Scientific Advisory Group For Emergencies Research Articles

Areas of enduring COVID-19 prevalence: drivers of prevalence and mitigating strategies

BackgroundUK local authorities that experienced sustained high levels of COVID-19 between 1st March 2020 and 28th February 2021 were described by the UK Scientific Advisory Group for Emergencies as areas of enduring prevalence. This research was carried out in order to examine the views of local authority Directors of Public Health, who played a crucial role in the local response to COVID-19, on reasons for sustained high levels of prevalence in some areas, alongside an investigation of the mitigation strategies that they implemented during the course of the pandemic.MethodsInterviews were conducted with Directors of Public Health in 19 local authority areas across England, between July and November 2021. This included nine areas identified as areas of enduring prevalence and ten ‘comparison’ areas.ResultsThe outcomes of this study suggests that the geographical differences in prevalence rates are strongly influenced by health inequalities. Structural factors including deprivation, employment, and housing, due to their disproportionate impact on specific groups, converged with demographic factors, including ethnicity and age, and vaccination rates, and were identified as the main drivers of enduring prevalence. There are key differences in these drivers both within and, to a lesser extent, between local authorities. Other than these structural barriers, no major differences in facilitators or barriers to COVID-19 mitigation were identified between areas of varying prevalence. The main features of successful mitigation strategies were a locally tailored approach and partnership working involving local authority departments working with local health, community, voluntary and business organisations.ConclusionsThis study is the first to add the voices of Directors of Public Health, who played a crucial role in the local COVID-19 response. Areas of enduring prevalence existed during the pandemic which were caused by a complex mix of structural factors related to inequalities. Participants advised that more research is needed on the effectiveness of mitigation strategies and other measures to reduce the impact of structural inequalities, to better understand the factors that drive prevalence. This would include an assessment of how these factors combine to predict transmission and how this varies between different areas.

Social media and COVID‐19 vaccination hesitancy during pregnancy: a mixed methods analysis

To evaluate the reasons for COVID-19 vaccine hesitancy during pregnancy. We used regular expressions to identify publicly available social media posts from pregnant people expressing at least one reason for their decision not to accept COVID-19 vaccine. Two social media platforms - WhatToExpect and Twitter. A total of 945 pregnant people in WhatToExpect (1017 posts) and 345 pregnant people in Twitter (435 tweets). Two annotators manually coded posts according to the Scientific Advisory Group for Emergencies (SAGE) working group's 3Cs vaccine hesitancy model (confidence, complacency and convenience barriers). Within each 3Cs we created subthemes that emerged from the data. Subthemes were derived according to the people's posting own words. Safety concerns were most common and largely linked to the perceived speed at which the vaccine was created and the lack of data about its safety in pregnancy. This led to a preference to wait until after the baby was born or to take other precautions instead. Complacency surrounded a belief that they are young and healthy or already had COVID-19. Misinformation led to false safety and efficacy allegations, or even conspiracy theories, and fed into creating confidence and complacency barriers. Convenience barriers (such as availability) were uncommon. The information in this study can be used to highlight the questions, fears and hesitations pregnant people have about the COVID-19 vaccine. Highlighting these hesitations can help public health campaigns and improve communication between healthcare professionals and patients.

COVID-19 and science advice on the ‘Grand Stage’: the metadata and linguistic choices in a scientific advisory groups’ meeting minutes

Science advice for governments attracted great scrutiny during the COVID-19 pandemic, with the public spotlight on institutions and individual experts—putting science advice on the ‘Grand Stage’. A review of the academic literature identified transparency, a plurality of expertise, the science and policy ‘boundary’, and consensus whilst addressing uncertainty as key themes. The Scientific Advisory Group for Emergencies (SAGE) has been the primary provider of coordinated scientific and technical advice to the UK Government during emergencies since 2009. Using the first 89 of SAGE’s meeting minutes (study period: 22 January 2020–13 May 2021), the ‘metadata’ and linguistic choices are analysed to identify how SAGE’s role and protocols are communicated. This includes understanding which experts were regularly taking part in discussions, the role of scientific experts in the science advisory system and their influence on policy choices, and the degree of consensus and uncertainty within this group of experts—all of which relate to the degree of transparency with the public. In addition, a temporal analysis examines how these practices, such as linguistically marking uncertainty, developed over the period studied. Linguistic markers indexing certainty and uncertainty increased, demonstrating a commitment to precise and accurate communication of the science, including ambiguities and the unknown. However, self-references to SAGE decreased over the period studied. The study highlights how linguistic analysis can be a useful approach for developing an understanding of science communication practices and scientific ambiguity. By considering how SAGE presents to those outside the process, the research calls attention to what remains ‘behind the scenes’ and consequently limits the public’s understanding of SAGE’s role in the COVID-19 response.

Modelling the epidemiological implications for SARS-CoV-2 of Christmas household bubbles in England

The emergence of SARS-CoV-2 saw severe detriments to public health being inflicted by COVID-19 disease throughout 2020. In the lead up to Christmas 2020, the UK Government sought an easement of social restrictions that would permit spending time with others over the Christmas period, whilst limiting the risk of spreading SARS-CoV-2. In November 2020, plans were published to allow individuals to socialise within ‘Christmas bubbles’ with friends and family. This policy involved a planned easing of restrictions in England between 23–27 December 2020, with Christmas bubbles allowing people from up to three households to meet throughout the holiday period. We estimated the epidemiological impact of both this and alternative bubble strategies that allowed extending contacts beyond the immediate household. We used a stochastic individual-based model for a synthetic population of 100,000 households, with demographic and SARS-CoV-2 epidemiological characteristics comparable to England as of November 2020. We evaluated five Christmas bubble scenarios for the period 23–27 December 2020, assuming our populations of households did not have symptomatic infection present and were not in isolation as the eased social restrictions began. Assessment comprised incidence and cumulative infection metrics. We tested the sensitivity of the results to a situation where it was possible for households to be in isolation at the beginning of the Christmas bubble period and also when there was lower adherence to testing, contact tracing and isolation interventions. We found that visiting family and friends over the holiday period for a shorter duration and in smaller groups was less risky than spending the entire five days together. The increases in infection from greater amounts of social mixing disproportionately impacted the eldest. We provide this account as an illustration of a real-time contribution of modelling insights to a scientific advisory group, the Scientific Pandemic Influenza Group on Modelling, Operational sub-group (SPI-M-O) for the Scientific Advisory Group for Emergencies (SAGE) in the UK, during the COVID-19 pandemic. This manuscript was submitted as part of a theme issue on “Modelling COVID-19 and Preparedness for Future Pandemics”.

How do we engage people in testing for COVID-19? A rapid qualitative evaluation of a testing programme in schools, GP surgeries and a university

BackgroundThe UK Scientific Advisory Group for Emergencies (SAGE) emphasises the need for high levels of engagement with communities and individuals to ensure the effectiveness of any COVID-19 testing programme. A novel pilot health surveillance programme to assess the feasibility of weekly community RT-LAMP (Reverse transcription loop-mediated isothermal amplification) testing for the SARS-CoV-2 virus using saliva samples collected at home was developed and piloted by the University of Southampton and Southampton City Council.MethodsRapid qualitative evaluation was conducted to explore experiences of those who took part in the programme, of those who declined and of those in the educational and healthcare organisations involved in the pilot testing who were responsible for roll-out. This included 77 interviews and 20 focus groups with 223 staff, students, pupils and household members from four schools, one university, and one community healthcare NHS trust. The insights generated and informed the design and modification of the Southampton COVID-19 Saliva Testing Programme and the next phase of community-testing.ResultsDiscussions revealed that high levels of communication, trust and convenience were necessary to ensure people’s engagement with the programme. Participants felt reassured by and pride in taking part in this novel programme. They suggested modifications to reduce the programme’s environmental impact and overcome cultural barriers to participation.ConclusionsParticipants’ and stakeholders’ motivations, challenges and concerns need to be understood and these insights used to modify the programme in a continuous, real-time process to ensure and sustain engagement with testing over the extended period necessary. Community leaders and stakeholder organisations should be involved throughout programme development and implementation to optimise engagement.

Offline: Sex and power during a pandemic

“At the height of the pandemic, women were underrepresented across the Scientific Advisory Group for Emergencies (SAGE) and related subgroups advising cabinet on the coronavirus response.” This conclusion comes from the Fawcett Society, which campaigns for gender equality and women's rights at work, in its latest report, Sex and Power 2022. It's impossible to disagree—at least in the UK. Chris Whitty and Patrick Vallance, together with Jonathan Van-Tam and Neil Ferguson, became the very masculine face of Britain's response. The Fawcett Society continues: “It is unsurprising, given the membership of the advisory boards early in the pandemic, that male voices dominated media coverage of the coronavirus outbreak.” They recommend that organisations, such as SAGE, must work harder to achieve equal representation for women, and especially for women of colour. These findings are important and deserve attention. But the reality may also be more complex than the Fawcett Society's report suggests. Indeed, I think a case could be made that COVID-19 was a breakthrough moment for women in the public sphere of science and public health. Kate Bingham was responsible for the UK's vaccine programme. She chaired the UK Vaccine Taskforce and secured millions of doses of multiple vaccines, guaranteeing Britain's successful immunisation roll-out. As Chief Executive of the Medicines and Healthcare products Regulatory Agency, June Raine ensured that early findings from vaccine trials were translated into rapid approvals for use. Sarah Gilbert and Catherine Green led research to devise one of the world's most successful vaccines against SARS-CoV-2. Their book, Vaxxers: The Inside Story of the Oxford AstraZeneca Vaccine and the Race Against the Virus, became an international bestseller. Beyond vaccines, the UK has been a global leader in SARS-CoV-2 genome sequencing. That success owes everything to Sharon Peacock, who heads the COVID-19 Genomics UK Consortium. Also consider: Anne Johnson, President of the Academy of Medical Sciences, which made important contributions to science advice to government; Yvonne Doyle, who, as Director of Health Protection, steered the UK's public health response; Nikki Kanani, Medical Director of Primary Care at NHS England, who supported general practice during the worst pressures of the pandemic; Linda Bauld, Chief Social Policy Adviser to the Scottish Government and prolific media commentator; and Jenny Harries, promoted from Deputy Chief Medical Officer for England to Chief Executive of the UK Health Security Agency. Angela McLean, Theresa Marteau, and Susan Michie have all had major roles in shaping the work of SAGE. Michie, in particular, has been a prominent public voice, holding the government accountable for its often mistimed decisions. Devi Sridhar, Professor of Global Public Health at the University of Edinburgh, has been a notable public commentator in the pandemic as well as being an adviser to the Scottish Government. Christina Pagel has been a trenchant analyst and critic on Independent SAGE. Zubaida Haque, also a member of Indie SAGE, has drawn attention to the issue of racial inequalities during the pandemic. Nisreen Alwan has been a powerful advocate for taking long COVID more seriously. Trish Greenhalgh has been a go-to voice for evidence-informed public health practice. Clare Gerada, Laura Spinney, and Anjana Ahuja have all been incisive commentators in national media. And Kathryn de Prudhoe and Jo Goodman co-launched the COVID-19 Bereaved Families for Justice. Internationally, Helen Clark and Ellen Johnson Sirleaf chaired the Independent Panel for Pandemic Preparedness and Response. Soumya Swaminathan and Maria Van Kerkhove have been the public face of WHO. Özlem Türeci co-leads BioNTech, which developed the first mRNA vaccine against SARS-CoV-2. Angelique Coetzee provided more reliable evidence about the omicron variant than most mathematical modellers. The Fawcett Society's report rightly calls for urgent action to achieve gender equity in science policy making. Yet it would be an error not to acknowledge and honour the vital contributions that women have made during the pandemic. The UK's experience may not be generalisable to other countries. But, in Britain, COVID-19 has seen a step change in recognition for women in science and science policy. The challenge now is surely to build on that success, beginning in schools and extending to the furthest reaches of government, universities, and the media.

SAGE advice and political decision-making: 'Following the science' in times of epistemic uncertainty.

This article presents a preliminary analysis of the advice provided by the UK government's Scientific Advisory Group for Emergencies (SAGE) held between 22 January and 23 March 2020 in response to the emerging coronavirus pandemic. Drawing on the published minutes of the group's meetings, the article examines what was known and not known, the assumptions and working practices that shaped their work, and how this knowledge was reflected in the decisions made by the government. In doing so, the article critically examines what it means for policy making to be 'led by the science' when the best available science is provisional and uncertain. Using ideas of 'externality' and 'evidential significance', the article argues that the apparent desire for high levels of certainty by both scientists and political decision-makers made early action impossible as the data needed were not, and could not be, available in time. This leads to an argument for changes to the institutions that provide scientific advice based on sociologically informed expectations of science in which expert judgement plays a more significant role.

Incorporating Well-Being and Mental Health Research to Improve Pandemic Response

This paper discusses the potential for well-being research to be institutionalised into emergency response in the UK. We review the short and long-run well-being impacts of covid policies and argue for a wider scope of groups such as The Scientific Advisory Group for Emergencies (SAGE). The potential form of such response could be based both on emerging multi-dimensional societal well-being frameworks and on rapid and scalable policy appraisal capacities that incorporate well-being considerations.

Scientific advice and COVID-19 policy making in the UK: an oral history study

BackgroundThe COVID-19 pandemic has posed severe challenges to policy makers in all countries: these include uncertainty about the science of the disease, its epidemiology, and public behaviour, coupled with the need to act fast. This real-time study was undertaken to capture UK Government scientific advisers' perceptions of how scientific advice worked and to learn lessons about what works best in a fast-moving response to a novel epidemic. MethodsRegular semi-structured calls were recorded with ten prominent scientific advisers to elicit their roles in, and reactions to, the UK's COVID-19 response. Interviewees were recruited using the existing networks of the NIHR Health Protection Research Unit for Emerging and Zoonotic Infections. They were active in fields including biomedical research, modelling, and global health, and they included members of the Scientific Advisory Group for Emergencies (SAGE). In pandemic conditions interviewing was opportunistic: one participant spoke to us almost every 1–2 weeks, others at longer intervals. Interviews were transcribed and coded using a published analytical framework for the study of policy decision-making. Findings93 interviews were conducted between Feb 17, 2020, and July 22, 2021. We report interviewees' perceptions that scientific advice had not led to sufficiently rapid policy decisions, and that a lack of transparency was sapping public trust. Interviewees also drew attention to policy makers' failure in the early months of the pandemic to frame a policy goal, and the problems this posed for giving scientific advice. It also became clear that scientific advisers and policy makers operated in different intellectual worlds, and that useful advice was most likely to be given when individuals could span this gap and understand the agendas of each group. InterpretationThese findings provide empirical information about how science advice has worked, uncovering power dynamics and business processes that are not otherwise well understood. We argue that politicians abdicated responsibility by their early “follow the science” rhetoric, later renegotiated. The study would be strengthened if the perceptions of policy makers were also included. We requested interviews with eight policy makers, who declined due to unavailability. FundingUK Research and Innovation—National Institute for Health Research.

Nowcasting towards sustainable SARS-CoV-2 endemicity

Nowcasting towards sustainable SARS-CoV-2 endemicity

Disease transmission and control modelling at the science-policy interface.

The coronavirus disease 2019 (COVID-19) pandemic has disrupted the lives of billions across the world. Mathematical modelling has been a key tool deployed throughout the pandemic to explore the potential public health impact of an unmitigated epidemic. The results of such studies have informed governments' decisions to implement non-pharmaceutical interventions to control the spread of the virus. In this article, we explore the complex relationships between models, decision-making, the media and the public during the COVID-19 pandemic in the United Kingdom of Great Britain and Northern Ireland (UK). Doing so not only provides an important historical context of COVID-19 modelling and how it has shaped the UK response, but as the pandemic continues and looking towards future pandemic preparedness, understanding these relationships and how they might be improved is critical. As such, we have synthesized information gathered via three methods: a survey to publicly list attendees of the Scientific Advisory Group for Emergencies, the Scientific Pandemic Influenza Group on Modelling and other comparable advisory bodies, interviews with science communication experts and former scientific advisors, and reviewing some of the key COVID-19 modelling literature from 2020. Our research highlights the desire for increased bidirectional communication between modellers, decision-makers and the public, as well as the need to convey uncertainty inherent in transmission models in a clear manner. These aspects should be considered carefully ahead of the next emergency response.

Formal and informal science advice in emergencies: COVID-19 in the UK.

The importance of scientific advice to government gains greater recognition in emergencies but inevitably has to be done in an environment of uncertainty, with limited data and at high speed. Adapting existing structures is more effective than creating new ones in an emergency. Between emergencies, the UK has a structured scientific advice system, including Chief Scientific Advisers, scientists in government, regulatory bodies and independent expert committees, which were adapted to COVID-19 under the umbrella of the Scientific Advisory Group for Emergencies. These worked alongside networks of informal scientific advice, including internationally. Multiple sciences were needed, including from the social sciences and engineering in addition to clinical science and epidemiology, and these had to be integrated. A centrally directed clinical research programme helped provide practitioners robust evidence, with observational and interventional trials providing data for policy and testing treatments and vaccines. The scale of the emergency meant unavoidable tension between detailed work and speed, and between an integrated scientific view usable in decision-making and constructive challenge. While a final judgement of the UK scientific response will take time, everyone should be grateful to the thousands of scientists involved for the research, synthesis and advice, which improved outcomes for the public.

Public health and expert failure.

In a modern democracy, a public health system includes mechanisms for the provision of expert scientific advice to elected officials. The decisions of elected officials generally will be degraded by expert failure, that is, the provision of bad advice. The theory of expert failure suggests that competition among experts generally is the best safeguard against expert failure. Monopoly power of experts increases the chance of expert failure. The risk of expert failure also is greater when scientific advice is provided by only one or a few disciplines. A national government can simulate a competitive market for expert advice by structuring the scientific advice it receives to ensure the production of multiple perspectives from multiple disciplines. I apply these general principles to the United Kingdom’s Scientific Advisory Group for Emergencies (SAGE).

Evolving Mortality and Clinical Outcomes of Hospitalized Subjects During Successive COVID-19 Waves in Catalonia, Spain

Background: The changes in shield strategies, treatments, emergence variants, and healthcare pathways might shift the profile and outcome of patients hospitalized with COVID-19 in successive waves of the outbreak. Methods: We retrospectively analysed the characteristics and in-hospital outcomes of all patients admitted with COVID-19 in eight university hospitals of Catalonia (North-East Spain) between Feb 28, 2020 and Feb 28, 2021. Using a mathematical model, we split admissions into four waves, one of them (summer wave) with little incidence. The main hospital outcomes included 30-day mortality and admission to intensive care unit (ICU). Findings: The analysis included 17,027 subjects admitted during the first wave (6,800; 39.9%), summer wave (1,807; 10.6%), second wave (3,804; 22.3%), and third wave (4,616; 27.1%). The highest 30-day mortality rate was reported during the first wave (17%) and decreased afterwards, remaining stable at 13% in the second and third waves (overall 30% reduction); the lowest mortality was reported during the summer wave (8%, 50% reduction). ICU admission became progressively more frequent during successive waves. In Cox regression analysis, the main independent predictors of 30-day mortality were the epidemic wave, followed by gender, age, diabetes, chronic kidney disease, and neoplasms. Interpretation: In-hospital COVID-19 mortality has decreased substantially after the first wave, but continues to be high and is highly dependent of patient’s characteristics and ICU availability. Highest mortality reductions occurred during a wave characterized by younger individuals, an increasingly frequent scenario as vaccination campaigns progress. Funding Information: This work was partially funded by the grant COVID19 6_17 (to Francesc Vidal), Direccio General de Recerca i Innovacio en Salut (Departament de Salut) and BIOCAT, Generalitat de Catalunya. Declaration of Interests: KK is a member of the UK Scientific Advisory Group for Emergencies. All other authors have nothing to declare. Ethics Approval Statement: The study protocol was approved by the independent ethics committee of the Hospital Germans Trias i Pujol (Badalona, Spain), which waived obtaining informed consent.

Improving diversity in research and trial participation: the challenges of language

Improving diversity in research and trial participation: the challenges of language

Modelling that shaped the early COVID-19 pandemic response in the UK.

Infectious disease modelling has played an integral part of the scientific evidence used to guide the response to the COVID-19 pandemic. In the UK, modelling evidence used for policy is reported to the Scientific Advisory Group for Emergencies (SAGE) modelling subgroup, SPI-M-O (Scientific Pandemic Influenza Group on Modelling-Operational). This Special Issue contains 20 articles detailing evidence that underpinned advice to the UK government during the SARS-CoV-2 pandemic in the UK between January 2020 and July 2020. Here, we introduce the UK scientific advisory system and how it operates in practice, and discuss how infectious disease modelling can be useful in policy making. We examine the drawbacks of current publishing practices and academic credit and highlight the importance of transparency and reproducibility during an epidemic emergency.This article is part of the theme issue ‘Modelling that shaped the early COVID-19 pandemic response in the UK’.

Using inclusive language around vaccine hesitancy.

As the UK’s vaccine rollout programme continues, there are emerging concerns about the rates of vaccine uptake in some minority ethnic communities. A recent report by the Scientific Advisory Group for Emergencies (SAGE), suggests high rates of vaccine hesitancy in Black, Pakistani, and Bangladeshi groups.1 The Royal College of General Practitioners have called for the dissemination of a high-profile national campaign to increase COVID-19 vaccine uptake in ‘BAME’ groups following findings that White people are approximately twice as likely to be vaccinated than people …

The UK Government’s COVID-19 Policy: What Does “Guided by the Science” Mean in Practice?

UK government ministers state that their COVID-19 policy is “guided by the science.” In practice they mean “our scientists,” and initial UK government policy was highly consistent with that advice. Ministers formed strong relationships with key scientific advisors, relied on evidence from their Scientific Advisory Group for Emergencies (SAGE), and ignored or excluded many other sources. I explore two types of lesson from this experience. First, UK studies of interest groups help explain the politics of expert advice. They show that the minister-adviser relationship is conditional on the ways in which the UK government assigns status to particular sources of science advice, and the willingness of those advisers to follow the “rules of the game,” within a wider political and policymaking context. Second, documentary analysis of SAGE minutes and meeting papers, and analysis of oral evidence to key House of Commons committees, shows high consistency between SAGE advice and UK government policy in the run up to lockdown. Ministers relied on their advisers to define the policy problem and identify feasible solutions throughout this period, while their advisors supported government policy and the right of ministers to make it. This new experience reflects and reinforces longstanding evidence from policy community studies: some experts remain core insiders if they advise on policies that they do not necessarily support, while outsiders have the freedom to criticize the policy they were unable to influence.

Influenza, Shingles and Pneumococcal Vaccine Uptake, Offer and Refusal in Adult Populations at High-Risk for COVID-19: A UK Population-Based Cohort Study

Background: As COVID-19 vaccination programs are being rolled out globally, we studied the ethnic, deprivation, household size and comorbidity ‘patterning’ of existing vaccination programs in populations at high-risk for COVID-19, to inform risk-stratified vaccination strategies and mitigate health inequalities. Methods: A population-level cohort study of UK adults aged 65 years or older, using a large primary care database. We used multivariable logistic regression to assess uptake of influenza, pneumococcal and shingles vaccination across ethnic groups, deprivation quintile, household size, and comorbidities, computing odds ratios (OR) adjusted for age, sex, demographics, body mass index and smoking. Offers and refusals of each vaccination type were analysed in those not receiving them. Findings: The cohort comprised 2,054,463 patients from 1,318 general practices. 1,452,014 (70.7%) patients received influenza vaccine, 1,391,228 (67.7%) received pneumococcal vaccine, and 690,783 (53.4%) received shingles vaccine. Compared to Whites, influenza vaccination uptake was lower in Pakistani (adjusted odds ratio (OR) 0.82; 99% confidence interval: 0.74-0.90), Black Caribbean (OR 0.46; 0.43-0.48), Black African (OR 0.63; 0.58-0.68), Chinese (OR 0.70; 0.64-0.76) and ‘Other ethnic group’ (OR 0.65; 0.63-0.69). The Black Caribbean group had higher vaccination refusal than the White group for influenza vaccination (OR 1.17; 1.05-1.30). Vaccination uptake was lower among the more deprived and those living in household sizes above 3 or more persons, with some significant interactions between ethnicity and comorbidities. Uptake of all three vaccines was higher in those with asthma, COPD, type 2 diabetes, hypertension and learning disability, whilst lower in those with dementia. Interpretation: Whilst uptake and refusal of influenza, shingles and pneumococcal vaccination are patterned by ethnicity, deprivation, household size and comorbidities, vaccination offer is mostly patterned by comorbidities. This information can inform national policies to ensure equitable implementation of COVID-19 vaccination programs to avoid exacerbating health inequalities.Funding Statement: This project was funded by the Medical Research Council (Grant Ref: MR/V027778/1).Declaration of Interests: PST reports previous consultation with AstraZeneca and Duke-NUS outside the submitted work. KK is a Member of the Scientific Advisory Group for Emergencies (SAGE), Member of Independent SAGE, Director of the University of Leicester Centre for Black Minority Health and Trustee of the south Asian Health Foundation. JHC is a member of several SAGE committees and chair of the risk stratification subgroup of the NERVTAG. She is unpaid director of QResearch and founder and former medical director of ClinRisk Ltd (outside the submitted work). MP, AKC, HDM, DS, TAR, FZ, BRS, SJG, CC, CG have no interests to declare.

Profile of Humoral and Cellular Immune Responses to Single BNT162b2 or ChAdOx1 Vaccine in Residents and Staff Within Residential Care Homes (VIVALDI Study)

Background: Residents of long-term care facilities (LTCF) have experienced high mortality rates from SARS-CoV-2 infection and as such have been prioritized for Covid-19 vaccination. Several countries have implemented an extended interval of up to 12 weeks between first and second vaccine doses to increase population coverage after single administration. Methods: Spike-specific immune responses that were induced following single administration of BNT162b2 or ChAdOx1 were studied in 89 staff and 35 residents within LTCFs. Quantitative antibody and cellular responses were determined as well as antibody inhibition of spike protein-ACE2 binding from viral variants. Results: 20% of staff and 34% of residents were found to have serological evidence of prior SARS-CoV-2 infection and all of these donors demonstrated strong antibody responses that were independent of age. Antibody responses were detectable within 99% and 79% of ‘infection-naive’ staff and residents respectively but were 8.2-fold lower within residents. This effect resulted from slower kinetics of antibody generation within residents which reached levels comparable to staff after only 42 days. In contrast spike-specific cellular responses were equivalent between both groups. Antibody inhibition activity against the B.1.351 and P.1 viral variants of concern was low using serum from ‘infection-naive’ older donors. Prior history of natural infection thus has a marked impact on the magnitude and quality of antibody response after a single Covid-19 vaccine in care home residents. Interpretation: Residents who are infection-naive have delayed antibody responses to the first dose of vaccine and might be considered for an early second vaccine where possible. Funding: UK Government Department of Health and Social CareDeclaration of Interests: LS reports grants from the Department of Health and Social Care during the conduct of the study and is a member of the Social Care Working Group, which reports to the Scientific Advisory Group for Emergencies. AH is a member of the New and Emerging Respiratory Virus Threats Advisory Group at the Department of Health.Ethics Approval Statement: Ethical approval for this study was obtained from the South Central - Hampshire B Research Ethics Committee, REC Ref: 20/SC/023.