The first review of vaccine trials conducted in care homes concludes that it is 'crucial' that future vaccine trials include care homes residents.
Led by the University of Aberdeen with NHS Grampian and published in Age and Ageing, the researchers describe how care home residents are particularly vulnerable to infection due to their age and communal living lifestyle. For these reasons, care home residents are prioritised in vaccine roll-out programs. However, the vaccines themselves may be less effective in this group due to the same age and health related factors. Despite all of this, the authors state that people who live in care homes are not currently adequately represented in vaccine trials.
The research team, who are part of the Moderna funded Widening Access to Trials in Care Homes (WATCH) consortium*, recommend that all future vaccine trials should include care home residents.
The review covered more than 700 articles and 20 vaccine trials, involving some 7479 people across 238 care homes across the UK.
The study was funded by Moderna and supported by the National Institute of Health and Care Research (NIHR). It was led by Professor Roy Soiza from the University of Aberdeen and NHS Grampian, with colleagues from NHS Grampian, The University of Glasgow, NHS Highland and The University of Edinburgh and the wider WATCH consortium.
The WATCH project was established in the UK as part of an initiative by the UK Vaccine Innovation Pathway (part of NIHR) to improve capacity and capability of vaccine trials in wider care settings. The aim of the WATCH project is to develop best practice guidance for planning successful future vaccines trials in care home settings. The consortium includes care home managers, researchers from across the NHS and universities in Scotland and expert representatives from NIHR and universities in England.
The group was established following the the vaccine rollout during the Covid-19 pandemic with a view to improve practice. Professor Roy Soiza, Honorary Chair at the University of Aberdeen and Consultant Geriatrician at NHS Grampian who is leading the project explains: “As demonstrated during the Covid-19 pandemic, care home residents are often worst affected by infectious diseases, so numerous vaccines are developed for older people with frailty, including care home residents.
“Despite this, care home residents are often excluded from trials of medications that are later prescribed to them, including vaccines.
“During the pandemic, not a single care home resident was recruited into trials despite this group being prioritised for vaccination.
“Improving the representation of care home residents in vaccine trials is crucial to ensuring the efficacy and safety of new vaccines.”
Dr Selvarani Subbarayan, Researcher at the University of Aberdeen and NHS Grampian adds: “The Covid-19 pandemic clearly demonstrated how rapidly infections can spread in care homes and how severely this vulnerable population can be affected. We know that care home residents are much older and frailer and live in communal settings, which significantly increases their risk of infection, hospitalisation, and in some cases, death.
“Although care home residents are prioritised for vaccination, their response to vaccines may be reduced due to factors such as frailty, dementia, reduced kidney function, and the nature of communal living.
“Even when vaccines are effective, immune responses in older adults may decline more quickly than in younger populations.
“All these factors make it essential to test vaccines directly in care home residents to fully understand their safety, effectiveness, and whether extra measures like booster doses are needed.
“Despite the importance of this research, recruiting care home residents into vaccine trials remains challenging. Addressing these barriers is critical to ensure that vaccines are properly evaluated in the populations most at risk and most likely to benefit from them. That is what we are trying to do here.