Health workers, older people, those with diabetes, lung conditions, heart failure and other chronic diseases: people at greatest risk of hospitalisation and death from influenza overlap with the at-risk groups for COVID-19.
We won’t have a coronavirus vaccine for the winter of 2020/2021. But we do have a flu vaccine. Yet every year, huge numbers of people who should be vaccinated are not.
In Europe, where health ministers committed in 2009 to achieve 75% flu vaccination among over 65s, no country is hitting its target. Only 44% of over 65s have the vaccine.
The flu vaccine is far from perfect. Unlike measles vaccines which lead to immunity in just about every child who receives it, flu vaccines don’t always trigger the required response from older people’s immune systems. They do, however, work for enough people to make a difference.
And, as well as reducing the number of flu cases in the community, influenza vaccination has knock-on positive effects, reducing asthma exacerbations and the rates of stroke and heart attack in at-risk individuals.
Above all, countries with high uptake of flu vaccination can reduce pressure on the hospital system. Remember the efforts we all invested in flattening the curve? A key element of our shared goal was to ensure intensive care units were not overwhelmed by cases of COVID-19.
Sadly, some people will die from COVID-19 and others from flu, but losing people because they couldn’t access a ventilator in an overburdened hospital should not be acceptable. The same logic applies to reducing rates of flu.
‘Flu is a serious disease for which we have a safe and effective vaccine, but demand for the vaccines has been too low. Meanwhile, COVID-19 is a new disease and people are crying out for the vaccine,’says Bram Palache, an experienced flu scientist. ‘If people realised how many people die of flu every year – if we spoke about the deaths and the burden on hospitals – it would be unthinkable that so many people are not vaccinated against influenza.’
Jane Barrett of the International Federation on Ageing says we should also think about other vaccine-preventable diseases. ‘We need to look at flu vaccination rates, but also immunisation against pneumococcal disease and shingles,’ she says. ‘Many of the same people suffering the worst of the COVID-19 outbreak are also those who would benefit from these vaccines.’
The coronavirus outbreak has also put the spotlight on healthcare workers. While a disproportionate number of frontline health workers have developed COVID-19 – and they are likely to be first in line if supplies of a SARS-CoV2 vaccine are limited – too few health workers have their annual flu vaccine.
How to reach at-risk groups
‘This year, more than ever, it is vital that all healthcare workers, but especially those in hospitals, are vaccinated against influenza,’ says Pamela Logan of the Irish Pharmacy Union. ‘At least 20% of healthcare workers are infected with influenza every year, many of whom continue to work despite being ill, increasing the risk of spreading flu to their colleagues and patients.’
Pharmacists could play a key role in reaching vulnerable groups known to be at higher risk if they catch the flu. Logan says that pharmacists in Ireland – as well as in Portugal, France, Denmark, Switzerland, Norway and the United Kingdom – all allow pharmacists to administer vaccines if they have completed a relevant training course.
The Irish experience shows that pharmacy-based vaccination has grown every year for nine years, helping to increase the total number of people receiving the flu jab. Data from the IPU suggests that pharmacists are reaching people who would otherwise not have received the vaccine.
Meanwhile, the International Pharmaceutical Federation says community pharmacists are also playing an important role in managing chronic conditions associated with higher mortality rates from COVID-19, including diabetes, heart problems and lung disease.
Pharmacists could be the key to boosting flu vaccine uptake this winter and may even have a role in administering a coronavirus vaccine should one become available.
While there is much uncertainty about the development of a COVID-19 vaccine and the risk of a fresh wave of cases this winter, it is clear that improving uptake of existing vaccines is vital to the health of individuals, communities and health systems.