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GP practices advised to order next year’s flu vaccine before NHS finalises programme

by Elisabeth Mahase
23 November 2018

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Public Health England has urged GP practices to order next winter’s flu vaccines, despite the fact NHS England’s final guidance on which vaccine to use is still pending.
PHE said practices should go ahead and order the same two types of vaccine they are using this flu season.
But the Government’s vaccination advisory committee is saying that a new vaccine – quadrivalent influenza cell culture vaccine (QIVc) – could be just as effective and used across all adults.
With NHS England’s vaccine guidance yet to be published, meaning QIVc could still be an option, GP experts are calling on NHS England to release guidance ‘as soon as possible’, so as to avoid the ‘difficulties’ faced by practices this year.
This comes after our sister publication Pulse revealed that GPs and pharmacists have been left with more than two million flu vaccines to administer within two weeks, in order to meet NHS England’s target of vaccinating all over-65s before December ‘when flu season usually hits’.
Ahead of the 2018/19 flu season, which started on 1 September, practices were advised to administer the quadrivalent vaccine (QIV) to patients aged 18-65 and the adjuvanted trivalent flu vaccine (aTIV) to patients aged over 65.
However, issues were caused by the phased deliveries of the aTIV, which saw almost 70% of GPs experience a shortage of the vaccine, forcing them to turn away vulnerable older patients as a result.
Despite this, PHE told GPs, in a letter released this week, that ‘both of the vaccines that were recommended for the 2018/19 season will continue to be recommended for next year’.
‘Please begin ordering currently licensed vaccines as set out above; ordering of these licensed vaccines should not be unnecessarily delayed. For the new, currently unlicensed vaccines, please wait for confirmation from NHS England that they are eligible for reimbursement before ordering,’ it added.
This comes after the Joint Committee on Vaccination and Immunisation (JCVI) released preliminary advice suggesting that a new vaccine – QIVc – could be used in all adults.
JCVI meeting minutes, published last week, said for adults over the age of 65, QIVc is ‘considered equally suitable for use in the elderly along with aTIV’ and ‘preferable to the available standard egg based QIV’.
In at-risk adults under 65, and children contraindicated to live attenuated influenza vaccine (LAIV), QIVc is ‘considered equally suitable for use along with QIV’.
QIVc was used last flu season in the US, but it is not yet licenced in the UK – although it could be by the end of 2018 according to PHE.
South London GP Dr Azeem Majeed, who also heads up the primary care and public health department at Imperial College London, said: ‘It seems that PHE are recommending the same flu vaccines for next winter. 
‘I guess that given the logistics of ordering vaccines and planning delivery programmes, it would be difficult to make a sudden change in vaccination policies. The change this year caused some disruption to flu vaccine programmes.
‘In the longer term, it would logistically better to have one flu vaccine but that would depend on data showing that this policy would be as effective at preventing flu as having different vaccines for younger and older adults. The JCVI minutes mentioned that this data was lacking at present.’
BMA GP Committee clinical and prescribing lead Dr Andrew Green is now calling for NHS England to release its flu vaccine guidance.
He said: ‘It is vital that NHS England decides as soon as possible its recommendations for next year’s vaccination programme, as their failure to do so in a timely fashion this year was the main cause of the difficulties GPs and patients faced.’
This story was first published on our sister publication Pulse.