A timeline of clinical vulnerability

Some people have always been at greater risk from infection, and UK policy has treated them in very different ways over the decades, from ’flu vaccination programmes in the 1960s to shielding in 2020 and narrowing vaccine eligibility today. This timeline sets out, in order and with sources, how clinical vulnerability has been defined, protected and sometimes overlooked.

Chapter One

Before Covid-19: protecting 'at risk' groups

1. December 1952

   The Great Smog of London

   Coal smoke trapped by cold, still weather covered London for five days. About 4,000 people died at the time, and later estimates put the toll at 10,000 to 12,000, mostly from breathing and lung illness. It led to the Clean Air Act 1956.^[57][58]

2. Late 1960s

   Annual ’flu vaccination recommended for clinical risk groups

   Influenza immunisation has been recommended in the UK since the late 1960s, initially for people in clinical risk groups at higher risk of serious illness and death.^[1][2]

3. 2000

   ’Flu vaccination extended to everyone aged 65 and over

   Policy was widened beyond clinical risk groups to include all people aged 65 or over.^[1]

4. 2004

   First Heatwave Plan for England

   Published after the August 2003 heatwave, which caused more than 2,000 excess deaths in the UK over ten days, the plan set out how the NHS, councils and other services should protect people during severe heat.^[59]

5. April to June 2009

   H1N1 ('swine ’flu') pandemic reaches the UK

   The first UK cases were confirmed on 27^th April 2009 and the World Health Organization declared a full pandemic (Phase 6) on 11^th June 2009.^[3]

6. 2009

   Risk groups prioritised for pandemic vaccine

   Vaccine priority went to pregnant women, front-line health and social care workers, and people aged over six months with chronic conditions that put them at higher risk of severe illness or death from influenza.^[3]

7. July 2010

   Independent review of the 2009 pandemic response

   Dame Deirdre Hine's review concluded that the UK response had been proportionate and effective, while noting that the H1N1 strain proved milder than the pandemic planners had anticipated.^[3]

8. 2013

   Children added to the ’flu programme

   Following JCVI advice in 2012, a phased extension of the ’flu programme to children aged two to under seventeen began in 2013.^[1]

9. January 2017

   Energy Priority Services Register widened

   Ofgem widened the register to any energy customer in a vulnerable situation, including temporary ones. People who rely on medical equipment that needs electricity can register for advance warning of planned power cuts and help in an emergency.^[60]

Chapter Two

2020: shielding

1. 2020

   Clinically Vulnerable Families is founded

   CVF describes itself as a community founded in 2020, providing information and support for people who are Clinically Vulnerable to Covid-19, and it began as a Facebook group. It is now a community interest company.^[4][5]

2. March 2020

   Two risk categories defined: Clinically Vulnerable and Clinically Extremely Vulnerable

   Early Covid-19 guidance set out a 'Clinically Vulnerable' group, which included everyone aged 70 or over, pregnant women and people with a range of chronic conditions, and a smaller 'Clinically Extremely Vulnerable' group advised to shield.^[6][7]

3. 20^th March 2020

   First NHS Shielded Patient List produced

   The first list of people at highest clinical risk was assembled from existing NHS data, then updated as GPs and hospital clinicians added patients.^[8]

4. 23^rd March 2020

   Shielding letters and texts begin; national support service goes live

   Notifications to people identified as Clinically Extremely Vulnerable began on 23^rd March 2020, the day the UK entered lockdown, and the public-facing Clinically Extremely Vulnerable People Service went live. NHS guidance defined shielding as staying at home and avoiding all face-to-face contact for at least 12 weeks.^[9][8][10]

5. April to May 2020

   The Shielded Patient List grows to 2.2 million

   The list rose from about 900,000 within two days to 1.3 million by 12^th April, 1.8 million by 18^th April and 2.2 million by 7^th May 2020.^[9]

6. 15^th June 2020

   Face coverings become compulsory on public transport

   Face coverings became a legal requirement for passengers on public transport in England, enforced by the police and transport operators, with a fixed penalty for refusing.^[11]

7. 22^nd June 2020

   Phased relaxation of shielding announced

   A letter from the Chief Medical Officer for England and NHS England's Medical Director set out an easing of shielding from 6^th July and again from 1^st August 2020.^[12]

8. 24^th July 2020

   Face coverings required in shops and other indoor places

   The requirement was extended to shops, enclosed shopping centres, banks, post offices and transport hubs, and later to more venues. From 24^th September 2020 the fixed penalty rose to £200 for a first offence, doubling on repeats.^[13][14]

9. 1^st August 2020

   Shielding paused in England

   The national shielding programme paused. Free food parcels, medicine deliveries and Statutory Sick Pay eligibility linked to shielding ended, and people were told they could return to COVID-secure workplaces.^[15][8]

10. Autumn 2020

    Clinically Extremely Vulnerable group extended; guidance tied to local restrictions

    New guidance issued on 13^th October linked advice to local alert levels, and further guidance followed ahead of the November lockdown. NHS England also asked trusts to add adults with stage 5 chronic kidney disease and adults with Down's syndrome to the Shielded Patient List, using an Oxford risk model.^[16][17]

11. December 2020

    Health Foundation analysis of the shielded population

    Analysis found over two million people had been identified as Clinically Extremely Vulnerable, that a third of those shielding reported reduced care for existing conditions, and that 37 per cent reported a decline in mental health and wellbeing.^[18]

12. 16^th December 2020

    Air pollution recorded as a cause of death

    An inquest found that air pollution made a material contribution to the death of nine-year-old Ella Adoo-Kissi-Debrah, who had severe asthma and lived near the South Circular road in London. It was the first time in the UK that air pollution was listed as a cause of death.^[61]

13. 22^nd December 2020

    Parliamentary committee criticises siloed support

    The Women and Equalities Committee found that support for the Clinically Extremely Vulnerable relied on medical criteria alone.^[19]

14. 30^th December 2020

    JCVI sets priority groups for Covid-19 vaccination

    The JCVI placed Clinically Extremely Vulnerable people under 70 in priority group 4, alongside those aged 70 to 74. Adults aged 16 to 64 with underlying health conditions that raise the risk of serious disease, the group that included Clinically Vulnerable adults under 65, were placed in group 6, after groups 1 to 5, which included everyone aged 65 and over.^[20]

Chapter Three

2021: a second lockdown, a new risk model, and the end of shielding

1. 5 and 6^th January 2021

   Shielding advice reissued for the third national lockdown

   Following the announcement of a further lockdown for England on 5^th January, guidance advising Clinically Extremely Vulnerable people to shield was reissued on 6^th January 2021.^[21]

2. 13^th January 2021

   Vaccines delivery plan sets the first target

   The government's delivery plan made its top priority offering a first dose to everyone in groups 1 to 4 by 15^th February, and said it would likely take until spring to work through all nine groups.^[22]

3. From 15^th February 2021

   Vaccination of priority group 6 begins

   GPs began vaccinating group 6 from the week of 15^th February, the date by which everyone in the first four groups was due to have been offered a first dose. Group 6 covered adults under 65 with conditions including chronic respiratory, heart, kidney and liver disease, diabetes, neurological conditions, cancer and weakened immunity, and some adult carers.^[23][24]

4. 16^th February 2021

   QCovid risk assessment adds people to the shielding list

   The government announced that a risk model developed by the University of Oxford would identify further adults at high risk; the government said up to 1.7 million people were identified, and the ONS reported an additional 1.5 million in England, taking the England total to 3.8 million.^[25][21]

5. 1^st April 2021

   Advice to shield paused

   From 1^st April 2021 the advice to shield was paused in England.^[26]

6. 12^th May 2021

   Public inquiry into the pandemic announced

   Prime Minister Boris Johnson announced an independent public inquiry into the UK's response to the pandemic.^[27]

7. 17^th May and 19^th July 2021

   Face coverings removed from schools, then from the law

   From 17^th May 2021 pupils and staff were no longer advised to wear face coverings in classrooms. On 19^th July 2021 the legal requirement to wear them in England ended, with no replacement duty on businesses or transport operators.^[28][13]

8. 1^st September 2021

   JCVI advises a third primary dose for people who are severely immunosuppressed

   The JCVI advised a third primary vaccine dose for people over 12 who were severely immunosuppressed at the time of their first two doses, noting that around 40 per cent showed low antibody levels after two doses.^[29]

9. 15^th September 2021

   Shielding programme ends

   The shielding programme ended in England. A letter dated 17^th September 2021 told people they would not be advised to shield in future and that no specific national guidance would be provided for them.^[26][30]

10. 1^st October 2021

    UK Health Security Agency launches

    UKHSA formed from Public Health England, NHS Test and Trace and the Joint Biosecurity Centre, and took over health protection responsibilities including guidance on respiratory infections.^[31]

11. December 2021

    Face coverings return under Plan B

    The government reintroduced a legal requirement to wear face coverings in shops and on public transport in England in response to the Omicron variant.^[32]

12. December 2021

    Baroness Hallett appointed to chair the Inquiry

    Retired judge Baroness Heather Hallett was appointed chair of the Covid-19 Inquiry.^[27]

13. 16^th December 2021

    Treatments for people at highest risk become available in the community

    Under an interim commissioning policy announced on 8^th December, neutralising monoclonal antibodies and antivirals became available from 16^th December 2021 to people at greatest risk, including people who are immunocompromised, have cancer or have Down's syndrome.^[33]

Chapter Four

2022 to 2023: 'living with Covid' and the prophylaxis question

1. 27^th January 2022

   Plan B ends and the legal requirement to wear face coverings lapses

   The 2021 regulations expired. There has been no legal requirement to wear a face covering anywhere in England since.^[32]

2. 21^st February 2022

   'Living with Covid-19' plan published

   The plan set out the end of legal self-isolation requirements from 24^th February and of universal free testing from 1^st April 2022, while stating that protection for the most vulnerable would continue through vaccination and targeted testing, with limited symptomatic testing for at-risk groups.^[34]

3. 17^th March 2022

   Evusheld authorised by the MHRA

   The UK medicines regulator authorised tixagevimab plus cilgavimab (Evusheld) as pre-exposure prophylaxis against Covid-19.^[35]

4. 30^th May and 24^th August 2022

   RAPID C-19 group advises against patient access to Evusheld

   The group advised the Chief Medical Officer that there was no certainty the treatment would prevent symptomatic illness caused by Omicron variants in the vulnerable population, and on 24^th August maintained that recommendation.^[35]

5. 1^st June 2022

   Universal masking in healthcare settings stepped down

   NHS England and UKHSA ended the routine requirement for staff, patients and visitors without symptoms to wear masks in health and care settings in England, keeping them for Covid and respiratory pathways, outbreaks and symptomatic patients.^[36]

6. 28^th June 2022

   UK Covid-19 Inquiry formally begins

   The Inquiry formally began with the publication of its terms of reference.^[27]

7. 2^nd March 2023

   CVF asks for interim Inquiry reports

   At a preliminary hearing for Module 3 (healthcare), CVF asked for interim reports to be published rather than waiting for a single final report, because of the ongoing risks to Clinically Vulnerable people. The Inquiry agreed, and has since published its findings module by module.^[37]

8. 5^th May 2023

   NICE final draft guidance does not recommend Evusheld

   NICE published final draft guidance on tixagevimab plus cilgavimab for preventing Covid-19. Its published recommendation is that the treatment is not recommended for adults unlikely to respond adequately to vaccination, or for whom vaccination is contraindicated.^[38][39]

9. 1^st September 2023

   Shingles vaccine for severely immunosuppressed adults

   The NHS began offering the Shingrix vaccine to severely immunosuppressed people aged 50 and over, with no upper age limit, and made them the first priority for the programme.^[62]

Chapter Five

2024 to 2025: Inquiry reports begin and vaccine eligibility narrows

1. 18^th July 2024

   Module 1 report published; CVF responds

   The Inquiry's first report, on resilience and preparedness, was published on 18^th July 2024. CVF said it had missed issues faced by Clinically Vulnerable families, including tailored guidance, PPE for home use and mental health support.^[40][41]

2. 2^nd August 2024

   JCVI advice for autumn 2024

   Eligibility was set as people aged 65 and over, care home residents for older adults, and people aged six months to 64 in a clinical risk group.^[42]

3. 2024

   CVF publishes its first Voting Accessibility Audit

   CVF's audit examined how the Electoral Commission's guidance was being implemented for Clinically Vulnerable voters. A follow-up audit was published in 2026.^[43]

1. 14^th November 2024

   JCVI advises narrower eligibility for autumn 2025 and spring 2026

   The JCVI advised offering vaccination only to adults aged 75 and over, care home residents for older adults, and people aged six months and over who are immunosuppressed. This removed two groups: all adults aged 65 to 74, and people under 65 in a clinical risk group who are not immunosuppressed.^[44]

2. 31^st January 2025

   Module 4 closing statements delivered for CVF

   Adam Wagner, Hayley Douglas and Lameesa Iqbal represented Clinically Vulnerable Families, instructed by Slater and Gordon, at the closing statements for Module 4 (vaccines and therapeutics).^[45]

3. 16^th July 2025

   JCVI keeps the same groups for autumn 2026 and spring 2027

   Advice for autumn 2026 and spring 2027 maintained eligibility for adults aged 75 and over, care home residents and immunosuppressed people aged six months and over.^[46]

4. October 2025

   CVF publishes a report on children and young people

   The report highlights school attendance and deregistration issues faced by Clinically Vulnerable children.^[43]

5. 27^th October 2025

   Awaab's Law comes into force

   Social landlords in England must now investigate and fix dangerous damp and mould within set deadlines. The law is named after two-year-old Awaab Ishak, who died in December 2020 from prolonged exposure to mould in his family's flat in Rochdale.^[63]

6. 20^th November 2025

   Modules 2, 2A, 2B and 2C report published

   The Inquiry published its report on core decision-making and political governance.^[40]

Chapter Six

The Inquiry reports, 2026

1. February 2026

   CVF Impact on Society report submitted to the Inquiry

   CVF's report, based on national survey data and case studies, was published alongside the Inquiry's Impact on Society hearings.^[43]

2. 19^th March 2026

   Module 3 report on healthcare published

   The Inquiry published its report on the impact of the pandemic on the UK's healthcare systems. CVF, a Core Participant, reported that the report criticised infection control policy, recommended prioritising HEPA filtration in NHS settings, said there was no good reason to prevent patients from wearing face masks, and documented DNACPR notices placed without consent.^[40][47][5] Read our response →

3. 16^th April 2026

   Module 4 report on vaccines and therapeutics published

   CVF reported that the report states protecting immunocompromised people through prophylactics must become a priority, and that it found the children's vaccine rollout was too slow, too limited and too short.^[40][48][49] Read our response →

4. 29^th June 2026

   Wearing a mask can now be an arrestable offence at protests

   Sections 157 to 159 of the Crime and Policing Act 2026, which received Royal Assent on 29^th April 2026, came into force. An inspector or above can designate an area at a protest where wearing anything that conceals identity is an offence, punishable by up to a month in prison or a fine of up to £1,000. A defence exists for covering the face for health, religious or work reasons, but Liberty notes it applies only after arrest or when a charging decision is made.^[50][51][52]

5. 14^th July 2026

   Module 5 report on procurement published

   The Inquiry published its report on procurement and distribution of key healthcare equipment, including PPE, ventilators and oxygen.^[40]

6. 16^th July 2026

   JCVI advises raising the age threshold to 80 for autumn 2027

   For autumn 2027 the JCVI advised offering vaccination to adults aged 80 and over, care home residents for older adults, and immunosuppressed people aged six months and over. This would remove adults aged 75 to 79.^[53]

7. 14^th September 2026

   UK government responds to the Module 3 report

   The government response covers infection prevention and control governance, workforce, surge planning and advance care planning, and says data systems should be improved to identify people at high risk in a future pandemic.^[54]

8. 24^th September 2026

   CVF responds to NICE's review of Covid antiviral guidance

   NICE proposed withdrawing its guidance on the antivirals Paxlovid, molnupiravir (Lagevrio) and remdesivir (Veklury), and with it the requirement for the NHS in England to fund them. As a registered stakeholder, CVF found that NICE's evidence review had missed a major 2026 study of more than 10 million patients, which found Paxlovid still cut hospital admissions by almost half and deaths by more than two-thirds.^[56] Its higher-risk group also covered conditions beyond NICE's current list: diabetes, asthma, COPD, high blood pressure, heart disease, chronic kidney disease, chronic liver disease and cancer. CVF asked NICE to reconsider the groups it removed in May 2025 too. CVF also argued that lower Covid rates across the population do not lower the risk for the people still eligible, that a lack of new trials is not evidence the medicines no longer work, and that each medicine should be judged on its own evidence.^[55]

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If you spot an error or a missing milestone, please tell us through the contact page. Last reviewed: 30^th September 2026.