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WHO revises Covid booster recommendations - medium-risk group need only one

WHO revises Covid booster recommendations - medium-risk group need only one
Estelle Ellis
By Estelle Ellis
29 Mar 2023
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The World Health Organization’s Strategic Advisory Group of Experts on Immunization no longer recommends more than one booster other than for those at high risk of severe disease. It has reiterated that they will not be recommending an annual booster at this stage.

The World Health Organisation’s Strategic Advisory Group of Experts on Immunization (Sage) has revised its recommendations for ongoing Covid-19 boosters for all, saying it is only necessary for high-risk patients.

Sage said in a statement that the decision was motivated by the impact of Omicron and high levels of population immunity. The committee also considered the overall decline in disease severity.

In South Africa, anyone over 18 can get their third Pfizer shot (a booster dose) after 90 days (previously, this was 180 days). The Johnson & Johnson vaccine booster dose is available to anyone over 18 after 60 days.

According to the new roadmap published on 29 March 2022, the cost-effectiveness of Covid-19 vaccination for those at lower risk — healthy children and adolescents — compared to other health interventions was a major concern.

“The current Covid-19 vaccines’ reduction of post-Covid conditions is also considered, but the evidence on the extent of their impact is inconsistent,” Sage said in their decision.

Sage Chair Dr Hanna Nohynek said their recommendations had been updated to reflect that much of the population is either vaccinated or previously infected with Covid-19, or both.

“The revised roadmap reemphasises the importance of vaccinating those still at risk of severe disease, mostly older adults and those with underlying conditions, including additional boosters.

“Countries should consider their specific context in deciding whether to continue vaccinating low-risk groups, like healthy children and adolescents (with the Covid-19 vaccine), while not compromising the routine vaccines that are crucial for the health and well-being of this age group.” 

High-priority group


The revised roadmap outlines three priority-use groups for Covid-19 vaccination: high, medium, and low. The high-priority group includes older adults; younger adults with significant comorbidities like diabetes and heart disease; people with immunocompromising conditions like those living with HIV and transplant recipients including children, pregnant women and frontline health workers.  (e.g. people living with HIV and transplant recipients), including children aged 6 months and older; pregnant persons; and frontline health workers. 

For the high-priority group, Sage recommends an additional booster of either 6 or 12 months after the last dose, with the timeframe depending on factors such as age and immunocompromising conditions. 

The WHO said that Covid-19 vaccine recommendations remain time-limited and these are not recommendations for an annual booster.

Medium-priority group


The medium priority group includes healthy adults — usually under the age of 50-60 without comorbidities and children and adolescents with comorbidities. Sage recommends primary series and first booster doses for the medium priority group. Although additional boosters are safe for this group, Sage does not routinely recommend them, given the comparatively low public health returns, their statement read. 

Low-priority group


“The low-priority group includes healthy children and adolescents aged 6 months to 17 years. Primary and booster doses are safe and effective in children and adolescents. However, considering the low burden of disease, Sage urges countries considering vaccination of this age group to base their decisions on contextual factors, such as the disease burden, cost-effectiveness, and other health or programmatic priorities and opportunity costs,” the statement added.

“The public health impact of vaccinating healthy children and adolescents is comparatively much lower than the established benefits of traditional essential vaccines for children — such as the rotavirus, measles, and pneumococcal conjugate vaccines — and of Covid-19 vaccines for high and medium priority groups. 

“Children with immunocompromising conditions and comorbidities do face a higher risk of severe Covid-19, so they are included in the high and medium priority groups, respectively,” the statement continued. 

Sage further recommended that countries with a booster policy should assess the evolving need based on national disease burden, cost-effectiveness, and opportunity costs. 

Spokesperson for the National Department of Health, Foster Mohale, said South Africa participated in the discussion about boosters and the necessary recommendations will be made to the Minister. 

Covid-19 cases remain low across the country, with the highest risk in Gauteng at 7/100 000 and the Western Cape at 3.7/100 000. The risk in the rest of the provinces is below 2/100 000.

The National Institute For Communicable Diseases (NICD) has announced that Covid-19 will from now on be incorporated in their reporting on respiratory pathogens and separate reports will no longer be issued. DM/MC

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