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Thursday, 16 December 2021

Interim recommendations for heterologous COVID-19 vaccine schedules

This interim guidance has been developed on the basis of the advice issued by the Strategic Advisory Group of Experts (SAGE) on Immunization at its meeting on 7 December 2021. All referenced documents are available on the SAGE COVID-19 webpage.

Summary of the recommendations:

WHO supports a flexible approach to using either homologous (single platform) or heterologous (mix and match) vaccination schedules.

SAGE considers two doses of any WHO EUL COVID-19 vaccine to be a complete primary series, with consideration of dosing order according to WHO’s recommendations.

SAGE has made specific recommendations for countries considering heterologous schedules, to ensure an equivalent or favourable immunogenicity or vaccine effectiveness:

Countries implementing WHO EUL inactivated vaccines for initial doses may consider using WHO EUL vectored or mRNA vaccines for subsequent doses, depending on product availability;

Countries implementing WHO EUL mRNA vaccines for initial doses may consider using WHO EUL vectored vaccines for subsequent doses, depending on product availability.

Countries implementing WHO EUL vectored vaccines for initial doses may consider using WHO EUL mRNA vaccines for subsequent doses, depending on product availability.

Many countries face severe vaccine supply constraints, combined with a high disease burden. The interim recommendations would allow for flexibility within national immunization programmes. Either homologous or heterologous should be utilized to achieve high coverage of priority groups in as timely a manner as possible.

The full text of the interim recommendations is available here: https://www.who.int/publications/i/item/WHO-2019-nCoV-vaccines-SAGE-recommendation-heterologous-schedules

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The Strategic Advisory Group of Experts (SAGE) on Immunization is the principal advisory group to WHO for vaccines and immunization. It is charged with advising WHO on overall global policies and strategies, ranging from vaccines and technology, research and development, to delivery of immunization and its linkages with other health interventions. SAGE is concerned not just with childhood vaccines and immunization, but all vaccine-preventable diseases. It meets at least twice a year, with working groups established for detailed review of specific topics prior to discussion by the full group.

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