Blog28th October 2025
On 1 October, the UK Government commenced roll-out of NHS flu and COVID-19 vaccines according to updated eligibility criteria. Previously, people aged 65-75 years old and those aged 6 months to 64 years in a clinical risk group were eligible for both vaccinations. However, in updated criteria there are restrictions on dual-vaccine provision with it being limited to care home residents, people over 75 years old and immunosuppressed individuals over the age of 6 months.
Unfortunately, the rationale for the Joint Committee on Vaccination and Immunisation (JCVI) changing the criteria was not communicated to the general public, and messaging given to eligible patients was unclear, which led to some people attending appointments expecting both vaccines when they were only eligible for one. This lack of information and consequent confusion has led to criticism that restricted eligibility criteria is unfair.
The JCVI have since emphasised that a cost-effectiveness assessment led to the changes. As is usual in public health, a utilitarian approach has been taken whereby decisions are based upon the best use of limited resources to maximise population health. Since people over 75 are most likely to be severely affected by COVID-19, require hospital treatment and are more likely to die from COVID-19, it might seem logical and fair to prioritise them for vaccination.
On the other hand, it could be claimed that it is unfair not to vaccinate the 65-75 age range as they too can fall seriously ill. However, current data the JCVI will be working off suggests that this group are less likely to be severely affected, and less likely to die. And if they do require care, an argument could be made that by giving vaccinations to the over 75s, it will mean they are less likely to be hospitalised and so more beds will be available for younger people who do need them.
Individuals who are disappointed that they are no longer eligible may find themselves concerned that they will now be at a greater risk of catching COVID-19. There is the option of paying for a private COVID-19 vaccine. However, with the price being around £75-£100, over 4 times the cost of a private flu vaccine, this will not be a viable option for everyone.
For many people, their main concern about being unvaccinated could be that they’ll fall ill and pass it on to other people. For example, if a carer becomes unwell with COVID-19, they might be worried about being infectious around those they look after. However, while current COVID-19 vaccines do provide good protection against hospitalisation, they offer lower levels of protection against symptomatic infections with the Omicron variant, and can have adverse effects. Therefore, the risk/benefit of vaccination to individuals should also be considered when deciding on the eligibility criteria.
Early in the pandemic a mass vaccination programme was promoted, arguing that we should all be vaccinated to protect those most at risk of severe illness. This was considered reasonable given there were no available treatments for COVID-19, and it was thought that the vaccine might lower transmission as well as reducing the severity of the illness. At the time, there was discussion about the ethics of vaccinating children who were less likely to be severely affected although more likely to transmit COVID-19. However, given today’s circumstances, a different strategy prioritising those most at risk can be justified and as explained, might be the fairest use of health resources to maximise benefits.
Although the update to the COVID-19 vaccination schedule is evidence-based and ethically justified in terms of weighing cost and benefit, it is important to learn from concerns expressed by the public. In this case, there would have been benefit in a greater degree of transparency and better communication about vaccine eligibility changes and the reasons for these changes. It will also be important to keep abreast of emerging data as with admissions to ITU with COVID-19 increasing, the Government might need to reassess vaccine eligibility if this suggests other risk groups could benefit from being included.
With adherence to vaccine programmes important for our health today and likely to be important in any future pandemic, we must avoid exacerbating the growing distrust in vaccinations. Having the ability to be open about the processes we follow to make decisions and a willingness to explain our choices clearly and honestly is what will help maintain support and trust in the NHS and decision makers such as the JCVI.
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