People aged between 50 and 64 years old will not be eligible for a free flu vaccination in the 2023/24 season, the government announced yesterday in its flu vaccination programme letter.

But the Pharmaceutical Services Negotiating Committee (PSNC) has said that the government should explain to patients in this age bracket why they won’t be eligible for the flu vaccine on the NHS, as they have been since 2020.

The government also announced tighter rules around using alternative vaccines, due to the risk of an egg-cultured vaccine being less effective against certain strains, and told providers to place orders with more than one manufacturer to ensure sufficient stock of the correct vaccine.

But PSNC said that the advice has come too late in the season to help pharmacy owners finalise their plans, and many may have already ordered less stock to minimise financial risk.

Changes to eligible groups

For the first time since 2020, UKHSA has decided that those aged between 50 and 64 will not be eligible for a free flu jab.

Alastair Buxton, PSNC’s Director of NHS Services, said that PSNC was ‘disappointed’ the cohort had not been included and added: ‘We hope that the government will ensure this change, along with the reasons for it, are properly communicated to the public and not left to pharmacy teams to deliver.’

A Department of Health and Social Care spokesperson told The Pharmacist: 'As we are now living with COVID-19, we will continue to focus on protecting those at greatest risk of flu. As such, the temporary adult flu programme expansion to include low-risk 50-64 year olds will not continue in 2023/24.

'Closer to the autumn season, those who are eligible for a free flu vaccination will be encouraged to book their appointments via letter, email and text message, and a major winter communications campaign runs each year.'

The Commissioning for Quality and Innovation (CQUIN) has set out a goal of vaccinating 75% of healthcare staff – ‘reflecting the importance of vaccinating staff both for their own protection and to reduce transmission to vulnerable patients’ – but community pharmacy employers will have to cover the cost of staff vaccinations for those in non-eligible groups.

Those eligible for a flu jab on the NHS include:

  • those aged 65 years and over
  • those aged six months to under 65 years in clinical risk groups (as defined by the Green Book, chapter 19 (Influenza))
  • pregnant women
  • all children aged two or three years on 31 August 2023
  • primary school aged children (from Reception to Year 6)
  • those in long-stay residential care homes
  • carers in receipt of carer’s allowance, or those who are the main carer of an elderly or disabled person
  • close contacts of immunocompromised individuals
  • frontline workers in a social care setting without an employer led occupational health scheme

And providers should align delivery of the flu vaccine programme with any other commissioned vaccinations that the patient is eligible for, where appropriate.

Tighter rules on alternative vaccines

For each cohort, a specified vaccination is recommended as a first option, with a specified alternative vaccine allowed only if the first cannot be used.

Commissioners could refuse to reimburse vaccine providers for use of alternative vaccines, unless contractors can provide evidence that they have exhausted all attempts to use the recommended first line vaccine.

For those aged 65 and over, the adjuvanted quadrivalent influenza vaccine (aQIV) / recombinant quadrivalent influenza vaccine (QIVr) is recommended as a first option, while the Cell-based quadrivalent influenza vaccine (QIVc) should only be used when every attempt to use aQIV or QIVr has been exhausted, the flu vaccination letter sent out yesterday by the Department of Health and Social Care (DHSC), NHS England (NHSE) and the UK Health Security Agency (UKHSA) said.

And for those aged 18 to 64 in clinically at-risk groups, the cell-based quadrivalent influenza vaccine (QIVc) / recombinant quadrivalent influenza vaccine (QIVr) should be prioritised as a first line vaccine, with the egg-grown quadrivalent influenza vaccine (QIVe) only to be used when every attempt to use QIVc or QIVr has been exhausted.

Community pharmacies may be asked to provide evidence of this to show upon request from their commissioner, and commissioners will ‘actively reclaim’ any payments made for administering the incorrect vaccine, the letter said.

This is because flu viruses grown in eggs can cause the virus used in the vaccine to change (‘egg-adaptation’) and therefore possibly be less effective, particularly against A(H3N2) strains, so flu vaccines which do not use eggs in the manufacturing process (cell-culture or recombinant) are to be prioritised.

Place orders with multiple suppliers

The letter also said that vaccine providers should ensure that they have ordered adequate supplies of the recommended vaccines to vaccinate all eligible individuals.

It warned that vaccines may be subject to delay or only available in limited quantities because of manufacturing processes and commissioning arrangements, and told providers to place orders with more than one manufacturer to make sure they have enough stock.

But Mr Buxton said that the letter had come ‘unforgivably late’, which ‘has not helped pharmacy owners to finalise their plans for the forthcoming season’.

‘The protracted delay is likely to have undermined the confidence of pharmacy owners, which given the current financial pressures, may have resulted in some of them ordering less flu vaccine stock than in previous years to reduce their financial risk,’ he added.

NHSE, DHSC and UKHSA have been contacted for comment.