By Laura Waters  

During World Immunization Week one year ago, the question on everyone’s lips was when can we expect an effective COVID vaccine? Even the most optimistic of us could not have predicted that just 12 months later there would be not one, but several, highly efficacious vaccines being rolled out. At the time of writing, 1.08 billion people have received at least on COVID vaccine dose. 

The rate at which researchers, manufacturers, regulators and health officials have developed and implemented COVID-19 vaccines is nothing short of phenomenal and testament to the powers of collaboration.  

In the UK to date, 70% of the population have received at least one vaccine; our position is one of great privilege considering the global figure is just below 14% and in India, a country struggling to cope with a devastating second wave, only 1 in 10 people have had at least on dose of vaccine. It was sadly predictable that the countries with the lowest pre-existing burden of ill-health and best equipped to deal with the fallout of a COVID-19 pandemic would also be the countries with the finances and infrastructure to deliver vaccination quickly. 

Why is COVID-19 vaccination so important for people living with HIV? 

Several studies have now demonstrated that people living with HIV have an increased risk of COVID-19 mortality. Although the degree to which this is driven by HIV per se, as opposed to other risk factors that tend to impact people with HIV disproportionately, remains unclear.  

The fact that several countries, including the UK, have prioritised people living with HIV for COVID-19 vaccine is good news. The World Health Organisation has developed clear guidance on vaccine prioritisation to promote equitable access for those in most need, and to minimise the impact of COVID-19 on essential services, including healthcare. We have also received good news from a trial demonstrating similar early effectiveness and safety of the Astra Zeneca vaccine in people with HIV compared with those without. However, concerns remain. There is some evidence that people with advanced HIV, unlike the people with generally well-controlled HIV who participate in clinical trials, may not mount as strong a response to vaccines and better understanding is crucial considering much of the world’s population with HIV are not on effective treatment. That evidence will be crucial if we are to optimise vaccine strategies, such as administering extra vaccine doses to people with suppressed immune systems. Secondly, some parts of the world most impacted by HIV have achieved lower vaccine coverage to date. Finally, certainly in the UK, some of the communities most impacted by HIV, such as people of Black African ancestry, are also communities who express suspicion or fear about vaccination. 

COVID-19 has also shone a light on the importance of vaccines against other infectious pathogens. Influenza and pneumococcal vaccine are recommended for all people with HIV yet in the UK we know coverage is poor. The simple fact that most HIV services are not able to provide these potentially life-saving vaccines, leaving people to fall through avoidable gaps, is just not acceptable in a high-income country in 2021. 

BHIVA has provided interim COVID-19 and COVID-19 vaccine guidance since the start of the pandemic and is currently undertaking a comprehensive update to our formal vaccine guidelines, including a new chapter on COVID-19 of course. We have worked with community organisations to understand the fears driving lack of vaccine uptake, producing patient-friendly Q&A pieces and accessible videos. 

On a large scale, ensuring all adults are offered COVID vaccination is a priority. On a local level, only by understanding the drivers of low vaccine uptake, addressing myths and reassuring people in language relevant to them will we ensure those most at need enjoy the benefits of the UK vaccination programme. 

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This guest blog have been written by Laura Waters, a Consultant Physician in Sexual Health & HIV at Central and North West London NHS Foundation Trust & British HIV Association Chair. Follow her on Twitter at: @drlaurajwaters