Vaccines Europe - 28 Jan 2022
I am writing to you on behalf of Steering Group on Influenza Vaccination – a multi-stakeholder platform aiming to drive influenza vaccination uptake in Europe – to draw attention to how the current influenza season is going, and in particular:
- Highlight best practices from various European countries on how to extend access to the flu vaccination and mitigate the risk of a severe influenza season;
- Express the group’s concern about the lack of timely data collection of vaccination uptake in the region. There are early signs showing low uptake rates for influenza vaccination in certain countries, however there is currently no clear overview of the situation to guide policymakers due to the lack of timely monitoring systems;
- Call on the European Commission and WHO Europe to urgently initiate action to help Member States mitigate the possible burden of influenza by:
- Issuing recommendations for national authorities to extend access to the flu vaccine by prolonging the influenza vaccination season to end of February, and broadening the campaigns beyond just the elderly and at-risk groups;
- Facilitating best-practice sharing between national, regional and local authorities and continue to advocate for meeting the WHO 75% target for influenza vaccination coverage rates among risk groups;
- Using lessons learned from the COVID-19 pandemic to work on enhancing and harmonising tools for timely monitoring and surveillance of influenza vaccination coverage rates at regional level for future seasons.
Overview and context
The EU has had on average low coverage rates for influenza vaccination compared to the WHO 75% target for at-risk groups and healthcare professionals (HCPs), which was acknowledged as an EU target in the 2009 Council Recommendation on seasonal influenza vaccination. While a few countries are close to reaching the target, coverage rates in others are as low as below 20%, bringing the average figure to 44.3% in Europe.
In this season, the acuteness of raising vaccine uptake is becoming even clearer, with the double threat of COVID-19 and seasonal influenza. The vulnerable groups for influenza, such as patients with asthma or chronic obstructive pulmonary disease (COPD), are especially at risk. In any given year, influenza leads to 3–5 million cases of severe flu, and up to 650 000 deaths globally. With COVID-19 also in high transmission across Europe, the ECDC is warning for a so-called twindemic, which would put extreme pressure on already overstretched health systems.
Due to the lockdown and social distancing measures taken to mitigate the COVID-19 pandemic, the 2020/21 influenza season saw influenza virus circulation dropping to very low levels. This prevention of COVID-19 transmission may have led to a decrease in herd immunity against future influenza virus infections, increasing the risk of a severe influenza season as societies open up again.
The effect of the COVID-19 pandemic’s impact on the flu season is already being recorded across the world. In the United States, data shows that the cumulative hospitalisation rate for the 2021/22 season so far is already higher than the rate for the entire previous season. Yet, Europeans are not being sufficiently protected; we are seeing alarmingly low vaccination coverage rates in some countries in the region.
Country-specific data from the current flu season
- Due to the lack of a timely monitoring system of influenza vaccination coverage rates in Europe, there is no certain way for policymakers to assess the urgency of the current situation in real time and act accordingly. There is also no robust way of comparing data between seasons, regions or countries.
- In the ongoing influenza season, there are some alarming signals showing:
- However, we are also seeing some positive signs:
Highlighted best-practices to protect populations this season
- In France, the influenza vaccination campaign has been extended until end of February. France has also recommended for identified vulnerable populations to receive both the flu and theCOVID-19 vaccine on the same date, to help promote synergies in the health system.
- In Ireland, the flu jab will be made available for free to everyone over 50 (rather than only 65+), to limit pressure on health services.
- In Spain, the flu jab is recommended to the entire population this year.
- In Germany, the Agency of the Federal Ministry of Health called on citizens to get vaccinated against influenza, especially since the annual flu season in Germany typically lasts until mid-May.
Call to action – What can policymakers do?
- This season, the EU should call on Member States to extend access to flu vaccination by
- prolonging the influenza vaccination season under advice of the ECDC,
- broadening the campaigns beyond just the elderly and at-risk groups,
- ensure coherence in the approach to influenza and COVID-19 vaccination,
- and provide stronger public health messaging about the influenza virus to address the complacency and changing epidemiology caused by COVID-19.
- For future seasons, EU and Member State level policymakers should
- Use lessons learned from the management of the COVID-19 pandemic to enhance and further harmonise tools for timely monitoring and surveillance of influenza vaccination coverage rates at regional level.
- Facilitate best-practice sharing between national, regional and local authorities and continue to advocate for meeting the WHO 75% target.
- Drive educational initiatives for healthcare professionals, as a majority assess their knowledge about pathogens, vaccines and immune systems as being on a medium level.
- Help expand vaccination delivery channels to facilitate access to vaccination and promote information that supports confidence in seasonal influenza vaccination.
- Encourage early demand planning to ensure sufficient supply of vaccines (due to the complex manufacturing process of vaccines, orders need to be placed no later than December/January for the next influenza season).
On behalf of the Steering Group on Influenza Vaccination, I want to stress our commitment to working together with the European Commission and WHO Europe towards better protection against seasonal influenza for European citizens and health systems. Thank you for taking these suggestions into consideration.
- Prof. Ab Osterhaus, Chair, European Scientific Working group on Influenza (ESWI)
- Ber Oomen, Executive Director, European Specialist Nurses Organisation (ESNO)
- David Sinclair, Director, International Longevity Centre UK (ILCUK)
- Dr. Julia Tainijoki, Medical and Advocacy Advisor, World Medical Association (WMA)
- Mariano Votta, Director, Active Citizenship Network (ACN)
- Prof. Sally Kendall, Chair, European Forum for Primary Care
- Sibilia Quilici, Executive Director, Vaccines Europe
- Susanna Palkonen, Director, European Federation of Allergy and Airways Diseases Patients Associations (EFA)
- Prof. Thomas Szucs, Professor of Pharmaceutical Medicine and Specialist in Prevention and Public Health; Co-Chair of the Steering Group on Influenza Vaccination
 Members of the Steering Group on Influenza Vaccination: Active Citizenship Network (ACN), European Federation of Allergy and Airways Diseases Patients Associations (EFA), European Forum for Primary Care, European Scientific Working group on Influenza (ESWI), European Specialist Nurses Organisation (ESNO), International Longevity Centre UK (ILC UK), Vaccine Confidence Project, Vaccines Europe, World Association for Infectious Diseases, World Medical Association (WMA).
 https://www.cdc.gov/flu/weekly/index.htm?ACSTrackingID=USCDC_7_3- DM73071&ACSTrackingLabel=Influenza%20Burden%20Estimates&deliveryName=USCDC_7_3-DM73071.
 Ministry of Solidarites and Health (Ministère des Solidarités et de la Santé) – Message d’Alerte Rapide Sanitaire (MARS) – 11/01/2022
 https://apmgf.pt/2021/12/28/vacinometro-mostra-que-mais-de-80-das-pessoas-acima-dos-65-anos-de-idade-ja-terao-sido-vacinadas-contra-a-gripe/ – Unofficial data coming from local survey
 https://www.vacunas.sanofipasteur.es/vacunaciongripe/coberturasvacunacion – Unofficial data coming from local survey 1
 Ministry of Solidarites and Health (Ministère des Solidarités et de la Santé) – DGS-URGENT N2022_08 – 11/01/2022
 https://fonse.eu/wp-content/uploads/2021/05/ESNO_Vaccination_Survey_2020-Final-version_12- May_2020.pdf