World watches as UK announces it will drop key childhood vaccine to two doses

The UK is set to become the first country in the world to cut a key childhood vaccine from three to two doses in a move that experts hope will encourage poorer countries to eventually follow suit.

Last July a government advisory group, the Joint Committee on Vaccination and Immunisation (JCVI), recommended that the dosing schedule for the pneumococcal conjugate vaccine (PCV) be reduced from three to two doses after a Lancet Infectious Diseases study showed that the vaccine was just as effective and safe when given in two shots.

The Department of Health and Social Care says that due to the "excellent effectiveness" of the vaccine and high vaccine coverage the UK has good control of pneumococcal disease.

The vaccine, which protects against diseases such as pneumonia, sepsis and some types of meningitis, is currently given in the UK to babies at two and four months of age followed by a booster at 13 months.

The new guidance means that the vaccine will now be given at 12 weeks and one year of age although no date has been set for the change.

The UK does not disclose how much it pays for the vaccine, Prevenar13, manufactured by US drug firm Pfizer. But in other parts of the world it is one of the most expensive vaccinations in the routine childhood schedule and in the US it costs $130 (about £100) for every shot. If the UK dropped one dose it could potentially save millions of pounds every year.

A Department of Health and Social Care spokesperson said it was estimated that the vaccine had prevented more than 5,000 deaths and 40,000 cases of serious disease since it was first introduced.

"The programme has been so effective in creating population-wide immunity in the UK that independent experts have advised we can sustain the excellent results we have seen already by moving from three doses of the vaccine to two," the spokesperson added.

Experts believe that the change could eventually pave the way for similar policies in lower and middle income countries, saving them significant amounts of money.

Low income countries get the vaccine at a fraction of the price paid by high-income countries – from just a few cents to a few dollars depending on a country's income per capita – via Gavi, the Vaccine Alliance. However, some middle income countries missing out on Gavi support cannot afford the PCV.

And for those countries which no longer qualify for Gavi support because they are becoming wealthier, the vaccine may become unaffordable in the long run.

Stefan Flasche, an associate professor at the London School of Hygiene and Tropical Medicine and a member of the JCVI's pneumococcal subcommittee, said the UK decision was significant.

"The world, and LMICs particularly so, will watch closely how the UK’s switch to a reduced-dose PCV schedule impacts local disease burden.

"If the switch is as successful as expected, the reduced-dose schedule would in principle add a 'low-cost' option that is particularly attractive for countries not having yet introduced PCV because of associated costs, or countries transitioning out of Gavi’s PCV support," he said.

David Goldblatt, professor of vaccinology and immunology at University College, London, who led the research that helped inform the JCVI's decision, said that the UK's decision would give confidence to other countries.

He said that the good vaccination coverage rate and good disease surveillance in the UK meant that the vaccine doses could be reduced safely - this is not the case everywhere.

"If you're a country which has only recently introduced the vaccine  you couldn't go straight to the [new dosing] schedule. But there are some countries in Africa - South Africa is one example - which could move to it relatively quickly," he said.

Prof Goldblatt added that a two-dose schedule could represent a significant saving.

"$3 a dose is a huge amount for many countries so anything that could reduce the cost of the vaccine would be very welcome. There are a lot of hidden costs in delivering vaccines so reducing the number of doses you have to give would be a major cost saving," he said.

In a statement Pfizer said it did not support the government's decision to reduce the number of doses which could "potentially pose a significant public health risk".

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