Guidance

Annexe A: information and resources for healthcare professionals and commissioners to support implementation

Published 13 June 2025

The Joint Committee on Vaccination and Immunisation (JCVI)

The Joint Committee on Vaccination and Immunisation (JCVI) is an expert scientific advisory committee which advises the UK government on vaccination and immunisation matters. 

Mpox

Building on the previous limited offer of pre-exposure mpox vaccination introduced during the mpox outbreak in 2022, the JCVI has since advised an ongoing routine vaccination strategy for protection against mpox to prevent future outbreaks and protect those at risk of exposure.

The JCVI advised that mpox vaccination should target gay, bisexual and other men who have sex with men (GBMSM) who are at highest risk of exposure, to be identified at sexual health services.

Gonorrhoea

The JCVI considered evidence on the cost-effectiveness of a potential 4CMenB for gonorrhoea vaccination programme and its likely impact on epidemiology. The committee agreed that a targeted programme should be initiated using the 4CMenB (Bexsero®) vaccine for the prevention of gonorrhoea in those who are at greatest risk of infection. As protection against gonorrhoea isn’t currently a licensed indication for 4CMenB vaccine, which is licensed for meningococcal B disease, this advice is based on off-label use of vaccine.

It is important for individuals offered vaccination to understand that real world studies have estimated that the 4CMenB vaccine has between 32.7 to 42% effectiveness against gonorrhoea. Therefore, although vaccination would be expected to reduce the chance of becoming infected with gonorrhoea, it would not completely eliminate the possibility. The main benefit of a vaccination programme is expected to be at a community level with a significant reduction in the number of cases overall.  It is expected that the vaccination programme would help tackle the increasing levels of antibiotic-resistant strains of gonorrhoea.

Service arrangements

In planning these services, commissioning partners and providers should consider how commissioning and operational delivery can be aligned with other vaccination programmes in sexual health services. All local authority commissioned sexual health service providers should be engaged in plans to consider how they could offer the programmes to ensure effective programme coverage and equity of access. There may be exceptional circumstances where the service offer is consolidated locally.

Commissioning will be through direct award process B under the Health Care Services (Provider Selection Regime) Regulations 2023. Funding for 2025/26 deployment has been communicated and distributed as part of the public health allocations to regional commissioners for 2025/26, who will confirm payment arrangements based on local agreements.

Providers should consider the most effective method of implementing the vaccination programmes, both in terms of optimisation of resources and high uptake of the vaccination offer. This will include opportunistic identification of eligible individuals attending the service for other reasons and might include use of vaccination clinic models or booking systems, for example, to facilitate appointments for second doses.  Providers should also consider what strategies can be adopted to address health inequalities when implementing these vaccination programmes.

Vaccine coverage data collection

Vaccination events should be recorded on the provider’s electronic patient records management system in a timely manner. The service will be required to report vaccination codes with their routine quarterly GUMCAD STI surveillance system returns to UKHSA in the usual way. Any additional reporting requirements will be agreed between the provider and the commissioner.

Centrally supplied vaccines

The following vaccines will be available for these vaccination programmes:

• mpox vaccination programme: Imvanex®, non-replicating, live modified vaccinia virus Ankara vaccine – Bavarian Nordic (MVA-BN)
• 4CMenB for gonorrhoea vaccination programme: Bexsero® meningococcal group B vaccine

The vaccines will be available to order by sexual health services online via the ImmForm website. Further information will be available from ImmForm. See the ImmForm help sheet for information on registering for an ImmForm account.

If providers also deliver routine childhood immunisations, they should ensure that they order the GBMSM Bexsero® product line on ImmForm for the 4CMenB for gonorrhoea vaccination programme, which is separate from the infant Bexsero® product line. This is to ensure appropriate stock allocation and data collection. Details on ordering will be available on ImmForm and in the Vaccine Update (vaccination newsletter for health professionals and immunisation providers) in due course.

Providers should ensure that local stocks of vaccine are rotated in fridges, or, in the case of the mpox vaccine, in freezers where available. While most providers will store Imvanex® in standard refrigeration, it is important to note that this limits shelf-life to 8 weeks. If stored in a freezer at -20°C the vaccine retains a longer shelf-life. This differs from vaccines in other routine programmes, which generally remain viable until their full expiry date under refrigerated conditions.

Providers must adopt robust and reliable stock management processes to minimise vaccine wastage whilst ensuring sufficient vaccine is available to support the opportunistic vaccination offer for eligible individuals. Providers should not stockpile vaccines.

Guidance on storage, distribution and disposal of vaccines: storage, distribution and disposal of vaccines: the green book, chapter 3.

Dose schedule

Most eligible individuals will be recommended a 2-dose course of Bexsero® and of Imvanex®. The dosing schedule in the Green Book should be followed.

The dose for both Bexsero® and Imvanex® is 0.5 ml via subcutaneous or intramuscular injection.

Previously, during periods of vaccine supply constraints, fractional doses of the mpox vaccine administered via the intradermal route were supported. Currently, this is not required for the routine mpox vaccination programme. Any change in this position, dependent on vaccine supply and the wider epidemiological situation, will be communicated by NHS England and UK Health Security Agency (UKHSA).

Patient Group Directions (PGDs)

Both of the following PGDs require appropriate authorisation before use:

• Mpox vaccine PGD template
• PGD template for the use of 4CMenB vaccine Bexsero against gonorrhoea will be available from 1 July

Immunisation Against Infectious Disease (the Green Book)

Prior to and during participation in the vaccination programmes, clinical teams must be up to date with clinical guidance and understand the latest version of the relevant Green Book chapters.

The latest smallpox and mpox Green Book chapter.

A new gonorrhoea Green Book chapter is available.

Training materials and information for healthcare practitioners

Staff must be trained and competent to undertake activities within their scope of practice to support the vaccination programmes.

Mpox resources (training slides, information for healthcare practitioners and an e-learning session) are already available.

Gonorrhoea resources (comprehensive training slides and information for healthcare practitioners) will be made available from 1 July. A very short (introductory) training session will be added to the main immunisation e-learning at a later date.

Consent

Guidance on informed consent can be found in chapter 2 of the Green Book.

Reporting suspected adverse reactions

Healthcare professionals and members of public are asked to report suspected adverse reactions through the online Yellow Card scheme, by downloading the Yellow Card app or by calling the Yellow Card scheme on 0800 731 6789 9am to 5pm Monday to Friday.

Responding to vaccine incidents

Guidance for those with a role in delivering the vaccination programmes, or in the investigation and management of vaccine storage or administration errors.