Supply Problems Delaying Flu Vaccination for Over-65s

Peter Russell

September 21, 2018

Many patients face significant problems getting vaccinated against flu this season because of problems with the timely supply of the new vaccine for people aged 65 and over.

Pharmacists have reported a serious shortage of the adjuvanted vaccine, which public health officials have said could prevent more than 700 hospital deaths from flu this winter and reduce GP consultations by 30,000.

They have called for new guidance from NHS England and Public Health England (PHE) about how to manage older people who cannot be vaccinated with the new adjuvanted trivalent vaccine (aTIV) but who could receive some protection from the quadrivalent (QIV) vaccine.

'A Major Problem'

Ash Soni, president of the Royal Pharmaceutical Society, told Medscape News UK, "there's a significant shortage in the market but also, even worse, a significant shortage in particular places." 

He described the supply issue as "a major problem" that was "causing significant issues for patients."

Earlier this month, PHE announced that the adjuvanted vaccine would be offered for the first time in the UK this year on a recommendation from the Joint Committee on Vaccination and Immunisation (JCVI).

The vaccine given during the 2017-18 flu season was effective in only around 1 in 10 over-65s. However, aTIV is expected to offer more protection in those aged 65 and over because it boosts the body's immune response to the vaccine.

In February, NHS England wrote to GPs and community pharmacists asking them to review their orders, whether provisional or firm, to ensure a supply of aTIV for older people. The letter said that suppliers had confirmed there would be enough adjuvanted trivalent vaccine and quadrivalent influenza vaccine to meet demand.

However, while QIV has several manufacturers, the new aTIV, first licenced for the UK in August 2017, is only being supplied by Seqirus, under the brand name Fluad.

Pharmacies 'Having to Turn Patients Away'

"There is only one manufacturer and there is only so much stock in the system," said Ash Soni. "I know at my own pharmacy, we tried to order it but were put on a waiting list and then were told there wasn't enough stock to supply us."

He said pharmacies were having to turn away some NHS patients because they did not have the age-appropriate vaccine.

Commenting on the supply issue, Dr Richard Vautrey, GP committee chair of the British Medical Association (BMA), said: "Provision of QIV to over-65s is an option of last resort and should only be offered in exceptional circumstances, and when aTIV is not available and is highly unlikely to become available locally."

Current BMA advice is that GP practices and community pharmacists who do not have supplies of aTIV should refer patients to other providers or encourage them to return when supplies become available.

"While practices will be reimbursed for delivering the clinically appropriate vaccine, we understand that consideration will be given to special circumstances related to availability," said Dr Vautrey. "However, if practices are found to have inappropriately provided the incorrect vaccine, payments may be recovered by commissioners."

Ash Soni said he expected fresh guidance from PHE and NHS England about how to manage vaccinations this autumn. "It may be that rather than people being vaccinated in October, we push it back slightly and people are vaccinated in November," he said.

A spokesperson for NHS England said supplies of aTIV would be dispatched in phases through September, October and November.

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