Until now, COVID vaccines have been available to as part of the twice-yearly booster programme, but this offer is being .

The UK’s vaccine body, the Joint Committee for Vaccination and Immunisation (JCVI), has that from spring 2025, pregnant women will no longer be eligible for free COVID vaccines. This is a concern for several reasons.

First, there is the direct vaccine benefit of reducing the chance of COVID infection and the consequences of infection in pregnancy. Pregnant women are at risk of severe COVID infection than women who are not pregnant, which can be significantly reduced by .

Severe COVID infection in pregnancy also carries , including . Although the risk with the currently circulating virus variants is lower, the risk remains to both mother and baby from . The good news is that not only protects the mother should she be infected, but also reduces the risk of both very preterm birth and stillbirth for her baby.

Second, there is the indirect benefit of vaccination in pregnancy in protecting newborns in those vital early months. Infants do not have fully developed immune systems, and a COVID infection is their first time meeting the virus. As such, they are very vulnerable to COVID infections, as they are to other . (Thankfully, there are safe and effective vaccines for , and respiratory syncytial virus .)

COVID vaccines for children under the age of four (from the age of ), while approved for use in the UK, are not, nor have been, made available – in contrast to countries such as the .

A recent , co-authored by one of us (Christina Pagel), looked at all hospitalisations in England of children with a COVID diagnosis or positive test between August 2020 and 2023. Admissions where COVID did not contribute to the reason for being in hospital (such as swallowing a toy or breaking a limb) were excluded.

Overall, infants accounted for 43% of all admissions in children under 18 (19,700 out of 45,900), rising to 64% of admissions in the most recent era as older children saw some benefit of “acquired immunity” (protection from having had a previous infection).

Of these admitted infants, only 10% had any underlying conditions that would normally be considered risk factors for severe COVID infection. While most infants were in hospital for only a short time – about two days – a significant minority required intensive care. For instance, between August 2022-23, about 5% needed intensive care and eight babies died.

A , which has not yet been published in a peer-reviewed journal, further categorised risks to different age groups for COVID hospital admissions in England. It showed that the risk for A&E attendance, hospital admission and severe hospital admission (requiring oxygen ventilation and hospitalisation for more than two days) was highest in babies under six months old – higher even than for people over 90 years old.

While much lower than for the youngest babies, the risk for babies aged six months to one year was also higher than most other age groups – comparable with adults in their 70s or 80s.

The good news is that babies can be protected from COVID in the first six months of life, if the mother has been recently vaccinated. This is because if the mother is vaccinated, she can pass on protective to the developing baby during pregnancy. These antibodies will wane over time, but if the mother is then able to breastfeed she can pass on antibodies that are found in .

These antibodies can make a massive difference. Data from the US showed that the overwhelming majority of infants hospitalised with COVID (95%) and all those who died from COVID were from mothers. It is for these reasons that vaccination against COVID during has been recommended around the world, including in , the and, until now, the .

JCVI’s workings not clear

It’s not clear how assessed the cost-effectiveness that has led to the change in recommendation to withdraw the COVID vaccine in pregnancy.

The cost-effectiveness model JCVI has been using for COVID vaccine decisions has only just been published, and is still in . JCVI’s criteria focus on preventing deaths, and the preprint only considered deaths in people 15 years and older, while the hospitalisation data used . This age grouping masks the much higher vulnerability of very young babies that other papers have shown.

A further concern about the JCVI analysis is that it seems to prioritise preventing deaths above all other considerations. For its decision on pregnancy eligibility, the committee used unpublished data from the Intensive Care National Audit and ����Ӱ�� Centre, which shows that there were no deaths in pregnancy in the last 18 months. Although this is excellent news, this data does not appear to include consideration of miscarriage, stillbirth and health risks to the baby.

While, of course, death matters a lot, and pregnant mothers and babies very rarely die from COVID, hospitalisation and severe hospitalisation are nonetheless also important outcomes to avoid.

COVID remains at . We would urge the JCVI to look at the wider data sets published on infant health as well as mortality and either revise its criteria on vaccination in pregnancy, or provide a much more detailed and transparent explanation for why it has been discontinued.

, Professor in Immunology, and , Professor of Operational ����Ӱ��, Director of the UCL Clinical Operational ����Ӱ�� Unit,

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The number of people in England with food allergies has more than doubled between 2008 and 2018, a reveals. The researchers, from Imperial College London, found that rates are highest among preschool children, with 4% having a “probable” food allergy.

They also found that a third of those people at risk of anaphylaxis – a life-threatening allergic reaction – don’t carry adrenaline autoinjector “pens”, such as EpiPens. People in deprived areas were found to be less likely to have been prescribed these life-saving injectors.

The true number of people with food allergies has been difficult to establish, with estimates varying between . This is because several methods are used to estimate the frequency of food allergies, including using either the number of prescriptions of adrenaline pens, self-reporting, or blood tests to identify telltale antibodies.

Self-reporting is the least reliable method because many people confuse food intolerance with allergy, as is evident from a by the UK’s Food Standards Agency.

Of the over 30% of adults who reported an adverse reaction to foods, only 6% were subsequently confirmed to have a true food allergy. To bridge this gap in understanding how common food allergies are, the new study from Imperial College took a much broader approach to better estimate the incidence of food allergy.

Population healthcare data from over 7.5 million people in England and a combination of clinical criteria were used to identify people with food allergies in these health records.

People were considered to have an allergy if doctors indicated they had either had a possible or probable allergy, or if they had been prescribed an adrenaline pen, or both. Using this combination, the number of people with food allergies was shown to have doubled in a decade. Curiously, since 2018, levels have plateaued somewhat at around 4% in preschool children, 2.4% in school-aged children, and under 1% in adults.

The study, published in The Lancet Public Health, used a broad range of criteria to identify people with food allergies. Not all cases were confirmed by medical professionals using additional tests, such as the presence of antibodies in blood or food-challenge tests where people are given increasing amounts of certain foods to see if an allergic reaction occurs.

Some types of food allergy may have been missed, such as . This occurs when people with specific pollen allergies eat some raw foods, including certain stoned fruits, that cause mild irritant symptoms, such as itching of the mouth. Still, there are important questions as to why food allergies have been rising, and why they may now be plateauing.

Puzzling

The trend in the increased rate of allergies in developed countries has puzzled scientists for years. The is one theory that may account for the growing incidence of chronic conditions such as allergies.

This hypothesis considers the role of the microbiome (the collection of helpful bacteria, fungi and viruses that live in and on us), infections and the environment in shaping our immune response and causing it to misfire.

Evidence to support this theory is accumulating. For example, studies show that in early childhood as the immune system and microbiome are developing is linked to a greater likelihood of allergy in later life.

Pollution exposure can also enhance the risk of allergy and .

The food we were exposed to in early life may be important in determining if we develop an allergy. from the UK government about avoiding early exposure to peanuts and eggs may inadvertently be linked to the rise in food allergy to peanuts and eggs.

Conversely, that early exposure before the age of five to is a reduced likelihood of developing an allergy.

The advice in the UK to avoid peanuts and eggs during pregnancy and early childhood was changed in , but the trials showing the positive effects of early exposure to eggs and peanuts were only published in 2015 and 2016. However, it is possible that the plateauing incidence of food allergy cases is linked to changes in advice and the published infant food exposure trials.

Diagnosis is only part of the story. People also need to be able to effectively manage their condition. This requires patients to have access to the right advice and support from experts, such as dietitians, as well as the drugs needed to halt an anaphylactic attack.

For babies diagnosed with a food allergy, there is now ) that incrementally reintroducing the food that causes the allergy can retrain the immune system and might help the child overcome their allergy. However, this must only be done under the guidance of a medical team.

The new study showed that allergy care was largely managed at GP practices in England. However, GP clinics may lack the specialist resources needed for proper allergy support, such as safely re-introducing foods.

It is clear that people in the UK with allergies need better support.

, Professor in Immunology,

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This summer has seen a large – one which is showing potential to be bigger than the 2023 winter wave was.

The current wave has largely been driven by the so-called variants, which have acquired greater immune evasion and ability to enter our cells. The rise in COVID cases has also been a .

COVID is not seasonal, as this current wave is stark evidence of. This is why vulnerable people are given . Nonetheless, most respiratory infections (COVID included) are at . Having access to a COVID booster in the autumn is of great importance, as it protects those who are most vulnerable from severe COVID infections.

The Joint Committee for Vaccination and Immunisation (JCVI) have just published their recommendations for the . Unfortunately, the recommendations they’ve made mean even fewer people will have access to vaccines for free on the NHS this autumn. And, the vaccines that will be made available may not be as effective against the current variants as newer formulations would be. This could leave more patients at risk of potentially serious infection.

The JCVI use a number of considerations in costing their recommendations for vaccine campaigns (although they have not fully released details of their costing model). What is clear is that the main concern is the cost of buying and delivering vaccines to prevent severe disease and deaths.

This year sees even fewer people able to access the vaccine for free on the NHS. The boosters will be offered to those over the age of 65, residents in old-age care homes and people who are at greater risk of catching COVID due to a compromised immune system. The JCVI haven’t advised offering the vaccine to frontline health and social care workers, staff in care homes and unpaid carers or household contacts of immunosuppressed people. Fortunately, the government has agreed to maintain the vaccine this year for .

Reduced vaccine coverage leaves those with regular, close access to vulnerable people unable to reduce their own risk of catching or spreading COVID. Although, it’s possible to purchase vaccines from many pharmacies, this is not cheap – with doses . Many people may not have the resources to pay for one.

Vaccines don’t just lower the risk of severe infection. They may also lower the risk of developing long COVID after an infection . Recent data shows that the risk of developing long COVID from an infection . The most recent Office for National Statistics data also shows are still being reported in the UK. Although fewer new cases are emerging, it’s still a significant number.

Despite the benefit of vaccination on reducing long COVID risk, the JCVI say there’s not enough evidence showing boosters reduce the risk of the condition. This is why they did not into their cost-benefit analysis.

The autumn vaccine campaign will also provide eligible patients with from the Autumn 2023 campaign instead of purchasing new vaccines.

Although using pre-procured doses means less money will be spent on the autumn booster programme, research shows older formulations of vaccines are less effective against variants which emerged after they were developed (such as the ). Modelling suggests they’ll be up to a against severe disease.

Indeed, the , in line with , have recommended boosters be updated to target the JN.1 variants. Several manufacturers have begun preparing updated formulas for . The US’s Food and Drug Administration noted the and requested a modification to vaccines in order to as well.

But even with vaccine modifications being made to it may still be too late, given FLiRT variants are . Recent data suggests the virus is even evolving away from the FLiRT variants with even more .

The fact we’re in a position where we’re using vaccines that may be less effective against current variants is enormously frustrating. Ideally we would be looking to develop or acquire more durable vaccines that confer longer-lasting immunity – such as or that may be more resilient against the ever-evolving virus.

These could potentially have been developed in the UK’s vaccine manufacturing production centre. However, was in 2022. This leaves us lagging well behind other countries, such as , and , which are continuing to invest in developing the next generation of vaccines.

Vaccines, of course, aren’t the only tool we have. We can reduce the impact of infection by widening access to anti-viral COVID drugs (such as Paxlovid). Access to Paxlovid was to be expanded to cover who aren’t eligible for the vaccine (such as people who are obese or have diabetes). But the reality is there aren’t enough supplies and funding to cover the 15 million people that could become eligible – so these plans . Patients currently eligible to access the drug have described difficulty getting hold of this .

Public health measures such as and in buildings could also help lower risk of infection. But again, no money is being invested into making these measures more accessible.

COVID is not just another cold. It still has the potential to cause serious disease – and this threat is not going away anytime soon. Ignoring it isn’t an option, which is why ensuring people still have access to the latest, most effective vaccines is so important.

, Professor in Biomedical Sciences,

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Hearing loss and dementia both cause difficulties with listening, understanding and communicating. This can lead to breakdowns in relationships because something as simple as a conversation with a loved one can become impossible.

People with dementia often don’t know, or can’t communicate, that they have problems with their hearing. This means that a lot of the time, their carers don’t know either.

Crucially, many people with dementia, and especially those living in care homes, rely on carers to support their hearing needs. This might mean helping with hearing aids or other hearing devices, using communication techniques, writing things down or using flashcards and making sure background noise isn’t too loud.

When hearing care is given properly it can improve residents’ , mood and engagement with peers. Unfortunately, in a new study, my colleagues and I found that only of residents with dementia in UK care homes are given help with their hearing loss.

Poorly supported hearing loss leaves residents at risk of emotional and behavioural problems, worsened confusion and difficulties communicating with important people in their life like family, friends, carers and healthcare professionals. In the same study, just 27% of care staff said that they check that residents’ hearing aids are working properly. This is a huge problem as most residents with dementia aren’t able to do this themselves.

Complicated reasons

The survey results also revealed that the reasons residents with dementia aren’t receiving help with their hearing are complicated. The biggest problem in care homes appears to be access to resources, such as enough time, enough staff or enough things like hearing aid batteries or flashcards. Staff who completed the survey said that not enough resources in the care homes made it difficult to provide hearing-related care to residents with dementia.

Another part of the problem is that care staff don’t always have the relevant knowledge and skills to help residents with their hearing problems. Just under 25% of staff reported having had any training on hearing loss (despite over of residents having hearing loss), but almost all said that they wanted this training to be provided.

Hearing loss isn’t always prioritised in care homes. Compared to dehydration, infections or injuries, hearing and communication problems don’t cause immediate risk or physical harm to residents. So helping residents to hear well isn’t often a priority for staff, who have limited time and a heavy workload. That doesn’t mean that hearing and communicating aren’t essential for a person’s wellbeing and happiness.

Hearing loss isn’t always prioritised.

Results from our survey show that people with dementia living in care homes are not getting the care that they need and deserve to help them to hear, understand and communicate. Care home residents are often very vulnerable, and being able to hear well is essential to maintaining a good quality of life and engaging with .

, Postdoctoral ����Ӱ�� Associate,

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Being ambulance staff can be a high-stress job. They encounter many situations in their daily line of work that can have a lasting impact on their mental health. According to MIND, around have experienced poor mental health at some point in their career. Another study estimated that around have post-traumatic stress disorder (PTSD).

Ambulance staff are often the first to attend the site of many difficult scenes, including deaths by suicide. We interviewed ambulance staff about the impact that has on their mental health. We found that not only did many feel ill-equipped to respond to these calls, these events also had a severe impact on their mental health.

Lasting impact

We carried out interviews with nine ambulance staff. They had all lost at least one colleague to suicide, and said that responding to suicide was a common part of their job. They described often being the first professionals at the scene of a suicide or attempted suicide, and how they undertook varied – and often conflicting – roles.

This often involved negotiating with people in crisis, informing families and friends of the death of a loved one, dealing with the intense emotional reactions of bereaved people, and protecting the site and the body of the deceased until police arrive to investigate the scene of the death.

Participants reported intense memories of these events even if the suicide was some time ago. One participant told us:

I wouldn’t believe anybody […] if they said that it didn’t affect them because it always affects you… I’ll go to bed and I’ll dream about it and I’ll have strange dreams and I’ll think about it… [suicide] affects you mentally in some other way whether you think that you’re over it or not.

All ambulance staff interviewed also said that the impact of attending a suicide did not seem to be recognised by their managers and they had received no guidance about how to cope.

Many said they felt pressure to continue working, because stress and trauma are “what the job’s all about”. Others felt there was a stigma in asking for help. Ambulance staff also told us there was little guidance on how to respond to suicides, or how to care for staff who may have been affected.

Many ambulance staff felt there was a stigma in asking for help.

����Ӱ�� shows the job puts a heavy toll on ambulance staff, with mental health issues widespread. One that 14% of respondents reported symptoms of depression, 28% had symptoms of anxiety, and 34% appeared to be high risk for suicide. Another study found that in emergency services personnel than other professionals. Paramedics also experience the compared to other emergency service personnel. But our exploratory study is the first to examine the reasons why these mental health issues might be prevalent in this group.

Wider issue

The participants in our study also reported they had no training in how to respond to suicides, or how to support people at the scene who were bereaved by suicide. Their lack of training made them feel helpless, they said, especially given that these calls are a common part of the job.

This lack of training isn’t a unique issue among healthcare professionals of all kinds, who are often faced with situations they aren’t prepared or trained for. One of our study’s authors previously conducted interviews with GPs to find out what when dealing with parents bereaved by the suicide of adult children. The study found that many GPs also felt they hadn’t received sufficient training, and don’t have enough support in their practices to deal with this incredibly difficult part of their job.

As a result of our work, for health and social care professionals about how to respond to people bereaved by suicide. This training is the first of its kind internationally, and involves increasing knowledge, skills and confidence in responding to the bereaved at the scene of deaths by suicide.

This training is also available for ambulance staff. But our study showed that ambulance staff have different emotional, practical and training needs compared to GPs and other mental health professionals. Part of this is because ambulance staff tend to be the first professional on site, which means they are exposed to both the scene of the suicide and the bereaved families. The current training programme gives training on responding to the bereaved family, but doesn’t currently focus on issues around trauma, managing the incident or balancing conflicting roles during a call.

There is still a need for better awareness by the general public of how to talk about suicide and how to help those struggling to help prevent these unnecessary deaths. Opening a dialogue about suicide and the impact that it can have may help reduce stigma in the future and allow those who most need help to be able to receive it.

If you have seriously harmed yourself, or you don’t feel that you can keep yourself safe right now seek immediate help by calling 999.

If you are experiencing suicidal thoughts and need support, you can also call your GP, NHS 111 or Direct, or a free helpline such as (116 123), , or (0800 068 4141).

, Professor of General Practice ����Ӱ��, Director of Clinical Academic Training, ; , ����Ӱ�� fellow, , and , Honorary research fellow,

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