Prof Sheena Cruickshank calls for the expansion of this autumn’s Covid-19 vaccine booster programme (Why aren’t we all being offered an autumn Covid booster? We can’t let cost prevent us keeping Britain healthy, 8 September). However, increasing the number of people eligible for vaccination is not a zero-cost option, and the funding needed for a wider programme needs to be looked at against the potential benefits.
With the NHS and wider public sector facing many challenges (for example, mental health and cancer, and schools that need substantial funding for repairs), there are many calls on public spending. Therefore decisions on eligibility for Covid vaccination need to be pragmatic and evidence-based.
Proponents of wider vaccination have not presented data showing that vaccinating groups at lower risk of complications such as hospital admission and death will be cost-effective and a better use of public spending than investment in other priority areas. The era of mass vaccination we saw earlier in the pandemic is ending and more countries will – like the UK - move towards targeted vaccination of higher-risk groups, as we already see every year for flu vaccination.
The only circumstances in which we are likely to see a return to mass vaccination is if a new variant of Sars-CoV-2 emerges that can bypass immunity from vaccination and prior infection, and cause more serious disease than the virus variants that are currently circulating. For now, targeted vaccination of higher-risk groups remains the most rational and cost‑effective policy.
Prof Azeem Majeed
Imperial College London
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