National flu immunisation programme plan 2022 to 2023

The annual flu letter describes the national flu immunisation programme and outlines which groups are eligible for flu vaccination.

The NHS influenza immunisation programme 2022 to 2023

For the last 2 years during the coronavirus (COVID-19) pandemic we have had the largest NHS influenza vaccination programmes ever. We have also seen some of the best influenza vaccine uptake levels ever achieved in many of the cohorts, with more people vaccinated than ever before. We extend our thanks for all the hard work undertaken by the NHS to achieve this.

As a result of non-pharmaceutical interventions in place for COVID-19 (such as mask-wearing, reduced social interactions and international travel) influenza activity levels were extremely low globally in 2020 to 2021 and at present continue to be low. A late increase in activity cannot be ruled out this season. As social contact returns to pre-pandemic norms there is likely to be a resurgence in influenza activity in winter 2022 to 2023 to levels similar to or higher than before the pandemic. The potential for co-circulation of influenza, COVID-19 and other respiratory viruses could add substantially to pressures in the NHS in 2022 to 2023, by addition, or by prolongation of the overall period for which respiratory viruses circulate in sequence.

Eligibility

Groups eligible for influenza vaccination are based on the advice of the Joint Committee on Vaccination and Immunisation (JCVI). The programme aims to provide direct protection to those who are at higher risk of influenza associated morbidity and mortality and to reduce transmission to all age groups through the vaccination of children.

The 2 March 2022 letter confirmed that those eligible for the NHS influenza programme are the cohorts offered vaccine prior to the pandemic:

all children aged 2 or 3 years on 31 August 2022
all primary school aged children (from reception to Year 6)
those aged 6 months to under 65 years in clinical risk groups
pregnant women
those aged 65 years and over
those in long-stay residential care homes
carers
close contacts of immunocompromised individuals
frontline staff employed by the following types of social care providers without employer led occupational health schemes:
- a registered residential care or nursing home
- registered domiciliary care provider
- a voluntary managed hospice provider
- Direct Payment (personal budgets) or Personal Health Budgets, such as Personal Assistants

Cohorts that were eligible in the 2021 to 2022 season but that are not included in the cohorts for 2022 to 2023 are:

those aged 50 to 64 years
secondary school children in Years 7 to 11 (between 11 and 15 years of age on 31 August 2022)

We will continue to keep JCVI’s advice for the influenza vaccination programme under review, but for winter 2022 to 2023 those aged 50 to 64 years will not be offered a free influenza vaccine through the NHS. Whilst the extension of the schools programme to include all children up to year 11 has been recommended by the JCVI, to be introduced as far as it reasonably practical, this will not be taken forward over the 2022 to 2023 season.

All frontline health care workers, including both clinical and non-clinical staff who have contact with patients, should be offered the influenza vaccine to protect themselves and those they care for. This should be provided by their employer as part of the organisation’s policy to prevent the transmission of infection. Social care workers who are in direct contact with people who receive care and support services should also have the influenza vaccine provided by their employer. There are circumstances where frontline staff, employed by specific social care providers without access to employer led occupational health schemes (see above), can access the vaccine through the NHS free of charge.

The influenza chapter in ‘Immunisation against infectious disease’ (the ‘Green Book’), which is updated periodically, gives detailed descriptions of the groups outlined above and guidance for healthcare workers on administering the influenza vaccine.

Vaccines for the programme

Influenza viruses change continuously and the World Health Organization (WHO) monitors the epidemiology of influenza viruses throughout the world, making recommendations about the strains to be included in vaccines, with recommendations now confirmed for 2022 to 2023. This process has been far more difficult and potentially less precise since early 2020 due to far fewer influenza viruses isolated and analysed worldwide.

Every year JCVI reviews the latest evidence on influenza vaccines and recommends the type of vaccine to be offered to individuals. Providers should ensure that they have ordered adequate supplies of the recommended vaccines as set out in the letter of 2 March 2022 which confirmed which vaccines that will be reimbursed by the NHS for adult cohorts in the programme (see Appendix C).

Providers must ensure they have sufficient vaccine available to vaccinate all eligible individuals included within this letter (see above) in order to provide coverage at least equal to and ideally exceeding 2021 to 2022 uptake levels.

The UK Health Security Agency (UKHSA) procures all influenza vaccines for the children’s programme and these will be available to order through ImmForm ^{[footnote 1]} (see Appendix D). This includes the injectable cell-based Quadrivalent Influenza Vaccine (QIVc) for healthy children whose parents object to the Live Attenuated Influenza Vaccine (LAIV) on the grounds of its porcine gelatine content.

In order for providers to receive payment for administration and reimbursement of vaccine they will need to use the specific influenza vaccines recommended in the letter referred to above.

Vaccine uptake achievements in the last 2 years

Over the last 2 seasons we have had the most successful influenza vaccination programme ever, exceeding the WHO target of 75% for those aged 65 years and over for 2 years in a row and achieving higher uptake in most other cohorts compared to previous years.

Table 1. Influenza vaccine uptake (provisional data for 2021 to 2022 compared to end of season data for 2020 to 2021) ^{[footnote 2]}

Eligible cohort	2021 to 2022 vaccine uptake	2020 to 2021 vaccine uptake
Aged 65 years and over	82.30%	80.90%
In clinical risk group	52.90%	53.00%
Pregnant women	37.90%	43.60%
Aged 50 to 64 years not in risk group ^{[footnote 3]}	45.70%	35.20%
Aged 2 years old	48.70%	55.30%
Aged 3 years old	51.40%	58.00%
Frontline healthcare workers ^{[footnote 4]}	60.50%	76.80%
Eligible school-aged children ^{[footnote 5]}	51.50%	61.70%

Vaccine uptake ambitions for 2022 to 2023

It is likely that higher uptake has been partly driven by concerns about the COVID-19 pandemic and a greater understanding about the role of vaccines in preventing illness, as well as, in a small number of circumstances, the influenza vaccination being offered to eligible patients when they presented for their COVID-19 vaccination or booster. We want to build on the momentum of this achievement in the influenza programme and the successful roll-out of the COVID-19 vaccination programme, to continue to encourage influenza vaccine uptake in those who are eligible. Improved uptake in those in clinical risk groups, children aged 2 and 3 years old, and pregnant women should be achieved to provide direct protection to those at increased risk from influenza.

General practices and school providers must demonstrate a 100% offer this season by ensuring all eligible patients are offered the opportunity to be vaccinated by active call and recall mechanisms, supplemented with opportunistic offers where pragmatic. The aim of the influenza programme for 2022 to 2023 is to demonstrate a 100% offer and to achieve at least the uptake levels of 2021 to 2022 for each cohort, and ideally exceed them. Community pharmacy service providers do not have a fixed patient list from which to undertake call and recall activities. However, they should proactively offer influenza vaccination to any patient they identify as being eligible to receive it should the patient present in the pharmacy for any reason.

We also need to support those who are living in the most deprived areas, from ethnic minorities and other underserved communities to have as high uptake as the population as a whole. High quality dedicated and interculturally competent engagement with local communities, employers, faith and advocacy groups will therefore be required. Providers should therefore ensure they have robust plans in place for tackling health inequalities for all underserved groups to ensure equality of access to the influenza vaccine. Efforts should be made to show improvement in coverage in those groups who were more than 5% lower than the national average.

NHS England and Improvement (NHSEI) are currently considering the use of a national call and recall service following the successful use of this function during the past 2 influenza seasons. Details and planned timings of any communications will be shared with appropriate stakeholders should this service be utilised in 2022 to 2023. However, this service is intended to supplement not replace local call and recall mechanisms that are already in place contractually.

Trusts should continue to offer vaccination to pregnant women where they are commissioned to do so, as we have found that those who are offered a vaccination when attending routine maternity appointments are very likely to accept the offer. The same applies to other eligible patients who may prefer to access their vaccine at a Trust, where providers are commissioned to vaccinate at in and out-patient clinics.

All frontline health care and social care workers should be offered vaccination by their employer. This is an employer’s responsibility to help protect their staff and patients or clients and ensure the overall safe running of services. Employers should commission or implement a service which makes access to the vaccine easy for all frontline staff, encourages staff to get vaccinated, and monitors the delivery of their programme. The complementary NHS influenza vaccination offer for primary care staff has not been extended for the 2022 to 2023 influenza season. Influenza vaccinations for primary care staff, like other frontline healthcare staff, revert to being an employer’s occupational health responsibility.

As for last season, the definition of a frontline healthcare worker for the influenza programme will be aligned with that of the COVID-19 vaccination programme to include both clinical and non-clinical staff who have contact with patients. One of the quality indicators in the 2022 to 2023 Commissioning for Quality and Innovation (CQUIN) is a goal of vaccinating between 70 to 90% of staff.

Where employee-led occupational health services are not in place NHSEI will continue to support vaccination of social care and hospice workers employed by registered residential or domiciliary care providers as well as those employed through Direct Payment or Personal Health Budgets to deliver domiciliary care to patients and service users (see eligible cohorts and frontline health care workers sections above). Vaccination will be available through community pharmacy and general practice, in accordance with the relevant service specifications. This scheme is intended to complement, not replace, any established occupational health schemes that employers have in place to offer influenza vaccination to their workforce.

Where a social care employer is not able to provide an occupational health scheme, the 2021 to 2022 Community Pharmacy Seasonal Influenza Vaccination Advanced Service and 2021 to 2022 Seasonal Influenza Vaccination Programme Enhanced Service enabled community pharmacies and general practices respectively to vaccinate both residential care or nursing home residents and staff in the home setting in a single visit. Where these influenza vaccinations are delivered by general practice, we are planning to enable the continuation of vaccinating eligible residents and staff regardless of whether they are registered with the practice, subject to negotiation.

Good practice guidance material can be found at Increasing Health Care Worker and Social Care Worker Flu Vaccinations: Five components and marketing resources will be available to download and order from the Campaign Resource Centre. A healthcare worker influenza vaccination best practice management checklist for Trusts can be found in Appendix H.

Timing

Vaccination should be given in sufficient time to ensure patients are protected before influenza starts circulating. If an eligible patient presents late for vaccination it is generally appropriate to still offer it. This is particularly important if it is a late influenza season or when patients newly at-risk present, such as pregnant women who may not have been pregnant at the beginning of the vaccination period. The decision to vaccinate should take into account the fact that the immune response to vaccination takes about 2 weeks to fully develop.

Parents of any child at risk from influenza because of an underlying medical condition can choose to receive influenza vaccination in general practice, especially if the parent does not want their child to have to wait for the school vaccination session (which may be one of the later sessions of the season). General practices should invite these children for vaccination, making it clear that parents have the option to have their child vaccinated in general practice.

Conclusion

We would like to extend a huge thank you to all those involved for your hard work during very challenging times which have led to record breaking influenza vaccine uptake rates over the last 2 influenza seasons.

This Annual Influenza Letter has the support of the Chief Pharmaceutical Officer, the NHS National Medical Director, the NHS Chief Nursing Officer for England and the UKHSA Nurse Lead.

Yours sincerely,

Dr Thomas Waite, Deputy Chief Medical Officer for England

Dr Mary Ramsay, Director of Public Health Programmes, UK Health Security Agency

Steve Russell, National Director for Vaccinations and Screening, NHS England and Improvement

Any enquiries regarding this publication should be sent to immunisation@phe.gov.uk ^{[footnote 6]}.

For operational immunisation queries, providers should contact their regional NHSEI Public Health Commissioner