An estimated 280,000 people with asthma in Great Britain deemed at increased risk of dying from COVID-19 failed to receive their first Covid jab by the end of March when they should have been vaccinated and more than 100,000 were still waiting, two months later, according to new estimates by Asthma UK.
Asthma UK says that while in principle those with asthma most at risk of dying from COVID-19 should have been prioritised for the vaccine, the reality is that hundreds of thousands of people missed out on getting it early because GPs couldn’t find them on their systems using the criteria set out by the Joint Committee on Vaccination and Immunisation (JCVI). This left people with asthma feeling ‘abandoned’ and GPs frustrated that they couldn’t identify patients at risk.
With attention turning to any potential future COVID-19 booster jab rollout and evidence showing that some people with asthma are at an increased risk of dying from COVID-19 and others are at risk of hospitalisation or developing Long Covid, the charity says there needs to be a simple and effective system to make sure that people with asthma who are eligible and most in need of a booster vaccine will get it.
It says there needs to be an easy way of letting people know that they are eligible and a simple, workable way for GPs to identify their patients who need the booster jab. Asthma UK is urging all governments in UK to urgently consider using the free flu jab list, which includes approximately 3.4 million people with asthma.
In February, the government confirmed that people with asthma would be prioritised to receive their first COVID-19 vaccine if they had a shielding letter (which meant they were in group 4) or if they had ever been hospitalised for their asthma or ever taken three courses of oral steroid tablets during a three-month period and therefore were in group 6.
However, a survey commissioned by Asthma UK, and conducted by YouGov, of more than 1,000 adults living with asthma in the Great Britain found that:
- An estimated 113,800 people with asthma in Great Britain deemed at increased risk of dying from COVID-19 were, in May 2021, still waiting for their first vaccine despite meeting the criteria to get it earlier than the rest of the population
- The data supports anecdotal evidence Asthma UK has heard from patients and clinicians that GPs have been struggling to find the people who should have been prioritised and people with asthma have continued to wait for their vaccine because their medical records were wrong. An estimated 13,300 were told their GP had no record of a hospital admission.
Asthma UK says the main reason people with asthma have not received their vaccine despite being at high risk from COVID-19 is because GPs struggle to identify them and the steroid tablet criteria is too complicated for a lot of GP computer systems to search for.
In some areas of the country communication between different parts of the NHS computer systems means that prescriptions for oral steroid tablets generated outside of GP practices are unlikely to appear on a patient's GP record and GPs aren’t always informed that someone has been admitted to hospital. The result is that some people didn’t get the call to get their COVID-19 vaccine and others were told by their GP practice that they didn’t fit the criteria. There has been variation in who receives the vaccine with some GPs giving up on NHS instructions and inviting everyone with asthma to be vaccinated early.
Asthma UK says that the fairest and easiest way for the government to keep people with asthma safe from coronavirus is to consider offering any booster vaccine to those with asthma who get the free flu vaccine. It would ease the burden on GP practices having to do manual searches to find those who qualify for the vaccine and even out access across the nations.
Currently, people with asthma are eligible for the free flu vaccine if they have been prescribed a preventer inhaler alongside their reliever inhaler (usually blue) or have been admitted to hospital because of their asthma.
While the charity acknowledges that there is still uncertainty about whether there will be a future booster vaccine, when this will happen and if those who have been vaccinated recently will still need a booster jab, it says it is clear that the current system is not working. There needs to be a simpler system to identify those people with asthma who are at risk from Covid so hundreds of thousands of people with asthma aren’t missed again.
Lauren Couchman, 31, from Nottingham works as a production team lead at a graphic design agency. She met the criteria for an early vaccine but was told she would have to wait for her age group to be vaccinated. She said:
“I had a bad asthma attack in 2019 and I was admitted to hospital for treatment. It took me six months to recover so when the pandemic hit, I was terrified about catching COVID--19 and ending up in hospital again, especially as viruses are one of the key triggers for my asthma. I took the decision to shield, which meant not seeing my parents for over a year. It’s been a really isolating experience and caused me a lot of anxiety with so many unknowns.
“When the Covid vaccine rollout began, I read in the news that I was eligible for an early jab as part of priority group six because of my hospital admission and was so relieved. I’d be able to get back to some sense of normality.
“But I wasn’t called up for my jab and when I questioned my GP surgery said they couldn’t find records of me being eligible. They said I’d have to wait until my age-group was vaccinated. I was left feeling utterly deflated, depressed and abandoned. I was most at risk of dying from COVID-19 yet was at the back of the queue to get the jab that could help keep me safe. I had to fight for my right to the vaccine and eventually the GP did give it to me, but I’m really concerned the same thing could happen again with the booster jab. Everyone with asthma who is eligible for the free flu jab should get the booster jab so they are protected and no one slips through the net.”
Dr Andy Whittamore, a practising GP and Clinical Lead at Asthma UK and the British Lung Foundation, said:
“NHS services have worked around the clock to ensure that people who need help continue to get the care they need safely during this time of crisis. The government has an opportunity to get the potential booster roll-out right and must listen to the experiences of patients and those on the frontline. What is clear is that the current system is not working for GPs or people with asthma. GP surgeries do not want to be faced with the same difficulties again later this year when valuable lessons can be learnt and acted on now.
“Keeping it simple is key. There is the chance now for the government to learn the lessons from last time around and get a simple and effective system in place ready for any booster campaign so that no-one with asthma at higher risk from coronavirus misses out on getting the added protection they might need.”
Sarah Woolnough, Chief Executive of Asthma UK and the British Lung Foundation, said:
“It is completely unacceptable that around half of people with asthma who are at higher risk of becoming very ill or even dying from COVID-19 have failed to get their vaccine at the right time despite being eligible because of issues with GP systems and search criteria. Asthma leaves people struggling for breath, at risk of potentially fatal asthma attacks and causes over 75,000 hospitalisations every year. It is time the government took asthma seriously.
“With a COVID-19 booster vaccine rollout looking likely, the government must act. We think the best way to ensure that no one is left behind is to look at vaccinating everyone with asthma who needs it and is on the free flu jab list. We are urging the government to make this a priority and encouraging everyone with asthma to write to their MP to make this happen.”
Notes to Editors:
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Asthma UK and the British Lung Foundation merged on the 1 January 2020.
Asthma UK’s mission is to stop asthma attacks and, ultimately, cure asthma. We do this by funding world leading research, campaigning for improved care and supporting people to reduce their risk of a potentially life-threatening asthma attack. We are entirely funded by voluntary donations. For further information, please visit: asthma.org.uk.
Asthma UK and the British Lung Foundation commissioned YouGov to survey people with asthma on their experiences of the covid vaccine. Total sample size was 10147 adults of which 1238 suffer with Asthma. Fieldwork was undertaken between 19th - 26th May 2021. The survey was carried out online. The figures have been weighted and are representative of all GB adults (aged 18+).
 To find out how many were eligible for the vaccine as part of the Group 6 clinically vulnerable group, we filtered survey responses for a previous hospital admission OR previous oral steroid use, no other qualifying condition, not being a carer or healthcare worker, not receiving a shielding letter and being under 65.
This equated to 13.7% (169/1231). 49% of respondents who would have met the Group 6 eligibility criteria did not receive a vaccine until April or May. Added to the 34 people who have not had one at all is 83 / 169 respondents or 6.7% (83/1231) of total respondents. We extrapolated this figure onto the number of adults with asthma in Great Britain. We used data based on number of people registered as having asthma with their GP and on the Quality and Outcomes Framework (QOF) list. Data via NHS Digital (2019/20), NHS Wales (2018/19) and ISD Scotland (2018/19), which equates to 4.1 million people with asthma. Extrapolated onto the QOF estimate of people with asthma is 276,296.
 Phase 1 of the vaccination programme aims to have offered a vaccination to all individuals in JCVI priority groups 1 to 9 by 15th April 2021. Accessed at: https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2021/04/COVID-19-weekly-announced-vaccinations-8-April-2021.pdf
 2.76% of total respondents eligible for group 6 but having not received their vaccine by the end of May. Extrapolated onto the QOF prevalence, this equates to an estimated 113,817 people with asthma in the UK that did not receive the vaccine despite being eligible by the 26th May.
 Bloom, Chloe. Alex, Beatrice et al. ‘Risk of adverse outcomes in patients with underlying respiratory conditions admitted to hospital with COVID-19: a national, multicentre prospective cohort study using the ISARIC WHO Clinical Characterisation Protocol UK’, The Lancet Respiratory Medicine, 2021, Accessed at: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00013-8/fulltext#%20 and Williamson, E.J., Walker, A.J., Bhaskaran, K. et al. ‘Factors associated with COVID-19-related death using OpenSAFELY.’ Nature 584, 430–436, 2020, Accessed at: https://www.nature.com/articles/s41586-020-2521-4#:~:text=COVID%2D19%2Drelated%20death%20was,and%20various%20other%20medical%20conditions
 Figure based on applying the 80% of people with asthma using inhaled steroids (flu jab eligibility criteria) from Bloom et al (2019) paper onto), applied to Data the number of people registered as having asthma with their GP and on the Quality and Outcomes Framework (QOF) list. Data via NHS Digital (2019/20), NHS Wales (2018/19) and ISD Scotland (2018/19)
 4 / 1237 were told there was no record of their hospital admission. Applied to the QOF estimate of number of people with asthma; this is 13,355 adults with asthma.
 Estimate via bespoke data request from NHS Digital (England), NHS Wales, ISD Scotland and the Department of Health (Northern Ireland).