The Flu Crisis. Why we need an adult immunisation strategy.

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We woke yesterday morning to hear that the Chair of the Royal College of GPs, Dr Clare Gerada, had told the Telegraph that private flu vaccinations had affected the “delicate balance” of availability and should be stopped by the Government (1).

She has subsequently denied she wanted the Government to ban healthy people – the so-called “worried well” from being able to access the vaccination in private pharmacies. And the Department of Health have said this is a non-starter anyway, pointing out that “Pharmacies are private businesses and we are not able to prevent them from selling the vaccine commercially”.
 
Whilst Dr Gerada is certainly right that we need to prioritise the most vulnerable, the spread of flu is prevented not just by vaccinating the most vulnerable, but also those who come into contact with them.
 
At a recent ILC-UK event we heard about the cost effectiveness and the efficacy of the flu jab for all. We also heard about the importance of immunising adults to protect vulnerable groups. We went as far as debating whether there was a case for compulsion and whether there was a role for employers to vaccinate their workforce.
 
But the dominance of the flu story across a couple of weeks of news cycles raises the question of: how did we get into this mess?
 
Ahead of Christmas, there was already talk of the low levels of take-up of the seasonal vaccine. And despite the recent rush and the current shortages of vaccine, it is still the case that the take-up of the seasonal flu vaccine among vulnerable groups is 10 per cent below the level at the same time last year. (2)
 
Part of the issue has probably been the Government’s decision to not run the advertising campaign in the same way as previous years. The Government decisions to heavily cut back on communications spend after the election was partly motivated by a need for quick spending cuts. Cutting communications across all Departments was seen as an easy target.
 
The decision may have been partly motivated as a result of public health communications spending attracting criticism and accusations of “nanny state” from the media and government. But, even if the Government was critical of the value of public health communications campaigns, they seem to have made a major mistake by also reducing communications on health protection campaigns.
 
Alongside the lack of a communications campaign, we have had a long period of media scepticism to (swine) flu, hanging over from the experience of last year. Over Christmas we had a very quiet news cycle which forced the flu story onto national news. It appears that the supply hasn’t been able to cope with the subsequent demand.
 
But even if these issues were not in place, what the current crisis has highlighted is that we do not have an adequate strategy for adult immunisation in the UK.
 
Looking at Government websites there is limited advice which suggests adults should take the vaccine. NHS Choices for example, recommends that vulnerable individuals should have the swine flu vaccination but says nothing about whether non-vulnerable adults should (2).
 
The private pharmacies point out that if you have a busy life and can’t afford to take time away from work or other responsibilities, then you should have the immunisation. For the self-employed, for example, who could lose significant income if they suffer from a flu virus, you could argue that it is irrational not to have the injection.
 
In the United States, the recommendations are firmer. The Centers for Disease Control (CDC) in the USA this year, for the first time recommended that essentially everybody should get a flu shot every year.
 
There is an interesting, if technical, detail about the flu procurement model, which is left to GPs locally rather than managed centrally (GPs keep the difference between purchase price and list price as their incentive to vaccinate). The procurement model helps explain the difference between the coherence of the National Childhood Immunisation programme and the more piecemeal approach to adult vaccination.
 
Of course, we currently seem to have a supply crisis and Dr Gerada is right to prioritise for the flu jab should be “at risk” groups.  But stopping the private sector from selling the flu vaccine would be a folly.
 
Criticism of the “worried well” (as some media commentators have) as selfish is a huge mistake in terms of health protection. In what other area would we criticise people for wanting to vaccinate themselves – and as a result, reduce the risk for themselves and those they come into contact with.
 
Rather than discourage the private sector, we should actually encourage to better promote vaccinations to adults. After all, if Sainsbury’s can provide a flu jab for £8 (plus nectar points!), it is probably better/cheaper for the “worried well” to get their vaccination from Sainsbury’s than their GP.
 
There has to be some responsibility on Government. We need to understand the extent to which a lack of an advertising campaign has had an impact for example.
 
Supply should not be/have been an issue and we must understand why it has been so. The drug companies will make enough drugs if there is demand.
 
But more fundamentally and quickly, the DH and others also need to put in place proper advice for adults. We need a proper adult immunisation strategy.
 

David Sinclair

(1)  http://www.bbc.co.uk/news/uk-12158420.
 (2)  http://www.yorkshirepost.co.uk/news/More-swine-flu-vaccine-released.6682640.jp
 (3)  http://www.nhs.uk/conditions/pandemic-flu/Pages/Introduction.aspx

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