Experts say that the UK could have avoided 7 180 hospital admissions and deaths last summer if people had received all their Covid jabs, with the research of 67m Britons finding that the gaps in vaccine coverage were highest in younger people, men, those in areas of higher deprivation, and people of non-white ethnicity.
Between a third and a half of the population had not had the recommended number of Covid vaccinations and boosters by 1 June, reports The Independent.
The study was led by Health Data Research UK (HDR UK) and the University of Edinburgh, using anonymised health data for the population of 67m people in Britain.
Under-vaccination was defined as not having had all doses for which they were eligible (from five-years-old and upwards).
The findings come hard on the heels of a surge of Covid infections across the UK at the end of December, with some hospitals in England having begun enforcing the wearing of masks again, to combat the surge.
The new JN.1 strain – also known as the Juno mutation – was driving most new cases, said authorities, warning that the return to school would fuel more infections.
The research paper gives the first UK-wide look at the link between vaccination coverage and severe Covid outcomes.
Professor Sir Aziz Sheikh, director of the Usher Institute at the University of Edinburgh, HDR UK research director, and study co-lead, said: “Large-scale data studies have been critical to pandemic management, allowing scientists to make policy-relevant findings at speed. Covid-19 vaccines save lives.
“As new variants emerge, this study will help to pinpoint groups of our society and areas where public health campaigns should be focused, and tailored for those communities.”
The findings showed that if the UK had been fully vaccinated in June 2022, there might have been 210 fewer five- to 15-year-olds being hospitalised or dying from severe Covid illness; 1 544 fewer 16- to 71-year-olds; and 5 426 fewer over-75-year-olds.
Sheikh said the database used was the only one of its kind in the world, with its capacity to let researchers use anonymised health data for all four nations of the UK.
He said: “There’s nowhere else in the world that can do this. This is a genuine landmark for the UK. We’ve got absolutely outstanding data assets and brilliant analysts.”
Study details
Under-vaccination and severe Covid-19 outcomes: meta-analysis of national cohort studies in England, Northern Ireland, Scotland, and Wales
The HDR UK COALESCE Consortium
Published in The Lancet on 15 January 2024
Summary
Background
Under-vaccination (receiving fewer than the recommended number of SARS-CoV-2 vaccine doses) could be associated with increased risk of severe Covid-19 outcomes – ie, Covid-19 hospitalisation or death—compared with full vaccination (receiving the recommended number of SARS-CoV-2 vaccine doses). We sought to determine the factors associated with under-vaccination, and to investigate the risk of severe Covid-19 outcomes in people who were under-vaccinated in each UK nation and across the UK.
Methods
We used anonymised, harmonised electronic health record data with whole population coverage to carry out cohort studies in England, Northern Ireland, Scotland, and Wales. Participants were required to be at least five years of age to be included in the cohorts. We estimated adjusted odds ratios for under-vaccination as of June 1, 2022. We also estimated adjusted hazard ratios (aHRs) for severe Covid-19 outcomes during the period June 1 to Sept 30, 2022, with under-vaccination as a time-dependent exposure. We combined results from nation-specific analyses in a UK-wide fixed-effect meta-analysis. We estimated the reduction in severe Covid-19 outcomes associated with a counterfactual scenario in which everyone in the UK was fully vaccinated on June 1, 2022.
Findings
The numbers of people under-vaccinated on June 1, 2022 were 26 985 570 (45·8%) of 58 967 360 in England, 938 420 (49·8%) of 1 885 670 in Northern Ireland, 1 709 786 (34·2%) of 4 992 498 in Scotland, and 773 850 (32·8%) of 2 358 740 in Wales. People who were younger, from more deprived backgrounds, of non-white ethnicity, or had a lower number of comorbidities were less likely to be fully vaccinated. There was a total of 40 393 severe Covid-19 outcomes in the cohorts, with 14 156 of these in under-vaccinated participants. We estimated the reduction in severe Covid-19 outcomes in the UK over 4 months of follow-up associated with a counterfactual scenario in which everyone was fully vaccinated on June 1, 2022 as 210 (95% CI 94–326) in the 5–15 years age group, 1544 (1399–1689) in those aged 16–74 years, and 5426 (5340–5512) in those aged 75 years or older. aHRs for severe Covid-19 outcomes in the meta-analysis for the age group of 75 years or older were 2·70 (2·61–2·78) for one dose fewer than recommended, 3·13 (2·93–3·34) for two fewer, 3·61 (3·13–4·17) for three fewer, and 3·08 (2·89–3·29) for four fewer.
Interpretation
Rates of under-vaccination against Covid-19 ranged from 32·8% to 49·8% across the four UK nations in summer, 2022. Under-vaccination was associated with an elevated risk of severe Covid-19 outcomes.
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