Here’s another thing to add to the long list of ways in which 2020 is turning expectations on their head. Most years, flu vaccination rates are too low. In fact, all EU countries have fallen short of their target to vaccinate 75% of older people.
But this is 2020. Normality ran out the door months ago, neglecting to tell us when it will be back. Instead of doctors, nurses and pharmacists encouraging at-risk patients to have their flu vaccine (sometimes with limited success), clinics across Europe have long waiting lists for the annual jab.
— WHO/Europe (@WHO_Europe) October 14, 2020
How did this happen?
First, demand is at an all-time high. Keen to avoid a ‘twindemic’ of COVID-19 and influenza which might overwhelm hospitals, governments have stepped up campaigns to encourage people to have their flu vaccine. Many countries decided in the spring and early summer to order more vaccines.
The public has responded. In the absence of a COVID-19 vaccine, large numbers of citizens are taking the advice to make better use of the vaccines we already have against flu and pneumococcal disease.
However, with a surge in public demand since September, supplies of flu vaccines are running low. More vaccines may be on the way but there is a real chance that not everyone who wants a vaccine will get one this year.
Jan De Belie, Pharmaceutical Group of the European Union (PGEU), said shortages were challenging for healthcare workers, including pharmacists who face angry customers. ‘We are often confronted with verbal aggression when people don’t get their flu vaccines,’ he said.
Will manufacturers just make more?
Vaccine makers have stepped up production significantly, with some expecting to continue delivering vaccines weeks or months after the usual peak in demand. Flu vaccination may even be available in December or January, which is significantly later than the norm, as new batches are delivered. According to Vaccines Europe, a trade association and sponsor of Vaccines Today, its members increased supply to Europe by an average of 30%.
Unfortunately, there are limits to how many additional vaccines can be made. Making flu vaccines takes between 12 and 18 months, meaning that the process of producing the vaccines arriving in clinics today began last year. Vaccines are biological products and there is a limited number of companies with the expertise and facilities to make them.
In a joint statement, Vaccines Europe and GIRP, an umbrella organisation representing pharmaceutical distributors in Europe, called for earlier engagement with governments to enable more accurate forecasting of demand for future flu seasons.
Okay, now what?
The World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) on Immunization is urging national governments to respond to the shortage of flu vaccines by actively prioritising older people and healthcare workers. Health workers are at elevated risk of catching the flu virus, while older people face higher risks of complications if infected.
This advice is new. Previously, the WHO has listed five risk groups: pregnant women (the highest priority), children, older adults, those with underlying medical conditions, and health workers, in no particular order.
‘There has been an increased demand and we’re hearing now that countries that are trying to get influenza vaccine cannot get it,’ says Dr Ann Moen, Chief, Influenza Preparedness and Response at WHO.
‘Based on a set of considerations, including alleviating the indeed burden on the healthcare system and vulnerable populations and managing potentially limited supplies of influenza vaccines, SAGE has recommended that health workers and older adults are the highest priority groups for influenza during the COVID-19 pandemic.’
For similar reasons, older people and health workers are expected to be first in line for COVID-19 vaccines which will initially be in short supply next year.
Vaccine shortages and the need to prioritise were discussed at a webinar to mark the launch of the first EU Flu Day on 14 October. The event featured contributions from the European Commission, WHO Europe, a Member of the European Parliament, a representative of community pharmacists, and two participants from the European vaccine sector. Watch it here
‘The COVID-19 pandemic has shown us once again the enormous value of vaccines,’ said MEP Dolors Montserrat. ‘Many countries including Spain are increasing orders for flu vaccine doses. Overall, it seems that we will see a record number of doses produced and distributed.’
While a COVID-19 vaccine is awaited, MEP Montserrat encouraged people to use the vaccines available, including flu which is particularly important for those in high-risk groups. ‘I recognize that the industry is doing its best to increase their supply to meet this demand, even if I’m aware that vaccines are complex biological products that cannot be produced overnight – it takes more than a year from start to finish,’ she said.
Industry experts said earlier engagement between governments and companies is needed to ensure a better match of supply and demand in the years ahead.
Some good news
Notwithstanding the global COVID-19 pandemic and the shortage of flu vaccines, there is some positive news. This flu season is likely to be milder than any in living memory, according to experts. The reason is simple: the restrictions, mask wearing and social distancing measures designed to reduce the spread of SARS-CoV-2 also contain the spread of other respiratory infections.
In the southern hemisphere, flu cases were exceptionally low. Testing usually suggests influenza infection rates ranging from 10% to 30%, according to Dr Moen. This year, just 1% of influenza tests have come back positive. Data from the northern hemisphere suggest a similar pattern, although it is still very early in the annual flu season.
‘This really is a historic low in terms of flu circulation,’ Dr Moen said. ‘And we feel confident this is not due to a lack of testing or lack of surveillance.’
Despite the apparently low threat, she urged people to remain vigilant when societies begin to reopen. ‘We are seeing some sporadic outbreaks in some areas of the world and so we really believe that as society opens back up, we’ll probably start to see flu circulate again back to more normal proportions.’
Therein lies the big question: will the unprecedented demand for flu vaccination, at a time of limited influenza outbreaks, be sustained next year when the risk of infection might return to normal levels?