WHO Prioritises COVID-19 Vaccination for High-Risk Groups

Routine COVID-19 vaccination should focus primarily on people most likely to develop severe disease, with national programmes adapting delivery to local epidemiology, feasibility and cost-effectiveness. The World Health Organization’s July 2026 position paper replaces earlier interim guidance and sets out a sustained approach for the period of widespread population immunity and continued circulation of Omicron sub-lineages. It recommends periodic vaccination for the highest-risk groups because protection wanes over time, while allowing countries to extend vaccination to additional populations according to local conditions. The guidance also addresses vaccine choice, dosing intervals, pregnancy, coadministration, safety monitoring and integration into routine immunisation services. 

Must Read: COVID-19 Vaccine Protection in Older Adults 

Highest-Risk Groups Remain the Main Priority 

Countries should consider routine vaccination for the oldest adults, with a nationally determined age threshold suggested at 75 or 80 years. This applies whether unvaccinated or last vaccinated more than 6 months earlier. Older adults, with a suggested threshold of 60 years, are also prioritised when they have significant chronic conditions or severe obesity. Relevant conditions include cardiovascular, respiratory, kidney, liver and neurological disease, as well as diabetes. Residents of care homes for older adults and people living in long-term care facilities are included because of their risk profile. 

Moderately or severely immunocompromised people aged 6 months and above are also placed in the highest-priority category. This includes people with active cancer, severe primary immunodeficiency or chronic dialysis, transplant recipients and those receiving significant immunosuppressive treatment. It also covers some people living with HIV, including those with low CD4 T-cell counts, detectable viral load, opportunistic infection or no treatment. 

Countries may additionally vaccinate older adults without major comorbidities and adults, adolescents or children with significant conditions or severe obesity. Other groups include pregnant adolescents and adults, health and care workers with direct contact with people at high risk and their cohabitants or caregivers. Previously unvaccinated healthy children aged 6–23 months may be included only where countries document a significant disease burden in this age group. 

Dosing and Delivery Depend on Local Conditions 

For people at highest risk, at least one COVID-19 vaccine dose is recommended each year, with 2 doses about 6 months apart preferred because protection becomes limited beyond 6 months. Countries should decide whether to offer 1 or 2 annual doses by considering cost-effectiveness and the practical feasibility of delivery. Additional groups may receive at least one annual dose where routine vaccination is considered appropriate. 

Variant-adapted messenger RNA vaccines may be used from 6 months of age, while variant-adapted protein subunit vaccines may be used from 12 years. Either type can be given to previously vaccinated or unvaccinated people who have no contraindication. Different products or vaccine types can be used for subsequent doses. 

The preferred routine interval between doses is approximately 6 months, although shorter intervals may be used when clinically indicated. A similar interval after a test-confirmed infection may be considered for someone due to receive a recommended dose. Timing should follow local COVID-19 epidemiology and delivery capacity because no consistent seasonal pattern has been established. 

COVID-19 vaccines may be given during the same visit as influenza or other vaccines, using separate injection sites. Pregnant adolescents and adults should receive one dose in each pregnancy at any stage, ideally during the second trimester. Breastfeeding women at higher risk should follow the same recommendations as others in their risk group. Healthy children aged 6–23 months who have not previously been vaccinated generally require a product-dependent primary course, but routine revaccination is not recommended. 

Evidence Supports Protection but Shows Waning Immunity 

Current evidence supports the ability of COVID-19 vaccines to reduce severe disease and death, including during circulation of Omicron sub-lineages. Variant-adapted vaccines produce stronger neutralising antibody responses against more recent variants than non-adapted vaccines, while cellular immune responses remain important when antibody protection is reduced. Protection against symptomatic infection is shorter-lived, and added protection against severe outcomes also declines over time, particularly among older adults, immunocompromised people and those with comorbidities. 

Vaccination before infection is associated with a reduced risk of post-COVID-19 condition and long COVID, although estimates vary. The main basis for routine policy remains prevention of severe disease and death, with protection against post-COVID illness considered an additional benefit. 

More than 5 years of safety evidence supports a favourable profile. Most reported reactions are mild or moderate and temporary, while serious events remain very rare. Myocarditis and pericarditis have been causally associated with messenger RNA vaccines, with the highest attributable risk previously observed in males aged 12–29 years, particularly after a second dose. Longer intervals are associated with lower risk, and recent population studies have not identified increased myocarditis risk from variant-adapted vaccines in the populations assessed. 

Evidence from pregnancy monitoring has not identified increased risks of miscarriage, stillbirth, preterm birth or adverse infant outcomes. Economic evaluations generally support vaccination of older adults and high-risk groups more strongly than vaccination of healthy younger populations. However, much of this evidence comes from high-income countries and around half of the evaluations had industry funding. 

COVID-19 vaccination is moving towards a routine, risk-based model centred on preventing severe disease and death. The highest priority remains older adults, people with major health risks, residents of long-term care facilities and immunocompromised individuals. Annual vaccination, preferably twice yearly for those at greatest risk, reflects the limited duration of added protection. National programmes retain flexibility over age thresholds, additional groups, timing and delivery. Integration with other vaccination services, continued safety surveillance and monitoring of disease patterns are central to maintaining practical and evidence-based programmes. 

Source: World Health Organization 

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