Health

'We don't want flu vaccine shortages again'

Professor David Salisbury
Image caption Professor David Salisbury says the problems this winter were unsatisfactory

Wellington House is a pretty unremarkable building.

Situated close to Waterloo train station, in the heart of London, it could be any block of offices.

But it is, in fact, the heart of the UK's vaccination programme.

Government officials working there take charge of ordering and supplying many of the main immunisations from MMR to the five-in-one jab for diphtheria, tetanus, whooping cough, Hib and polio.

They also played a key role during the swine flu pandemic.

But there is one major exception - seasonal flu.

Unique nature

When the government was taking charge of the vaccination programmes during the 1990s, it was decided flu would be best left with GPs because of the unique nature of the vaccination programme.

Whereas childhood jabs are offered to the entire population of youngsters, seasonal flu is restricted to certain groups.

As well as the over 65s, it is given to people with health problems such as diabetes - and the argument was that only GPs knew who they were.

But after a winter beset by shortages of the flu vaccine, which led to the government opening up stockpiles of the old pandemic vaccine even though it did not protect against all of the strains circulating, the government seems keen on change.

In an interview with the BBC News website, sitting in his office next to where the vaccine management is done, Professor David Salisbury, the UK's head of immunisation, said there was a "pretty compelling" case for government to take charge of ordering and supplying flu vaccines to GPs.

Professor Salisbury, who is leading a review into how the flu vaccine programme should be run, explained: "The question is: can we find a more effective way of contracting and purchasing and then monitoring and distributing using the sophistication that we now can bring to the process? Some of the reasons why we didn't do it before are no longer as robust because of the sophistication of the information systems that we now work with.

"Certainly this winter we have seen an unsatisfactory position with seasonal influenza vaccine where we know that there were people who wanted to be vaccinated who were in risk groups and couldn't be because the vaccine wasn't available at their practices.

"That is a situation that we don't want to see happen again. We compare that with the routine childhood immunisation programme where we have not had to suspend part of the programme because of shortage of vaccine for at least a decade. This argues that we do need to look very carefully at whether flu vaccine supply can be done on a more dependable basis."

His desire is based on the system that has been perfected by the Department of Health over the last decade. GPs and primary care trusts can put in orders through an online system.

Vaccine can be despatched within hours and there is an up-to-date record of where they go and how much is left - something that would have proved invaluable this winter.

"I'm so proud of what we have got here. Because we have got the whole thing integrated and accessible, we can challenge and test and monitor and performance manage. That is very powerful."

Emergency supply

But he acknowledges that such a change could not happen overnight and instead England may have to follow Scotland's lead and buy in an emergency supply as an interim measure.

One of the key issues which needs to be addressed is to do with GPs. They are paid to manage the vaccination programme.

Professor Salisbury said: "On the one hand, yes it is obvious in terms of supply management because it would certainly make the issues of, for instance, shortages much more preventable. But there are issues to do with GP payment, which is bound up in the purchase arrangements.

"It is not just the operational management that we have to work on. We also have to work with the GPs about the income they get from the flu vaccine programme. So it is complex and we have to be sure the profession agrees whatever we move to is a better way."

He said there would be discussion with GPs soon as he wanted to draw up plans for changes in the first half of the year.

Image caption The flu jab is only offered to certain at-risk groups

He also wants to establish what exactly caused the shortages. Since the government has given GPs access to the pandemic stockpile, more than 250,000 doses have been ordered, suggesting a significant number of doctors actually ran out.

He said it was a "conundrum" and he did not want to blame anyone until the facts were fully established.

However, he did suggest the most likely scenario was that GPs gave the vaccine to people who did not fall into the risk groups as figures suggested that the numbers coming forward for vaccination were not higher than previous years and the same amount of vaccine seemed to have been ordered.

"Unless we were above previous levels the vaccine doesn't sound like it went into people with risk factors. One GP did say when he was interviewed that in November they felt that they had got surplus stock because some of the regulars were not coming. And they were not coming because of fears over swine flu vaccine. And maybe they lowered the bar as to who they would give the vaccine to.

"Now that's not me, that was a GP on television. And then the regulars saw the coverage about the seriousness of H1N1… and then came back to the GPs. That may be what precipitated some of the problems."

Positive

One of the other key questions many people are asking about is whether children should be vaccinated against flu.

Current vaccination policy is based on immunising those most at risk of getting seriously ill, which does not include children.

But Professor Salisbury acknowledged there was a growing case for them to be included as a way of curbing the spread of the disease.

Children are sometimes known as "super-spreaders" as they are the most likely to spread the disease and, therefore, immunising them would have the double benefit of protecting children and limiting spread around the community and, as a result, deaths in the at risk groups as well.

"We know that young children and particularly school children are extremely good at spreading influenza. And if we vaccinated them there would be a personal benefit and a community wide benefit as well.

"But it has to be cost effective. So we will have to look very carefully at whether vaccinating these groups is indeed a good use of resources because resources we use for one part of health may mean there is less available for another part of health. The school-age children are an important part of the consideration as are the under fives."

He said this was a matter for the government's independent expert body, the Joint Committee on Vaccination and Immunisation, to consider, but he said in his personal view it was an "attractive concept".

Whatever happens in the coming months, Professor Salisbury's hopes something perhaps even more positive can come out of this winter's problems.

Vaccination rates - particularly for the younger risk groups - remain stubbornly low. Less than half of people with problems such as heart disease, diabetes and asthma come forward for jabs.

He admitted if that figure was to increase the government and NHS had to learn lessons about reaching out to those in the risk groups.

He refused to be drawn on the controversial decision by ministers not to run its normal advertising campaign at the start of the flu season urging people to get the jab.

But he also acknowledged the high-profile coverage of this winter's outbreak may also help.

"If the consequence is that next year we have even higher coverage I will be delighted."

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