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Health Matters: Delivering the flu immunisation programme during the COVID-19 pandemic

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The latest edition of Health Matters, PHE’s professional resource, focuses on the national flu immunisation programme and the delivery of the 2020/21 programme, which will be the largest one to date offering 30 million people a flu vaccine.

This blog provides a summary of the full edition’s content and the main things to know about the 2020/21 programme.

Please note we cannot answer any questions that relate to individual health concerns. You should consult your GP or specialist consultant.

What is flu?

Flu is an acute viral infection of the respiratory tract, usually characterised by a fever, chills, headache, aching muscles, joint pain and fatigue, but not a new, continuous cough or a loss of or change in your normal sense of taste and smell, which are symptoms of COVID-19.

Flu is a highly infectious virus different to the common cold, and spreads rapidly in closed communities and even people with mild or no symptoms can infect others.

There is a higher risk of severe illness from flu for some at-risk groups, including:

  • older people
  • the very young
  • pregnant women
  • those with an underlying condition
  • those who are immunosuppressed

The average number of estimated deaths in England for the last five seasons (2015/16 to 2019/20) was over 11,000 deaths annually. This ranged from almost 8,000 deaths last season (2019/20) to over 22,000 deaths in 2017/18.

Flu vaccination remains the best defence we have against flu and protects those people who are most vulnerable.

The co-circulation of flu and COVID-19

We are approaching a winter where we are likely to face co-circulation of flu and COVID-19 and it is possible to be co-infected with flu and COVID-19 at the same time. New PHE research suggests that people with flu and COVID-19 co-infection are more at risk of severe illness and those infected with both viruses were more than twice as likely to die than someone with COVID-19 alone. Most co-infection cases were in older people and more than half of them died.

Helping to protect against flu is particularly important as COVID-19 is still circulating and people vulnerable to COVID-19 are also at risk of complications from flu. This will in turn protect the NHS and social care, which is crucial this year as the system will also be dealing with COVID-19 cases.

What’s new for 2020?

This year, there is a need for a concerted effort to reach eligible groups particularly those who are at risk from COVID-19 as well as flu. Therefore, the population eligible for the flu vaccine has increased to 30 million for the 2020/21 programme, up from 25 million in 2019/20, making it the largest programme to date.

A new national call and recall service will alert people that they are eligible, with a further reminder prompting them to book their appointment to help drive vaccine uptake. This will support the work of local GP practices and pharmacies, many of which already routinely invite registered eligible patients.


The following groups are newly eligible for the flu vaccine this season:

  • Secondary school children in Year 7

For the first time, the nasal spray vaccine will be offered to an extra 600,000 children in school year 7.

  • Household contacts of those on the NHS Shielded Patient List

Household contacts of people who have been shielding will also be offered the vaccine, which makes an estimated 920,000 extra people eligible this year (excluding those people estimated to already be in another cohort).

  • 50 to 64 year olds

There will also be a phased extension later in the season, to offer free flu vaccine to 50 to 64 year olds.

  • Domiciliary health and social care workers

There is an expanded offer this year for frontline social care workers. To help increase uptake in the social care sector, for the first time, pharmacists will be able to vaccinate both residents and care home staff at the same time.

The eligible groups have also been expanded to include those health and social care workers employed through Personal Budgets and/or Personal Health Budgets to deliver domiciliary care to patients and service users.

What happened last year and what are the ambitions for this year?

In the 2019/20 season:

  • over 15 million adults and children were vaccinated in England from the eligible population of 25 million
  • England had some of the best uptake rates in Europe, but it varied by cohort
  • Vaccine uptake in frontline healthcare workers was the highest ever, but we want to do better

PHE is calling for a concerted effort to achieve a minimum of 75% uptake across eligible groups and where possible, it is expected that coverage will be higher than this.

How do we know which strains should go into the flu vaccine?

The World Health Organization (WHO) reviews the global situation (once for the Northern Hemisphere vaccine and once for the Southern Hemisphere) each year and recommends which flu strains should go in the vaccine to be manufactured for the following season. This recommendation is based on the viruses circulating each season and epidemiological data from around the world.

The WHO has to make a decision on which strains of flu to protect against, before flu starts circulating several months later the following season. For more information on this year’s strains, visit this page on the WHO’s website.

You can read more about this process in our ‘Flu detectors’ blog.

Delivering the programme during the COVID-19 pandemic

This year, people will need reassurance that appropriate measures are in place to keep them safe from COVID-19 when going for their vaccine.

Providers are expected to deliver the programme in line with standard operating procedures that have been issued and guidance on social distancing and infection prevention and control. They should be prepared to make adjustments in the face of any local restrictions to ensure those at highest risk can continue to be vaccinated.

This edition of Health Matters includes calls to action for delivering the programme in the context of COVID-19, for:

  • all frontline health and social care workers
  • General Practice and community pharmacists
  • System Transformation Partnerships (STPs), Integrated Care Systems (ICSs) and Clinical Commissioning Groups (CCGs)
  • local authorities
  • employers of individuals working as providers of NHS and social care services

Visit the Health Matters area of GOV.UK or sign up to receive the latest updates through our e-bulletin. If you found this blog helpful, you can read other Health Matters blogs here.

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