Are you ready for winter?

Key facts 

• The winter vaccination programme starts this month with pharmacies on the frontline of delivery once again
• In a world first, early adopter pharmacies  in England are also taking part in a RSV vaccination scheme 
• Consumers trust pharmacies as a source of self-care advice and treatments for common winter ailments

Learning objectives

After reading this feature you should be familiar with:

• Who is eligible for free NHS vaccinations this winter
• How to help patients book their flu, Covid, RSV and other vaccinations
• How to support customers with OTC self-care products and advice for common winter conditions.

As shorter and darker days herald the arrival of the cold and flu season, it is time for community pharmacies to start offering winter vaccinations again — and this year there is more to consider than just flu and Covid-19.

The sector has been providing seasonal flu vaccinations under a nationally commissioned service since September 2015, with the number administered by community pharmacists under the NHS advanced service in 2023/24 reaching a staggering 3,773,929. The end of last year also saw community pharmacy hit the milestone of providing 40 million Covid-19 vaccines.

Company Chemists’ Association modelling suggests that pharmacies could deal with a further 10 million vaccination appointments a year.

Chief executive Malcolm Harrison says that in time, pharmacies could become the natural home for all vaccinations. “Now is the time for policymakers to explore this enhanced role and build on the NHS vaccination strategy,” he says.

Flu and Covid outlook

World Health Organization (WHO) surveillance data for the week ending August 4, 2024 shows that flu rates in northern hemisphere countries remained at “interepidemic levels”, with activity elevated in a few countries in Central America and the Caribbean, Middle Africa, Western Africa, Southern Asia and South East Asia. The data shows that flu A(H3N2) viruses were predominant, except in Western Asia, South East Asia and Southern Asia, where A(H1N1)pdm09 viruses predominated.

In the Southern hemisphere, WHO data shows that flu activity remained elevated in a few countries in South America, Eastern Africa and Oceania, but was stable or decreasing in all reporting countries. Flu A(H3N2) viruses predominated, except in Eastern Africa, where A(H1N1)pdm09 viruses were predominant.

SARS-CoV-2 activity, reported from WHO surveillance in 62 countries, was elevated in most countries in Northern Europe and South West Europe, and a few countries in Eastern Europe, Western Asia, Southern Asia, South East Asia, Eastern Asia, Central America, and the Caribbean and Tropical South America. Increasing activity was reported in a few countries in Eastern Europe, Western Asia, Eastern Asia, and Central America and the Caribbean.

Here in the UK, Superdrug recently reported a 319 per cent spike in sales of its Covid lateral flow tests, alongside a 297 per cent increase in cold and flu relief products, suggesting a surge of illness across the nation this summer from the so-called FLiRT variant.

Lifesaving impact

A WHO/Europe study has set out the lifesaving impact of vaccines. It says that the known Covid death toll since the start of the pandemic in the WHO European region of 2.2 million might have been as high as 4 million without the vaccines that were introduced in December 2020.

Countries that implemented early vaccination programmes covering large parts of the population (such as Belgium, Denmark, Iceland, Ireland, Israel, the Netherlands, Malta and the United Kingdom) saw the greatest benefit in terms of overall number of lives saved. Most of those saved were aged 60 years or older, the group at highest risk of severe illness and death from SARS-CoV-2.

However, the study’s author, Dr Margaux Meslé, warns: “It is impossible to predict how the virus will behave for the remainder of 2024. Multiple waves could be possible as countries in the region have transitioned from crisis management to sustainable, integrated, longer-term disease management.”

Vaccination timings

Community Pharmacy England recently sent out a reminder of NHS England’s flu vaccination start dates. Like last year, these have once again been subject to change. The key changes for this season’s service are:

• Programme start date for pregnant women:  September 1
• Start date for other eligible adults, including frontline healthcare workers: October 3.

NHSE says the decision to push back the start date is based on evidence that the vaccine’s effectiveness can wane over time in adults. The Joint Committee on Vaccination and Immunisation therefore advised moving the start of the programme for most adults to the beginning of October. This is on the understanding that most vaccinations will be completed by the end of November, closer to the time when the flu season commonly starts. Pregnant women are an exception, in order to protect women and babies during pregnancy, and to protect babies in the first few months of life. Babies aged under six months are at high risk of complications from flu.There are no changes to the eligible cohorts for the 2024/25 season.

From September 16, NHSE’s National Booking System will open for all participating sites to post Covid and flu appointments. It will open for bookings from the public from September 23.

The last available appointment date will be December 20 for both flu and Covid vaccinations (apart from outreach activities).

Flu vaccines

Sanofi’s recombinant quadrivalent flu vaccine (QIVr) will not be available for the 2024/25 flu vaccination programme.

Instead, the seasonal flu vaccines for 2024/25 for at-risk adults aged 18-64 years (including pregnant women) are cell-based quadrivalent influenza vaccines (QIVc). People aged 60-64 years will be offered this or, for the first time, a new high-dose quadrivalent influenza vaccine (QIV-HD). Egg-grown quadrivalent influenza vaccine (QIVe) may be offered only when every attempt to use QIVc or in the case of 60-64 years also QIV-HD has been exhausted – evidence of this may be requested by the commissioner before reimbursement is agreed.

All adults aged 65 years and over will be offered adjuvanted quadrivalent influenza vaccine (aQIV) or high-dose quadrivalent influenza vaccine (QIV-HD). NHSE says cell-based quadrivalent influenza vaccine (QIVc) may be offered only when every attempt to use aQIV or QIV-HD has been exhausted – again, evidence of this may be requested by the commissioner before reimbursement is agreed. It is also recommended that aQIV is offered off label to those who become 65 before March 31, 2025.