The Pfizer/BioNTech vaccine is a lipid nanoparticle-formulated mRNA vaccine. The mRNA encodes the SARS-CoV-2 full length spike protein. The mRNA in the vaccine is translated and transcribed by the body to produce the spike protein. The protein then acts as an intracellular antigen to stimulate the immune response. The mRNA in the vaccine is normally degraded within a few days and cannot incorporate into the host genome. Data from the Pfizer/BioNTech vaccine trials undertaken in over 40,000 individuals indicate high vaccine efficacy, with no serious safety concerns observed.
AstraZeneca COVID-19 vaccine
AstraZeneca COVID-19 vaccine uses a replication deficient chimpanzee adenovirus as a vector that encodes the full-length SARS-CoV2 spike protein. Chimpanzee adenoviruses are non-enveloped viruses, meaning that the glycoprotein antigen is not present on the surface of the vector, but is only expressed at high levels once the vector enters the target cells. Genes are inserted to render the virus replication incompetent, and to enhance immunogenicity. Once the vector is in the nucleus, mRNA encoding the spike protein is produced that then enters the cytoplasm. This leads to translation of the target protein which acts as an intracellular antigen. Headline data from vaccine trials undertaken indicate high vaccine efficacy, with no serious safety events related to the vaccine.
Classification: Official Publications approval reference: C 109915 February 2021
Information on an additional cohort of patients identified at increased risk from COVID 19, and the implications for their vaccination, support and advice
We are very grateful for your ongoing work to identify and support people who are clinically extremely vulnerable to COVID 19.
We are continually learning more about COVID-19 and the factors that lead to severe outcomes including hospitalisation and death.
We are writing today to make you aware of a new, data-driven risk assessment, called the COVID-19 Population Risk Assessment. This has been developed to help identify people who may be at high risk from COVID-19. It has been used at a national level to help identify an additional group of patients with specific multiple risk factors which, combined, may put them at similar risk to those who are clinically extremely vulnerable to severe outcomes.
As a precautionary measure, this group will now be added to the Shielded Patient List (SPL), on the advice of the Chief Medical Officer. This is to enable them to be prioritised for vaccination, if not already vaccinated, and to provide them with additional advice and support. In practice, this means they will now be offered vaccines at the top of cohort 6.
What does this mean for patients?
Additional patients identified by this risk assessment will be added to the SPL by NHS Digital, starting with those aged 19-69. They will be contacted directly to inform them from this week. You do not need to inform patients yourself.
Patients will be informed that this measure will allow them more rapid access to vaccination if they have not already been vaccinated. They will also be advised to follow Government guidance for those who are high risk, which currently includes shielding, as a precaution. Government communications will recognise that whilst people may feel that the advice is not so relevant as infection rates decline, it is still important that they are aware of their risk status.
What does this mean for GP practices?
To act as quickly as possible and reduce GP workload, NHS Digital will add these patients directly to the SPL and you should be able to see this in their record in the coming week to ten days.
As part of the current SPL process, you can add or remove a patient at any time.
As now, you can continue to review individual patients on an ongoing basis, according to your clinical judgement and patient request.
We ask that you familiarise yourself with the changes explained in this letter and that Primary Care Network Local Vaccination Services should prioritise this group for vaccination, as set out in section 3 of the annex below.
What information is included in this letter?
The annex below provides detail on:
1. How these patients have been identified
2. How these patients will be informed
3. How these patients should be prioritised for vaccination
4. The advice these patients should follow to keep themselves safe and the support available
5. How these patients will be added to the Shielded Patient List
6. The opportunity for practices to review and amend the additions, and;
7. Questions that patients may ask
We hope this approach will help you and the NHS to support more people to stay safe. Please note that a similar letter is also being issued to NHS trusts this week.
Thank you again for everything you are doing in supporting this important phase of the COVID 19 response.