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The mass COVID-19 vaccination programme is being deployed in the context of widespread community transmission of COVID-19 infection. The Joint Committee on Vaccination and Immunisation (JCVI) has considered how to design the programme to achieve the greatest reduction in mortality as fast as possible.
Vaccine priority groups
The JCVI advises the first priorities for the COVID-19 vaccination programme should be the prevention of mortality and the maintenance of the health and social care systems. The order of priority for each group in the population corresponds with mortality data on the risk of dying from COVID-19, estimated from UK data obtained from March to June 2020:
- residents in a care home for older adults and their carers
- all those 80 years of age and over and frontline health and social care workers
- all those 75 years of age and over
- all those 70 years of age and over, clinically extremely vulnerable individuals (excluding pregnant women and those under 16 years of age)
- all those 65 years of age and over
- all individuals aged 16 years to 64 years with underlying health conditions which put them at higher risk of serious disease and mortality and relevant unpaid carers
- all those 60 years of age and over
- all those 55 years of age and over
- all those 50 years of age and over
It is estimated that taken together, these groups represent around 99% of preventable mortality from COVID-19.
Revised national guidance from the JCVI describes unpaid carers as:
Those who are eligible for a carer’s allowance, or those who are the sole or primary carer of an elderly or disabled person who is at increased risk of COVID-19 mortality and therefore clinically vulnerable.
Those clinically vulnerable to COVID include children with severe neuro-disabilities, those who are designated Clinically Extremely vulnerable (CEV), adults who have underlying health conditions and those who need care because of advanced age. Eligible carers should be vaccinated in priority group 6.
The aim of this Welsh Government guidance is to provide clarity and consistency and ensure we vaccinate those unpaid carers that will have the greatest impact on preventing deaths. Due to the large numbers of unpaid carers across Wales (estimates vary but are often in excess of 400,000) and the importance of vaccinating those at the highest risk, we cannot vaccinate everyone who provides care for a friend or family member. This is not to devalue the significant caring role undertaken by so many, rather it is to maintain the clear focus of the vaccination programme on preventing deaths and protecting our vital health and social care systems.
Many unpaid carers will receive an earlier vaccination depending on their age (age groups listed above at paragraph 2). Unpaid carers aged 50 years and over, who are not prioritised for vaccination as an unpaid carer, will nevertheless be offered the vaccine in priority groupings 7-9. Our aim is to offer vaccination to all those in these priority groups by the middle of April 2021.
Prioritisation for vaccination
In deciding which unpaid carers should be prioritised for vaccination, there are three important factors to consider:
The vulnerability of the person being cared for:
- is 65 years old and over (group 5)
- is deemed extremely clinically vulnerable (group 4)
- has a defined underlying health condition including mental illness (qualifying as group 6)
- is a child under 16 with complex medical needs/ severe neuro-disabilities
- The nature of the care provided to those 16 and over:
- includes, but is not restricted to, helping with eating, bathing, shaving, managing continence, dressing and walking. It may include intervening in challenging or risky behaviour. It may include providing significant levels of support and supervision at home or in the community and where social distancing is not possible
The nature of the care provided to children under 16 with complex medical needs/ severe neuro-disabilities:
- is beyond the care and support parents ordinarily provide for a child. It is likely to include tasks like tracheostomy tube care, airway suction, repositioning to manage pressure areas and care interventions such as respiratory physiotherapy. It may include intensive personal care such as daily washing and continence care and /or managing behaviours that challenge.
- The unpaid carer is the sole or primary carer:
- we recognise that caring for some people may require two people to assist with such tasks as positioning, hoisting, bathing and changing. There may be arrangements whereby two people evenly divide the caring responsibilities. In such instances, both unpaid carers may be considered as the primary carers
To be prioritised for vaccination, an unpaid carer should satisfy all three factors.
Young carers under 16 will not be offered the vaccination. No children under 16 are being vaccinated, unless in exceptional circumstances due to severe-neuro disabilities.
Eligibility for prioritisation is not dependant on receipt of carer’s allowance, membership of a carers’ organisation or being known to social services.
The Local Health Boards working with their respective Directors of Social Services have ultimate responsibility for identifying unpaid carers. There is a recognition of the need for discretion, but that discretion should be discharged within the parameters set out in this guidance.
Vaccination does not remove the requirement for social distancing, hand hygiene, good levels of ventilation and any other measures to reduce the potential for transmission of the virus.