POLICY REPORTS

Influenza Vaccination in the COVID Era: A LifeCourse View Report 2020

The report Influenza Vaccinations examined how the arrival of COVID-19 vaccines reshaped the flu season — from delivering both vaccines together and sustaining supply, to persistent low uptake among healthcare workers and the role of women and community HCPs in reaching high-risk groups. The Group set out observations, challenges, strategies and a full slate of 2021/22 campaigns.

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5th Life Course
Immunisation Summit
December 2020

Working Group on Influenza Vaccinations

Observations, Challenges, Strategies and Actions

Influenza & COVID Vaccines Together
Observations
The Introduction of an Annual COVID Vaccine May Affect Influenza Vaccinations
  • There are many unknown factors when administering the flu vaccine and COVID vaccine together in the future.
  • The current expectation is that most people will have to receive a COVID-19 vaccine or booster annually.
  • We do not know whether COVID vaccinations will be delivered in the future through the health systems or the parallel systems developed during the pandemic.
  • It might be possible to utilise contacts for COVID vaccination to administer the influenza vaccination, increasing overall uptake.
Challenges
Influenza and COVID Vaccines Delivered Together Might Be Challenging
  • Utilising the contact to administer the COVID vaccine for other vaccinations may only be possible when COVID vaccinations are delivered through the health systems.
  • When administering vaccines of different technologies there are many unknown factors, e.g. the new mRNA vaccines for COVID with the existing influenza vaccines.
  • It is currently unknown if the mRNA technology will be used for influenza vaccines in the future.
Strategies
We Must Utilize the Annual Contact to Vaccinate People with the Influenza Vaccines As Well
  • Look to utilise the contacts made for COVID vaccination across all ages and groups to bring up the importance of vaccination for appropriate people depending on age or group.
  • Utilise the infrastructure developed by countries to keep records for COVID vaccination and start keeping records for influenza vaccination, setting the national registry base for adulthood vaccination.
Influenza & COVID as Part of a LCI Strategy
Observations
There Has Been a Significant Increase in Influenza Vaccinations in 2020/21
  • There have been widespread campaigns for as many people as possible (but especially the over-50s) to have the influenza vaccine and alleviate pressure on healthcare services needed for COVID-19 patients. In France, rates reached 60% coverage — a rate not seen for the past two decades.
  • The COVID vaccine will be highly given in nursing homes, to both residents and carers. It is the first time in history that the elderly are in the frontline of a vaccination program.
Challenges
The COVID-19 Vaccine Is Mostly Delivered Through Parallel Systems
  • Many EU countries deliver COVID vaccinations through parallel systems and not through their primary organised prevention system responsible for other vaccinations.
  • With adults being a priority for COVID and influenza vaccination, there is a shift, for the first time in history, towards vaccination in adulthood.
  • COVID mortality rates among elderly people establish the need to get vaccinated and protected.
Strategies
A Life Course Approach to Vaccines Starting with Care Homes and the Elderly
  • Utilise the momentum of adults being a priority for protection to achieve high uptake for all vaccinations, especially among the 70+ population.
  • Utilise the newly acquired willingness to get vaccinated and protected against COVID to increase influenza vaccination across adulthood.
  • Establish that adulthood protection against all vaccine-preventable diseases, and the need to avoid unnecessary hospitalisations, should remain a priority for the years to come.
HCP Influenza Vaccine Uptake
Observations
Healthcare Worker Uptake of Flu Vaccines Remains Sluggish
  • Vaccination uptake among healthcare professionals and nurses in hospitals remains extremely low.
  • Despite significant demand for flu vaccination from the general population, healthcare workers still don't seem to understand the importance of flu vaccination.
  • Nurse uptake of influenza vaccination is often far lower than doctors', and with nurses being a considerable percentage of the workforce, this needs to be addressed urgently.
Challenges
Can We Make HCPs See the Dangers of Not Being Vaccinated Against Flu?
  • HCPs don't always perceive the danger of influenza, either for themselves or their patients.
  • HCPs are taking measures to be protected against COVID infections and consider themselves not in danger of being infected by influenza.
  • Interventions from hospitals to their staff are either non-existent or, in the best case, very reluctant.
  • The education offered for healthcare professionals, and especially for nurses, is very limited.
Strategies
Improved Education and Interventions to Persuade Healthcare Professionals
  • Vaccination of healthcare professionals should be presented as personal protection and as an ethical obligation to protect patients and hospitals.
  • Advocate more robust interventions from hospitals to include vaccination of healthcare professionals in their expected obligations as part of their occupation.
  • Insist and invest heavily in the education of healthcare professionals and nurses, driving a behavioural change.
HCP Influenza Vaccine Uptake
Observations
Analysing the Current Resistance Amongst HCPs for Not Taking the Flu Vaccine
  • In many hospitals, HCPs are offered the flu vaccine every autumn free of charge, yet uptake is still low.
  • HCPs do not feel at risk of infection, and this attitude has further increased due to the protection measures they are taking this year for COVID.
  • HCPs doubt the risks and consequences of being infected by influenza, so they do not consider influenza vaccination necessary.
  • HCPs are not trained to understand the various vaccine technologies and their related benefits, so they cannot make a choice for themselves or advise their patients.
Challenges
Why Is Flu Vaccination for HCPs Such an Ongoing Challenge?
  • HCPs resist any interventions to make influenza vaccination obligatory, considering it a personal choice.
  • HCPs doubt the efficiency of influenza vaccines, further decreasing their willingness to get vaccinated.
  • It is not clear what contributes more to their hesitancy — trust in vaccine efficiency, the perception of infection risks, or a general attitude towards all vaccines?
  • The efficiency rates of the new mRNA COVID vaccines might, in contrast to existing influenza vaccines' efficiency rates, worsen the situation.
Strategies
How Can We Persuade HCPs to Get Vaccinated?
  • Extensive training of HCPs and nurses is needed for them to understand the mechanisms and pros/cons of the various vaccine technologies.
  • Improvement of vaccine efficiency is needed to build trust that vaccinated people will be protected against influenza.
  • Strongly communicate that for the coming months, due to the COVID pandemic, hospitalisation will be difficult due to limited capacity and potentially dangerous, exposing patients to the dangers of other infections.
2021/22 Influenza Season Planning
Observations
Uncertainty in Planning Vaccine Availability, Supply and Demand
  • Demand for next season is highly unpredictable due to the social distancing and personal protection measures still in place.
  • There is still uncertainty on many issues related to administering the COVID and influenza vaccines simultaneously.
  • With COVID vaccines being a priority, it is uncertain whether national procurement systems will secure the supply of influenza vaccines needed to cover highly uncertain demand.
  • The public is now more familiar with efficiency rates of over 90% for the new technology COVID vaccines.
Challenges
Uncertainty in Vaccines Efficiency for 2021/22 Due to Low Prevalence
  • We do not know whether influenza vaccine production will be affected because the industry is focused on producing COVID vaccines.
  • We do not know whether low influenza prevalence will affect the influenza vaccines' efficiency for the coming season.
  • It is unclear whether the mRNA vaccine technology will also be applied to influenza vaccines in the future, improving the efficiency of the vaccine.
Strategies
How Do We Sustain Vaccine Uptake into Winter 2021/2022 and Beyond?
  • We must reach out to decision-makers to ensure adequate supply for the next season to cover high demand.
  • Utilise contacts for COVID vaccination to increase awareness and sustain high demand for next season.
  • Keep influenza vaccination a priority for next season and, despite the COVID pandemic, strongly communicate the need for people to get vaccinated against influenza.
  • Insist early on high influenza vaccination uptake to avoid an increase in infections when COVID restrictions are relaxed and people gradually return to normality.
Role of Women in Influenza Vaccine Uptake
Observations
Women Play a Crucial Role in Increasing Influenza Vaccine Acceptance and Uptake
  • Women's vital role in taking care of children and elders in their families is often overlooked in relation to influenza vaccination.
  • The intranasal vaccine is fairly well established but not promoted to sustain uptake and avoid transmission rates increasing within communities.
  • Vaccination uptake among children in the past season has decreased.
  • The school environment is where parents often discuss choices and decisions with other parents to increase vaccination acceptance.
Challenges
We Must Better Engage with Women As Family Behaviour Influencers
  • Women are more familiar with vaccinations, as they are often responsible for keeping their children's scheduled vaccinations.
  • Vaccinations are not yet considered part of a healthy lifestyle alongside diet or exercise.
  • The perception of annual children's vaccination, apart from routine vaccinations, might change when a decision is made about annual COVID vaccination for children.
Strategies
Women Must Be Central in Communication Strategies
  • Targeted communication and social media strategies are needed to engage women in influenza vaccination uptake.
  • Grassroots-level work is needed for women to become advocates for influenza vaccination in their families and local communities.
  • Communicate the importance of children being asymptomatic spreaders of influenza infections and the risks for the whole family, especially the elders.
Targeting High-Risk Groups – Working with Communities
Observations
People in Higher Risk Groups Are Not Taking Up Vaccinations
  • Acceptance of health prevention strategies and influenza vaccination is highly affected by socio-economic backgrounds.
  • Uptake among high-risk groups such as ethnic minorities, the obese, people with pre-existing conditions and smokers is significantly lower.
  • We have overlooked the value of community healthcare professionals such as GPs and community pharmacists, who are the most credible source of health information and advice for local communities.
Challenges
Universal Access Is Missing in Many Cases for Marginalized and Hard-to-Reach Groups
  • There is a lack of universal access to vaccination for marginalised and hard-to-reach groups, both in terms of funding and information.
  • Immunisation recommendations are relatively consistent across Europe, but there is a considerable gap between the recommendations and actual vaccination coverage in the EU.
  • Community HCPs are the ones who know their patients and their conditions and can identify those at risk, and still we focus more on general communication than grassroots work.
Strategies
Activate Community Healthcare Professionals and Settings to Increase Uptake
  • Prepare ready-to-use tools for GPs and community pharmacists to assess their patients and advocate influenza vaccination to those at risk.
  • Reach marginalised communities and groups with the help of their community healthcare professionals and through community settings.
  • Identify the opinion leaders and role models for each community and ask for their help to change attitudes and perceptions towards a preventive strategy.

Influenza Vaccinations Suggested Actions and Campaigns 2021/22

  • HCPs Advocating Influenza Vaccines in Every Consultation Campaign — with the focus on protecting elderly people from influenza, healthcare professionals of all specialties in contact with elderly people need to advocate for all vaccinations.
  • Production of Online Educational Materials and a Dedicated Campaign for HCPs on Influenza Vaccine Efficacy — designed to provide HCPs with the latest improvements to influenza vaccine efficacy, to build trust and advocate the use of seasonal influenza vaccines.
  • 2021 Expert Working Group on Increasing Influenza Vaccine Uptake Amongst HCPs — hosting an expert meeting on interventions to increase vaccination uptake among healthcare professionals, where rates remain low in many EU countries.
  • Healthcare Professionals Promoting Flu Vaccines Online — a campaign for individual healthcare professionals to actively engage on social networks through campaigns, scientific evidence and interventions, keeping influenza vaccination a priority after COVID vaccines have been given.
  • Women as Influenza Vaccine Influencers Communication Campaigns — targeted communication and a social media strategy to engage women in influenza vaccination uptake, advocating at the grassroots level in their families and local communities.

Influenza Vaccinations Suggested Actions and Campaigns 2021/22

  • Social Media Campaign to the Public on Children as Asymptomatic Spreaders of Influenza — targeting a reversal of the decrease in childhood influenza vaccination uptake during the COVID pandemic, and avoiding the risks for the whole family and especially the elders that low childhood uptake creates.
  • Community Healthcare Professionals Educational Campaign to Increase Uptake — production of ready-to-use tools for GPs and community pharmacists to assess their patients and advocate influenza vaccination to those at risk, targeting marginalised communities and groups with the help of their community healthcare professionals.
  • Community Opinion Leaders as Role Models Local Campaign — identify the opinion leaders and role models for each community and ask for their help to change attitudes and perceptions towards a preventive strategy.
  • A Dedicated Campaign for Nurses to Take the Seasonal Influenza Vaccine — a webinar series for nurses to drive behavioural change, increase seasonal flu vaccine uptake when offered, and advocate at every opportunity to patients.

Influenza Vaccinations Suggested Actions and Campaigns 2021/22

  • HCP Campaign to Colleagues Within Their Hospitals and Clinics Presenting Taking Flu Vaccines as an Ethical Obligation — presenting HCP flu vaccines as personal protection and an ethical obligation to protect patients and hospitals.
  • HCP-Led Vaccine Policy Group Looking at Utilising the Infrastructure Developed to Keep Records for COVID Vaccinations for Influenza Vaccinations — using COVID infrastructure and demand as a base for an adulthood vaccination national registry, leading with influenza vaccines.
  • Public Campaign for the 2021/22 Flu Season Early on in 2021 — with very few cases of influenza this season due to social distancing and high vaccine uptake, an awareness campaign is needed to warn of a super-resurgence of flu in 2021/22 without widespread vaccine uptake again.

Contributors

Roman Prymula • Gary Finnegan (Vaccines Today) • Elisabeth Sanders (RVIM) • Jess McNamara (EPSA) • Barbara Rath (ViVI) • Anna Odone • Hanna Nohynek (THL) • Daniela Quaggia (ACN) • Peggy Maguire (EIWH) • Roy Philip • Catherine Weil-Olivier • Elena Moya (CoMO) • George Syrogiannopoulos • Paolo Bonanni • Timo Vesikari • Dace Zavadska • Mihai Craiu