COVID-19: WHO revises its vaccine advisory — All You Need to Know

Covid Vaccine Production and Logistical Facilities at Serum Institute, the World's Largest Vaccine Maker

The World Health Organisation (WHO) in a statement on March 28 said, its Strategic Advisory Group of Experts on Immunization (SAGE) has revised the roadmap for prioritising the use of COVID-19 vaccines, to reflect the impact of Omicron and high-level population immunity due to infections and vaccination.

SAGE had its meeting between March 20 and 23, where the main topic of discussion was the COVID-19 vaccine. Other subjects also discussed included polio, regional reports on measles, the status of new tuberculosis vaccines, malaria, and identifying priority pathogens for new vaccines, as per the statement.

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Separately, SAGE also updated their recommendations on bivalent COVID-19 vaccines, now recommending that countries can consider using BA.5 bivalent mRNA vaccine for the first dose or primary series.

What does the revision state?

WHO said the revised roadmap continues “prioritising and protecting populations at greatest risk of death and severe disease from the SARS-CoV-2 virus … and maintaining resilient health systems”.

SAGE Chair Dr Hanna Nohynek said the new roadmap reemphasises the importance of vaccinating and providing boosters for at-risk individuals such as older adults with underlying health conditions. She said the update reflects “much of the population is either vaccinated or previously infected with COVID-19 or both”.

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Factors considered by the roadmap include the cost-effectiveness of the COVID-19 vaccine for those at lower risk i.e. healthy children and adolescents; revised recommendations on booster doses and spacing out of boosters; and the impact of vaccines on reducing post-Covid conditions (but evidence was limited).

Nohynek however added that countries should consider their specific context when deciding whether to continue vaccination of low-risk groups, and ensuring non-disruption of routine vaccines for such groups.

What’s the change?

— The revised roadmap lists three priority-level groups for COVID-19 vaccines: high, medium and low.

— The priority levels are based on the risk of severe disease and death, vaccine performance, cost-effectiveness, community acceptance and program factors.

— High Priority Group: These include older adults; pregnant individuals; frontline health workers; young adults with comorbidities such as heart diseases and diabetes; immunocompromised individuals i.e. transplant recipients and cancer and HIV patients; and children above 6 months of age.

— Medium Priority Group: Healthy adults below 50-60 years of age without comorbidities; and children and adolescents with comorbidities.

— Low Priority Group: Healthy children and adolescents aged 6 months to 17 years.

— It noted that the burden of severe COVID-19 in the younger population is for infants under 6 months, followed by children aged 6 months to 5 years.

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— Further, countries that already have a policy in place for additional boosters should assess the evolving need based on national disease burden, cost-effectiveness and opportunity costs.

What are the recommendations?

— These SAGE recommendations are for a near-to-mid-term plan for countries and may be reviewed and updated annually based on current epidemiological scenarios.

— High Priority Group: Additional booster either 6 or 12 months after the last dose, with the timeframe depending on factors such as age and immunocompromising conditions.

— Medium Priority Group: Primary series and first booster doses. No recommendation for routine additional booster doses the comparatively low public health returns.

— Low priority group: Primary and booster doses are safe and effective. Recommendation to consider vaccines based on contextual factors such as number of cases, cost effectiveness, and other health factors. Traditional essential jabs for rotavirus, measles, and pneumococcal conjugate vaccines to continue.

Impact on vaccine manufacturers

Notably, the latest advisory comes as the rate of booster administrations have fallen across countries. In the United States only 16 percent lined up for jabs during the Omicron variant, Bloomberg reported.

Pfizer and Moderna, the vaccine makers with the major stake in these markets are set to feel the financial impact of lessening demand. In its investor call this month, Pfizer’s COVID-19 vaccine partner BioNTech told analysts it expects low revenue from COVID-19 vaccine as “demand wavers”, report said.

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BioNTech saw global sales of around $18.7 billion in 2022, but laid out lower-than-expected numbers for 2023 guidance. It expects $5.4 billion worth COVID-19 vaccine sales in 2023, “significantly below” the consensus estimates of $8.4 billion due to “plummeting demand for population-wide levels of booster vaccinations”, as per analyst Lee Brown of Third Bridge.

The share closed in the red at $123 on March 28, below the previous close of $123.60. It has been on a consecutive decline over the past six months.

Pfizer has not been spared, reported Investopedia. The pharma major is facing a profit drop and is expected closed in the red at $39.99 on March 28, down from previous close of $40.24. All investors’ eyes are set on the earnings call scheduled on May 2 and guidance for 2023 amid low COVID-19 vaccine demand. Three analysts — Wells Fargo, Bank of America and UBS, have downgraded the stock this month due to grim outlook.

Moderna has also reported a slump in projected revenues, The Financial Times reported. Shares are down in the red at $146.92 on March 28 compared to last closed at $148.39. Year-on-year (YoY) the stock is down from December 2022 highs and has been on a red road. The company has projected sales for 2023 to be around $5 billion, compared to $18.4 billion in 2022, as per reports.