J.GAO1, P.LUN1, DING.Y.Y1, P.P.GEORGE2
Geriatric Education and Research Institute1, National Healthcare Group HQ2
This study assesses the safety and effectiveness of COVID-19 vaccines for frail older adults through a rapid review and Delphi study.
We searched MEDLINE and Web of Science on 01/02/21 using terms related to COVID-19, vaccine, and older adults. We also searched Google Scholar and reference lists of review articles. The content was updated on 08/04/21 via handsearching. We included studies on Phase III randomized controlled trials and real-world vaccines rollout. A two-round Delphi study was conducted with 15 geriatricians.
Five Phase III randomized controlled trials reported vaccine efficacy (VE) from 66.7% to 95% among participants aged 16-95. The VE for participants aged 65 and above is 94.7% and 86.4% for Pfizer-BioNTech and Moderna respectively. Sputnik V reported a VE of 91.8% for participants 60 and above. Serious adverse events were reported by 0.27% to 1% of participants who received at least one dose of the four vaccines. For the Delphi study, 16/24 statements achieved consensus. The panel opined that frail or very old adults should be vaccinated after weighing the risks-benefits based on limited evidence. They agree that vaccination decisions should be made by patients, with the involvement of next-of-kin should patients be unable. Lastly, the panel thought that future clinical trials should involve frail older adults.
Although current vaccines are effective and safe among the general population, their efficacy and safety among frail older adults is unknown. The geriatricians’ consensus indicate that frail older adults should be vaccinated with caution and future trials should include them.