The Oxford/AstraZeneca vaccine has been recommended by the World Health Organization for use in all adults, despite limited data on the jab’s efficacy for older people, which has caused some countries in Europe to rule out its use in the over-65s.
The WHO’s Strategic Advisory Group of Experts (Sage) said the vaccine should be given in two doses, eight to 12 weeks apart, bolstering the stand the UK government has taken in its mass vaccination programme.
“The efficacy of the vaccine is higher when the second dose is administered later,” said Dr Joachim Hombach, executive secretary of WHO’s Sage.
“You can expect to see a higher efficacy if you administer the vaccine in our recommended schedule which is 8-12 weeks between doses.”
The WHO decision opens the way for the UN-backed Covax scheme to start shipping doses of the Oxford/AstraZeneca vaccine around the world to lower income countries. The vaccine, which is set at not-for-profit prices and only needs ordinary refrigeration at 2 to 8C, is the best hope for many countries of vaccinating their health workers and most vulnerable citizens.
But it follows controversy after some European countries, including France and Germany said they would not give the vaccine to older people. And in recent days, leaked results from a small, unpublished study involving younger people appear to show minimal protection – about 10% – against mild to moderate illness caused by the South African variant of the virus. South Africa has paused its deployment of the vaccine as a consequence.
Sage did not wait for evidence that may answer the question of efficacy in older people. A major trial of 30,000 people is being carried out in the United States with substantial numbers of over-65s as well as people from ethnic minority groups not well represented in the original trials.
But Dr Alejandro Cravioto, chair of WHO’s Sage, said the urgency was too great.
“I think one of the considerations that Sage is making is the need to stop severe disease and mainly people dying – and withholding a recommendation for a number of weeks, waiting for more information, when we have enough to make a recommendation I think would not be appropriate,” he said at a briefing on the decision.
“We have 1000s of people dying from infection, in many countries of the world, daily, and I think anything we can do to use a product that might reduce that is totally justified, even if the information is not as complete as we would like.”
Dr Katherine O’Brien, director of WHO’s department of immunisation, said that even if the efficacy against becoming ill with new variants of the virus dropped to a low level, the vaccine will still stop severe disease and death.
“Even if the efficacy drops down to as low as 10%, it is still the right thing to do to immunise older adults because of the higher risk of severe disease and mortality in that age group,” she said.
Andrew Pollard, professor of paediatric infection and immunity, and chief investigator on the Oxford vaccine trial, said the WHO guidance “is an important milestone in extending access to the Oxford/AstraZeneca vaccine to all corners of the world and providing further endorsement that after rigorous scrutiny by the WHO Strategic Advisory Group of Experts the vaccine can be used to help protect populations from the coronavirus pandemic.”
Dr Jeremy Farrar, director of Wellcome, said the WHO’s recommendation was an important step that paved the way for many more countries to get the vaccine. “The world is at a critical juncture. These new variants are a powerful reminder that we’re now in a new and very unpredictable phase of this pandemic. It is vital healthcare workers and vulnerable populations in all countries are vaccinated as fast as possible,” he said.
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