Expansion of Pneumococcal Vaccine Eligibility to People Experiencing Homelessness (WHC/2026/023)

Issue Date:   

27 July 2026

Status:  

Compliance / Action

Category: 

Public Health 

Title: 

Expansion of Pneumococcal Vaccine Eligibility to People Experiencing Homelessness

Date of Expiry / Review: 

Not applicable

For Action by:

• Chief Executives, Health Boards and Trusts
• Immunisation Leads, Health Boards and Trusts 
• Immunisation Coordinators, Health Boards
• Vaccination Operational Leads, Health Boards and Trusts
• Occupational Health Leads, Health Boards and Trusts
• Medical Directors, Health Boards and Trusts
• Directors of Primary Care, Health Boards and Trusts
• Nurse Executive Directors, Health Boards and Trusts
• Directors of Therapies and Health Sciences, Health Boards/Trusts
• Chief Pharmacists, Health Boards and Trusts
• Directors of Public Health, Health Boards and Trusts
• Heads of Maternity Services, Health Boards and Trusts
• Directors of Workforce and Organisational Development, Health Boards and Trusts
• Executive Director of Public Health, Public Health Wales
• Nurse Director, Public Health Wales
• Head Vaccine Preventable Disease Programme, Public Health Wales
• Director of Vaccination Delivery, Vaccination Programme Wales, NHS Wales Performance and Improvement
• General Practitioners 
• Community Pharmacists 
• Digital Health and Care Wales

Sender: 

Dr Keith Reid, Deputy Chief Medical Officer (Public Health)

Health, Social Care and Early Years Group Welsh Government Contact(s):

Vaccination Division,
Welsh Government,
Cathays Park,
Cardiff CF10 3NQ 
Email: wg.vaccinationsprogrammeteam@gov.wales 

Enclosures: 

None

Dear Colleagues, 

The pneumococcal programme has been in place for clinical at-risk groups since 1992, and for adults over 65 since 2003. The programme currently offers vaccinations to eligible groups based on advice from the Joint Committee on Vaccination and Immunisation (JCVI). These groups are:

• Adults 65 years and over
• Individuals in clinical risks groups (2 to 64 years old)
  • Chronic respiratory, cardiac, renal or liver disease
  • Diabetes
  • Cochlear implants or cerebrospinal leaks 
  • Immunosuppression
  • Asplenia or splenic dysfunction

Additionally, pneumococcal vaccination is offered as part of the childhood schedule to all children at 16 weeks and 12 months through the Routine immunisation schedule for Wales (PHW).

In 2025, following recommendations by the JCVI, a Welsh Health Circular (WHC/2025/054) was issued to inform you of a product change for routine adult pneumococcal vaccination programme. This changed from PPV23 to PCV20 for those aged over 2 years old, and information was provided for those under 2 years old in certain clinical risk groups who would also be eligible for this product. 

At the February 2024 and June 2024 meetings, the JCVI reviewed evidence for the expansion of the pneumococcal vaccination programme to include people experiencing homelessness. The JCVI agreed to this advice based on evidence demonstrating that the risk of community acquired pneumonia in young individuals experiencing homelessness exceeded the risk for adults aged 65 to 74 years old (the group routinely eligible for pneumococcal vaccination). The evidence also demonstrated that Influenza and pneumonia was the second most common cause of unplanned hospital admissions in males experiencing homelessness. 

The Welsh Government has accepted this advice and from the 1 October 2026 the pneumococcal vaccination programme will be expanded to include people experiencing homelessness.

From 1 October 2026, the pneumococcal programme will be expanded to include people experiencing homelessness. This is defined as:

a person who is sleeping rough; in emergency accommodation; or is recently homeless in supported accommodation.

Supported accommodation means accommodation provided to individuals who require support to live independently, where that support is provided in connection with the accommodation. This includes, but is not limited to, accommodation where support is provided to assist individuals to maintain or secure housing, manage health or wellbeing, develop independent living skills, or access employment or other services, regardless of the type of provider or tenure. 

“Support” includes but is not limited to the provision of care, supervision advice, training, guidance and counselling.

It should be noted this definition differs from the Green Book: Pneumococcal Chapter and instead aligns with the definition used for delivering the National Influenza Immunisation Programme to people experiencing homelessness in Wales. 

This vaccination offer is to persons of any age experiencing homelessness, provided there is no contra-indication identified in clinical review.

PCV20 will usually be the standard product for pneumococcal vaccination of people experiencing homelessness. Other pneumococcal vaccines continue to be used across other vaccine programmes. Conjugate vaccines use in the childhood programme (PCV13) are unaffected. 

PPV23 may still be used for the adult and clinical risk group programme in line with Pneumococcal: the Green book, chapter 25 advice. Once local stocks of PPV23 are depleted PCV20 should be routinely used. Further information is available in Annex 1 to this circular.

The programme will be expanded to support routine delivery to people experiencing homelessness in October 2026. Health boards are encouraged to co-administer with Influenza during the national flu programme wherever possible. 

Delivery arrangements should be determined locally to reflect population need, service capacity, and existing care and outreach pathways. Vaccination may be led by health boards or delivered through primary care contractors, outreach and community services, or a combination of models as deemed appropriate to meet local needs. Local areas should adopt flexible approaches to ensure equity of access for this cohort, especially as they may not routinely engage with primary care, while maintaining clear clinical governance and reporting arrangements. 

Following the conclusion of the Influenza programme, the pneumococcal vaccine should continue to be offered routinely to anyone who is defined as experiencing homelessness and who has not been previously vaccinated.

In accordance with Green Book guidance the pneumococcal vaccine can be safely co‑administered with most other indicated vaccines, including seasonal vaccines such as Influenza. Refer to relevant Green Book chapter for further information.

Co‑administration is actively encouraged for people experiencing homelessness to maximise protection, reduce missed opportunities for vaccination and recognise the challenges that this population may face in attending repeat appointments. 

Vaccinators should also consider opportunities to review the vaccination record of all eligible individuals who present for pneumococcal vaccination and identify any opportunities to deliver outstanding vaccinations to those eligible (for example, Shingles, RSV, influenza and COVID-19). 

Health boards should continue the ongoing work to increase vaccine uptake, reduce waste, and ensure fair access for everyone eligible. 

A coordinated, equity‑focused vaccination approach is required to overcome barriers and meet the diverse needs of underserved communities, ensuring maximum uptake. While progress has been made across Wales to embed equity into vaccination policy and practice, inequalities in uptake persist in some areas.

Equity needs to be built into the design and delivery of services, to promote universal accessibility, but with tailored interventions to understand and overcome the specific barriers faced by different population groups. Health boards should ensure pneumococcal vaccination for people experiencing homelessness is easily accessible, offered through outreach and trusted local services where appropriate.

I recognise the commitment shown by health boards and GP practices in delivering the pneumococcal programme alongside other vaccination programmes. Expanding the cohort is an important step in strengthening protection for this clinically vulnerable group and will help reduce the impact of pneumococcus on primary and secondary care services in future winter seasons.

Yours sincerely,

Dr Keith Reid

Deputy Chief Medical Officer (Public Health)

Information and resources to support implementation

Funding and service arrangements

The routine NHS-funded adult and at-risk Pneumococcal vaccinations programme in Wales is delivered as a directed supplementary service by GPs. With this change in eligibility, the Primary Medical Services Supplementary Services Directions for the Pneumococcal Immunisation Scheme will be amended to incorporate this change in cohort to include People Experiencing Homelessness. 

Practices are expected to continue delivering routine vaccinations in line with national standards, including active call/recall systems. These updates have been incorporated into the Green Book, which provides clinical guidance and eligibility criteria for all vaccines in the UK immunisation schedule. Except, in this instance, Wales is operating under a wider eligibility criteria for this cohort as defined in this document.

Any person presenting for pneumococcal vaccination who has an incomplete immunisation history for their age should be managed according to the UKHSA uncertain or incomplete immunisation algorithm.

Digital support

Accurate and timely recording of all vaccines given and good management of all associated documentation is an essential requirement of the programme. The pneumococcal vaccination should continue to be recorded in existing systems and wherever possible the individuals General Practice should be notified of the vaccination and records updated to reflect. In the longer term it is our ambition for the adult/at risk Pneumococcal programme to be recorded via the Welsh Immunisation System (WIS). Stakeholders will be kept informed on progress on the move and supported to enable the transition. 

Vaccine coverage surveillance data collection

The Public Health Wales Vaccine Preventable Disease Programme is responsible for carrying out surveillance of all routine vaccinations in Wales. Data for surveillance of childhood vaccinations are provided through CYPrIS. Data for the surveillance of adult pneumococcal vaccinations are currently collected directly from general practices through Audit+ (and will continue to be collected from practices through the successor product to Audit+ in 2026). 

The latest vaccine uptake data for Wales is available here (adult and clinical risk program): Pneumococcal Vaccination Coverage in Wales - Public Health Wales and here (childhood program):Public Health Wales - National childhood immunisation uptake data . 

Public Health Wales also works with other UK nations to conduct surveillance of pneumococcal infections and incidence. 

To support delivery of the programme, Public Health Wales will provide surveillance reports and will work closely with Digital Health and Care Wales to access data from appropriate national data systems, centrally reconciling uptake data where appropriate.

Centrally supplied vaccines 

The switch from PCV13 to PCV20, should have been made immediately for children aged under 2 years with asplenia, splenic dysfunction, complement disorder, and severe immunosuppression. 

PCV20 is available to order in the usual way online via the ImmForm website. Providers should ensure that local stocks of vaccine are rotated in fridges so that wastage is minimised. It is recommended that practices hold no more than two weeks’ worth of stock. 

PCV20 is supplied as a pack of 10 x pre-filled syringes without needles.

See Green Book: Storage, distribution and disposal of vaccines chapterfor more information on storage, distribution and disposal of vaccines.

Patient Group Directions (PGDs)

Updated UKHSA developed PGD templates and an Advisory Document will be made available as a reference resource for health boards to develop and authorise for use locally. They can be found here: Patient Group Directions (PGD) - Welsh Medicines Advice Service.

Immunisation Against Infectious Disease (the Green Book)

The latest information on the programme is available in the Green Book: Pneumococcal: the green book, chapter 25 - GOV.UKGreen Book: Pneumococcal chapter.

Training and information resources for healthcare practitioners 

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

Training and information resources for Healthcare Practitioners will be made available on the Public Health Wales website.

Patient facing resources

Patient facing information resources will be made available on the Public Health Wales website: Immunisation and Vaccines - Public Health Wales.

Patient information leaflet resources can be ordered for free at: Health Information Resources - Public Health Wales.

Consent

Guidance on informed consent can be found in the Green Book: Consent Chapter

Reporting suspected adverse reactions 

PCV20 is a black triangle product and is subject to additional monitoring by the MHRA.

Healthcare professionals and members of public are asked to report suspected adverse reactions through the online Yellow Card scheme (www.mhra.gov.uk/yellowcard) 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 involved supporting immunisation services to decide the appropriate response to vaccine incidents: Vaccine incident guidance: responding to vaccine errors - GOV.UK .