Vaccines Europe - 19 Jul 2021
Seasonal influenza poses a significant but often under-recognised challenge to national health systems across Europe. Despite influenza vaccines being available for decades, influenza still has one of the highest and recurring impacts in terms of incidence and mortality among vaccine-preventable diseases and is estimated to cause up to 70,000 deaths in the EU each year, particularly among older adults and other at-risk groups.
The persistence, or resurgence, of COVID-19 during influenza seasons threatens to overwhelm healthcare systems and workforce, due to an even greater number of illnesses, hospitalisations and deaths. This is a significant worry as many healthcare professionals, exhausted from the COVID-19 pandemic, are exhibiting symptoms of psychological trauma, anxiety and depression.
In 2020, we observed an unprecedented increase in demand for influenza vaccines as health authorities sought to minimize preventable disease and keep individuals at risk of influenza complications out of hospitals and community practices. Vaccine manufacturers responded to this increased demand by supplying on average 30% more doses in Europe for the 2020/21 influenza season through maximising their production campaigns.
Complacency and changing epidemiology might undermine efforts to protect population from influenza
While governments have been very active in purchasing influenza doses to protect their populations, there is a risk that complacency might lead to very low vaccination uptake. The extremely low levels of influenza circulating, due to travel restrictions, exceptional social distancing measures and the possibility of viral interference along with higher vaccination rates, may result in lower population natural immunity, increasing the risk of an upsurge of cases for future influenza seasons. World leading epidemiologists warn that the current situation severely challenges our ability to predict the epidemiology of the next influenza season and that as lockdowns and border controls are eased and international travel gradually resumes, the threat of an upsurge in influenza and the devastating health impacts that could come from a severe influenza season needs to be taken seriously.
The unpredictable risk from influenza further reinforces the need to remind governments and their populations of the importance of protecting older people and those with underlying conditions through vaccination, not only from COVID-19 but also influenza.This is especially important as the risk factors and populations at risk for COVID-19 and influenza overlap.
Addressing challenges of concomitant deployment of COVID-19 and influenza vaccination
We recognize that concomitant deployment of COVID-19 and influenza vaccination programmes may pose significant challenges, which need to be promptly anticipated and addressed to ensure continuity in and high uptake of available vaccinations in the population. Complacency, due to lower influenza epidemiology and strong focus on COVID-19 vaccination, coupled with complexity and confusion about where and when to get vaccinated may hamper people’s ability and willingness to get the influenza vaccine. The recent experience in Australia, where 2021 flu vaccination rates have been significantly lower than in 2020 is a reminder of the importance of clear and consistent public messaging to maintain uptake of other vaccinations, despite of COVID-19 vaccination program continuation.
In this context, the French Haute Autorité de Santé (HAS) recently issued a reminder that influenza vaccination reduces the risk of concomitant or successive infections with both viruses, especially in people with comorbidities. Several health authorities have also published recommendations on concomitant administration of COVID-19 and influenza vaccines to avoid any delay in influenza vaccination and simplify the vaccination process. The outcome of a preliminary Phase 3 sub-study provided initial data which are supportive of this approach, however the data from further larger studies are still awaited. At the time of writing, concomitant administration of COVID-19 and influenza vaccines has not been approved by the European Medicines Agency.
Early demand and accurate forecasting – key to the success of influenza vaccination programme
The demand for influenza vaccines has remained high for the 2021/22 season and we acknowledge the significant efforts from governments to anticipate and secure adequate doses to protect their population from influenza and its complications.
Preparation for influenza vaccine production commences one year in advance of delivery with sourcing of e.g. raw materials, critical reagents, disposables. For vaccines to be delivered in time for vaccination to begin in the fall, vaccines manufacturers may commence manufacturing of one or more of the vaccine viruses at risk, prior to the WHO and EMA recommendation based on their available information as to which viruses are most likely to be included in the vaccine.
Early planning and forecasting for future seasons, as well as dialogue and anticipation of policy changes and recommendations with the vaccines manufacturers and the healthcare distributors are critical to the success of influenza vaccination programmes. Ensuring timely and accurate vaccine supply for the upcoming influenza seasons does not only allow vaccines manufacturers to maximize their existing influenza vaccines production capacity but also allow to continuous investment in building manufacturing capacity for meeting the future demand. The inclusion of the healthcare distribution sector in the dialogue is similarly essential to ensure the availability of the necessary cold room storage capacities to accommodate both influenza and COVID-19 vaccines in parallel.
Continued commitment from influenza vaccines developers, manufacturers and distributors
The vaccine industry continues to work around the clock to develop and deliver the COVID-19 vaccines in response to the current pandemic. In parallel with these efforts, influenza vaccine manufacturers have continued to develop enhanced influenza vaccines, for example, through the use of adjuvants, high dose, cell or recombinant based technologies. Several companies are also investigating the use of the “new” technologies which have been employed in the COVID-19 response for influenza vaccines.
However, seasonal influenza and COVID-19 will continue to be a combined threat this year, hence, it is critical today to ensure the best use of existing vaccines which have proven benefits in preserving people’s health and avoiding sustained pressure on healthcare systems.
Calls for action
We encourage EU Member States to demonstrate strong political leadership and to take the necessary policy measures to underline the importance of influenza vaccination to the public and healthcare professionals (HCPs), while balancing the considerations of implementing concomitant influenza and COVID-19 vaccination programmes. Multi-stakeholder approaches will contribute to achieve this, including:
- Strong, clear and consistent campaigns and calls to get vaccinated, and extension of the influenza vaccination campaign duration to broaden vaccination opportunities.
- Facilitation of access via healthcare professionals in local communities.
- Equal priority on maintaining progress in all vaccination programs, including for influenza, through pro-active public education and communication by authorities in collaboration with key stakeholders including medical, nurses & pharmacist associations, healthcare distributors, civil society groups and public health institutions to secure uptake and confidence in vaccinations.
- Clear communication and guidance to HCPs on the programmatic management of the influenza vaccination alongside the COVID-19 one, timing and location of vaccine supply, right time to vaccinate and co-administration, so they can plan and advise patients and citizens accordingly.
In summary, we encourage early multi-stakeholder dialogue and initiatives and welcome on-going actions from EU Member States as they work to ensure their national influenza vaccination programmes are effectively communicated and implemented. Policy changes and early engagement in future influenza seasons will help to both increase and sustain demand and supply for influenza vaccines in the long-term, which is not only in the interest of public health and security but is also a key element in increasing pandemic preparedness.
 Data provided by Vaccines Europe Members (Abbott, GSK, Sanofi Pasteur, Seqirus) in October 2020.
 Baker, Rachel E et al. “The impact of COVID-19 nonpharmaceutical interventions on the future dynamics of endemic infections” Proceedings of the National Academy of Sciences of the United States of America vol. 117,48 (2020), https://doi.org/10.1073/pnas.2013182117 ; The Academy of Medical Sciences. COVID-19: Preparing for the future. Looking ahead to winter 2021/22 and beyond. https://acmedsci.ac.uk/file-download/4747802?utm_source=POLITICO.EU&utm_campaign=17f953b4ef-EMAIL_CAMPAIGN_2021_07_16_11_00&utm_medium=email&utm_term=0_10959edeb5-17f953b4ef-190173357
 FluTracking. Weekly reports – Week ending 17 May 2020, Week ending 16 May 2021. Available via https://info.flutracking.net/reports-2/australia-reports/ Accessed May 2021
, Opinion n° 2021.0033/AC/SEESP of 12 May 2021 of the college of the Haute Autorité de santé concerning the launch of the 2021/2022 seasonal influenza vaccination campaign in France in the northern hemisphere and in Mayotte in the context of the Covid-19 epidemic
 France : https://www.has-sante.fr/upload/docs/application/pdf/2021-05/avis_2021_0033_seesp_du_12_mai_2021_du_college_de_la_has.pdf; US: https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fcovid-19%2Finfo-by-product%2Fclinical-considerations.html ; Austria: https://www.sozialministerium.at/dam/jcr:5eef37df-f71c-410c-8a38-044329b13fef/COVID-19-Impfungen_Anwendungsempfehlung_des_Nationalen_Impfgremiums_Version_4.1_(Stand_24.06.2021.pdf ; UK: https://www.gov.uk/government/publications/jcvi-interim-advice-on-a-potential-coronavirus-covid-19-booster-vaccine-programme-for-winter-2021-to-2022/jcvi-interim-advice-potential-covid-19-booster-vaccine-programme-winter-2021-to-2022