Are we heading towards a FLU JAB CRISIS?

As more are encouraged to get the vaccine this winter, there are concerns over supplies

IT could be the move that helps us keep Covid-19 under control this winter. More of us are being encouraged to go to our GPs or local pharmacies and get the annual flu vaccine when it arrives in September.

But some GPs are expressing concern as the number of vaccines on order by the HSE will cover just 40 per cent of the population. A few days ago the Department of Health confirmed that 1.35million flu vaccines for adults and 600,000 for children have been ordered for the flu season. Independent TD Denis Naughten — who is himself a trained GP — says more should have been ordered as we need population-wide immunity to the flu to rule out confusion over the two viruses which have similar symptoms.

said ‘The only way our health service can manage a surge in Covid-19 infection this winter is if we can rule out the possibility that the patient has flu, as the symptoms are so similar.’

He is among those calling for a populationwide vaccination programme, rather than just the at risk groups and healthcare workers who normally get the injection.

This would be similar to Britain where it is hoped the whole population will be vaccinated in a special scheme being rolled out by the population there.

FLU AND COVID-19 SHARE SYMPTOMS

ONE of the main objectives is to make it easier to spot local outbreaks of Covid-19. The infection shares many symptoms with flu — such as a cough, fever and headache — and it can be difficult to tell them apart in the early stages.

The rationale is that if more people are protected against flu, it’s more likely that those displaying such symptoms do have Covid-19 rather than flu and can be socially isolated to stop it spreading.

Doctors are also worried that catching the two viruses together, or in quick succession, could overwhelm the body. ‘If your lungs have been affected by flu and then Covid-19 comes along, the combined damage could be very serious,’ says Professor Andrew Easton, a virologist.

Each winter, flu kills around 200 to 500 people in Ireland. Early indications from the southern hemisphere — where winter is well under way — is that flu cases are significantly down on previous years, something experts think is most likely due to lockdown measures halting the spread of infection.

But as we are out of lockdown here and the flu season will only kick in during late September and early October, we can’t expect the same results as Australia.

Dr Fergal Hickey consultant in Emergency Medicine Sligo University Hospital, says the problem of flu should not be underestimated.

‘The HSPC (Health Protection Surveillance Centre) produces figures on this on an annual basis but in the winter of 2019/2020— the winter that has just gone — there were 11,140 proven cases of influenza, 4,329 hospitalisations, 152 critical care admissions and 106 deaths,’ he told RTE radio.

‘What we will gain from the lockdown experience hopefully is the public health measures — better hand hygiene, better respiratory etiquette, better social distancing, I think they will all help.’

But he is concerned than an influx of flu patients combined with a Covid increase will leave hospitals struggling as it is hard to tell flu and other common respiratory viruses apart from Covid-19.

‘Our big problem in the Irish healthcare system is capacity. A 2018 report into acute capacity said we were short of over 2000 beds. Our difficulty now is that hospitals are having to effectively run two hospitals in one so you have a Covid stream and a non Covid stream but also because of the social distancing requirements bed capacity is going to fall rather than rise.’

Dr Richard Vautrey, chairman of the GP committee at the BMA, says vaccines will help make it easier for doctors to spot Covid-19 cases. ‘Reducing the numbers with flu will make it easier to spot outbreaks of Covid-19.

‘But it is crucial that we get the vaccine supply we need to make it work,’ he says.

‘In previous years, we have suffered delays in supplies of the flu vaccine reaching the frontline and that has been a concern. I hope it’s not going to happen this year.’

DELIVERY DELAYS CAUSE CONCERN

LAST year, manufacturing problems delayed the arrival of doses of the flu vaccine for at-risk and elderly adults by around a fortnight, while in some countries children due to get their nasal spray version also had to wait until early December.

This was the result of a fault in the testing process that meant millions of doses had to be reHe tested, thus causing the delay.

Flu vaccine production begins in February, when the World Health Organisation predicts which strains present the greatest threat over the coming 12 months.

That means GPs had to order their supplies for this year before the Covid crisis became clear, and they may not have enough to meet new guidelines.

The production process, which involves growing the vaccines in chicken eggs, takes six months or more, with the first of doses arriving at GP surgeries (where they must be stored in a fridge) at the end of September.

Questions remain about whether the half-a-dozen different suppliers of the vaccine, including firms such as GSK and AstraZeneca, will have the spare capacity to supply all the countries who have increased demand.

And some GPs are worried that if they order extra vaccines and the demand isn’t there, they could be left with thousands of euro worth of stock that must be destroyed by the expiry date of the end of March next year.

However, professor of international health and consultant on infectious diseases for the Royal College of Surgeons in Ireland, Sam McConkey said it is difficult to get the public to take the flu jab.

‘Our past experience has been that a lot of people for various reasons [don’t take the vaccine] some are just too busy, some are sort of running around and maybe it’s not a top priority and they kind of like it in theory, but in practice they just don’t get it while some others are worried about it,’ he explained.

Even for hospital staff, who are at more of a risk to the common flu, it is hard to get them all to take it, he said, adding: ‘Ordering things is difficult because if you order too much and it goes off then you waste your money.’

The HSE said of its flu vaccine programme: ‘Population estimates are taken from the Office of National Statistics and the estimated number of people who are in one of the risk groups is taken from survey data, as there are no chronic disease registries in Ireland. Healthcare and social care workers are estimated from the Census and pregnant women from births data.

Based on this, 1.4million doses of Quadrivalent Inactivated Influenza Vaccine have been secured and delivery will commence early September to GPs, pharmacies, hospitals etc.’ The Department said the HSE has also ordered 600,000 doses of the Live Attenuated Influenza Vaccine, which is delivered via nasal drops and will be made available to all children aged two to 12.

‘The quantities of vaccine ordered are expected to be sufficient to meet even an increased level of demand as a result of Covid,’ it said, adding there are no plans to make flu vaccinations mandatory at present.

The World Health Organisation says vaccine firms produce around 1.5 billion doses every year but have the capacity to boost this to six billion in the event of a flu pandemic.

Professor John Oxford, a

virologist, says: ‘Flu vaccine production capacity around the world has increased significantly in recent years.’

PHARMACIES ARE AN OPTION

EVEN so, some experts warn leaving vaccination too late can increase the risk that patients are not properly protected. ‘The earlier you give the jab, the better,’ says Professor Easton. ‘Once you have had the injection it takes two to three weeks before your immune system produces enough antibodies [infection-fighting cells] to reach full protection.

‘This is especially the case if you are older and your immune system has become less responsive with age. We need to see vaccine deliveries taking place when they are actually needed. We don’t want anxious patients facing long delays.’

Another option is getting it in pharmacies who also provide flu jabs for around €20.

This year will be no different, according to Laura Dowling, a pharmacist for Lloyds Chemist, based in Stillorgan, Co. Dublin.

‘We are doing flu vaccines in 89 of our stores and we will be encouraging everyone and anyone to get the vaccine,’ she says.

‘It will be important for the whole of society as well as the health service this year. It is important people are vaccinated as the flu, like Covid, is a respiratory tract infection and it is going to be difficult for doctors to discern between the both of them so if people get the vaccine hopefully they will be immune to flu.’

All pharmacists will be trained to give the vaccine in line with the current Covid-19 guidelines and restrictions.

‘We will santise the care room before and after every patient,’ Ms Dowling says. ‘The patient will be asked to wear a face mask, the pharmacists will be wearing full PPE and we will be limiting the contact with the patient.

‘The patient will be asked to book an appointment then fill out a short questionnaire off the premises. They bring that in and we can upload it. Everything will be done with a limited time on the premises.

‘This year we have the nasal vaccine for children between two and 18 years old as well we will have availability for all.’

Ms Dowling has long been a champion of the flu vaccine and often posts educational information via her social media site @fabulouspharmacist.

‘The flu vaccine provides the best form of protection against the flu and its complications,’ she says.

‘Although it can be self limiting, in some cases, it can make people seriously ill and the more people who are immunised against it, the less likely they are to spread it. For example if you have elderly or immunocompromised people in the family and all the other members around them have been vaccinated, the elderly person is less likely to get flu.

‘We are advising people to get it to protect themselves but also the vulnerable in society from new born babies and pregnant women to the elderly.

‘I have always been a strong advocate for the flu vaccine but certainly this year it is very important for people to get the vaccine because if we get an increase in Covid-19 cases coupled with the flu, that will put an unprecedented strain on our health care system.’ WILL SOME HAVE A BOOSTER JAB?

WHILE there may be risks for some patients in delaying vaccines until late in the year, other evidence suggests giving them too early could be just as problematic. With the number of people getting the vaccine steadily rising, concerns have grown about whether immunity lasts long enough to protect recipients all through the winter.

Research has shown that within weeks of being administered, the effect of any flu jab starts to wear off. A 2018 study by scientists from the US health provider Kaiser Permanente Northern California found that just three months after being vaccinated, patients were 50 per cent more likely to catch the virus than in the first week or two of being immunised — suggesting a fairly rapid decline in the level of protection the jab provides.

Flu vaccines are never a perfect match for the virus in circulation because, in the time between the start of the production process and immunisation of patients, the virus often mutates.

Although the vaccine can still have a strong effect on the immune system, its potency is reduced. Some research suggests flu vaccines’ effectiveness is reduced by about 10 per cent every 30 days after they are given. Some specialists think a second ‘booster’ jab might be needed for those vaccinated in late September, October or November.

Others insist the optimal time to have a flu vaccine is from the beginning of October to December. But it is still important to take up the offer of vaccination outside this window.

It takes between ten and 14 days for your immune system to respond fully after you have had the flu vaccine. MEDICS NEED TO SET AN EXAMPLE

A SIGNIFICANT proportion of doctors, nurses and midwives have been resistant to having the vaccine. Some research suggests many shun the jab as they have concerns about its effectiveness (studies show it reduces flu risk by about 60 per cent).

Experts warn the deficit is undermining public confidence in vaccines generally. Professor Oxford says: ‘They should be setting an example.’