Nick Hopkinson: Covid-19 vaccination—people with asthma deserve basic respect 

“Why have asthma sufferers been removed from vaccination priority group six? Are we not at risk of suffering more severe illnesses from covid? Why do we get the flu jab but not a covid jab?”

Boris Johnson “I think that there’s a bit of a misunderstanding. I think people have got the idea that people with asthma, with severe asthma are not being vaccinated. That’s not right. Anybody who is clinically vulnerable for any reason, including the asthmatic, are in the priority groups.” [Friday 12th March]

This exchange played out on Twitter last week. In fact, the question from a person with asthma was reasonable and factually based. Johnson may not be on top of the details of vaccine policy, but treating it with more respect might have produced a more helpful response. Why did the Prime Minister think the person was asking it? Disappointingly, 48 hours and a flurry of responses later, this exchange is still on the Number 10 Twitter feed without correction. 

Since early in the pandemic it has been clear that some medical conditions increase an individual’s risk from covid-19. Respiratory viruses are known to trigger asthma attacks and it was reasonable to think that the disease would be a risk factor. Those defined as having severe asthma were included on the list of people who were “clinically extremely vulnerable” and offered support to “shield.” Other people with less severe asthma were defined as “clinically vulnerable” and have lived and experienced the last year accordingly. 

With covid vaccine rollout, the JCVI has focussed on vaccinating healthcare workers and those groups identified as being at greatest risk of death—care home residents, the clinically extremely vulnerable, and older people with the aim of vaccinating all over 50s and vulnerable groups by May.  

Given prior announcements and based on who is advised to receive an annual flu jab, the expectation was that people with asthma would be included in the clinically vulnerable band 6 vaccination wave. The announcement on 14 February that this would still only be available to a group with more severe asthma—those with asthma that requires continuous or repeated use of systemic steroids, or with a previous exacerbation requiring hospital admission—came as a shock to many. There was an outpouring of complaint against the charity Asthma UK who were simply reporting the policy change, not making it.

The basis for JCVI’s decision includes a judgment that the available population data do not show an increased risk of death from covid-19 except among those with severe disease. There may also be pragmatic considerations about speed and simplicity in the rollout process. 

This reduction in the assessed risk ought to have been good news story for people with the condition. Instead, poor communication and the breakdown in trust in government since the Cummings affair, coupled to a lack of basic respect in addressing the issue, has led many people with asthma to be frustrated, scared, and angry. They deserve better.

Nicholas S Hopkinson, reader in respiratory medicine, National Heart and Lung Institute, Imperial College, London, medical director of the British Lung Foundation and Chair of ASH. @COPDdoc

Competing interests: none declared.