Conclusions and recommendations
Flu vaccination programme 2017–18
1.We are concerned about the impact that higher levels of flu had on frontline NHS hospital staff in the 2017/18 season, and reports that this could have been reduced by changes to the vaccination recommendations. However, we heard that the evidence available did not support the use of the quadrivalent vaccine in all eligible groups and we are convinced by arguments made to us that whilst the B-Yamagata strain was responsible for a significant burden of disease in the 2017/18 season, use of the quadrivalent vaccine in all individuals would not have made a huge difference to the additional burden placed on frontline staff in the NHS. (Paragraph 36)
2.We have heard that flu vaccine effectiveness varies from year to year and is dependent on how well the strains within the vaccine match those circulating in the flu season. In the 2017/18 season the vaccine was less effective than it had been in previous seasons. Nevertheless, we agree with health professionals that the flu vaccine is still the most effective protection available against the serious effects of flu and it is critical for eligible groups to be vaccinated. (Paragraph 37)
3.We welcome changes introduced to flu vaccines in response to new evidence which seek to further improve effectiveness in future seasons. We were reassured by the response of Joint Committee on Vaccination and Immunisation (JCVI) and Public Health England (PHE) to this new evidence and welcome the specific guidance on use of both the quadrivalent vaccine for eligible individuals under 65 and the new adjuvanted vaccine for the over 65s. (Paragraph 38)
Vaccine uptake
4.We heard that vaccine uptake rates were increasing year-on-year but there remains high geographical and demographic variation in uptake in some groups. We are reassured to hear about communication campaigns and other actions being taken to improve vaccine uptake in eligible groups. We recommend that the Government ensures that research into better understanding of the causes of unacceptable variation in vaccine uptake takes place. We call on the Government to continue to look at what actions work to increase flu uptake. Further, we call on the Government to invest in campaigns that are proven to be successful. (Paragraph 45)
5.Despite the 2017/18 season having the highest flu vaccination uptake ever in healthcare workers, significant variation remains. Some hospital trusts only achieved 30 to 40% uptake, whereas others achieved over 90%. All hospital trusts should give the same level of priority to vaccination programmes for staff. We recommend that the Care Quality Commission should continue to assess how well trusts have performed this role and take action where fundamental standards relating to infection prevention and control have not been met. (Paragraph 55)
6.It is a professional duty for healthcare workers in hospitals to be vaccinated each year. We welcome recent advice to hospital trusts from NHS England and NHS Improvement on healthcare worker vaccination. The Government should undertake and conclude a review by the end of February 2019 to establish whether flu vaccination should be mandatory for certain categories of healthcare workers. (Paragraph 56)
7.We believe it is as much a professional duty for staff working in social care to be vaccinated as it is for frontline healthcare workers. We were surprised that no effective system of monitoring uptake of flu vaccination rates amongst staff working in social care settings has been established in England. While we accept there may be challenges in relation to information collection, we recommend that the Government should review this and determine how vaccination uptake data can be collected from care homes. An effective system of data collection should be established by the 2019/20 flu season. In its role regulating within the social care sector, the Care Quality Commission should take action where poor immunisation rates (or poor recording of uptake) could impact on standards of infection prevention and control. There should be an expectation of full coverage amongst staff working with individuals who are most at risk from serious illness from flu (Paragraph 60)
8.We were shocked by survey results from Public Health England which showed that the best flu vaccination uptake in social care settings was around 25%. The poor response rate was also disappointing. We welcome the extension of the NHS programme to frontline social care workers. We call on the Government to look at ways in which uptake among social care staff could be improved and establish the same principle as now exists in the NHS—the aim of 100% coverage. (Paragraph 61)
Vaccine procurement in England
9.There are different procurement processes for flu vaccination programmes in the UK. We see no reason why this arrangement should change. There has been geographical variation in previous flu seasons with regards to vaccine purchasing but we were reassured that action had been taken to address this variation in vaccine provision in the 2018/19 season. We welcome that GP practices were able to change their orders following a change in advice on flu vaccination. Co-operation in this way between GPs, Public Health England, NHS England and flu vaccination manufacturers should continue. (Paragraph 70)
Future developments in flu vaccination
10.We note the important role of the Joint Committee on Vaccination and Immunisation in keeping emerging evidence on vaccines under review and in providing advice. We urge the Government to take account of the future relationship with the European Medicines Agency and the impact this could have on flu vaccination in the UK as part of preparations for the UK leaving the European Union. The Government should set out in response to this Report how this relationship might be maintained in various outcomes of the Brexit negotiations. (Paragraph 76)
11.We call on the Government to ensure that it continues to support and invest in the development of important new medical products, including new and more effective vaccines. (Paragraph 77)
Published: 18 October 2018