decisions on COVID-19 treatments during the pandemic, in addition to RAPID C-19. These include the COVID-19 Prophylaxis Oversight Group, which was established in 2020 to guide the development of pre- and post-exposure prophylaxis for COVID-19 infection, and the Therapeutics Clinical Review Panel, which was launched by the Department in May 2022 to focus on at-risk patient cohorts that could be eligible for COVID-19 therapies. Arrangements to record possible conflicts of interest are also in place.
All activity within the Department is overseen by the audit and risk committee which meets quarterly and includes challenge from independent non-executive directors. This is further underpinned by the challenge of the health group internal audit service, and by other independent assurance processes, such as National Audit Office reviews and the scrutiny of the Health and Social Care Select Committee.