For want of a jab… are vaccines out of fashion for NHS England?

Vaccinations seem to have slipped out of fashion in the English health service’s autumn 2023 collection.

This is quite the change from their status as the country’s COVID-19 liberators in our very recent past, but it seems the unavoidable conclusion, judging by the recent recommendations of the Joint Committee on Vaccination and Immunisation. Earlier this month, it concluded that, for the English NHS, autumn 2023 COVID-19 vaccine boosters would only be offered to the over-65s, health and care staff and the clinically vulnerable, and that the flu vaccination programme minimum age limit should be moved back up to 65 years (with the same eligible groups as for the COVID-19 vaccine).

This seems like a curious decision — to put it mildly. There is no indication that demand pressures on the NHS will be greatly less this winter compared with the last, which was particularly crisis-ridden. In fact, at 7.6 million people, NHS England’s wait times for referral to treatment are already at their longest ever, and the service’s activity problems are being compounded by the ongoing industrial dispute over pay with the British Medical Association, which shows no signs of ending.

There are other reasons this may be an unwise move. Australia has just had a significant flu season, especially among children and young people, and we tend to get their variants, particularly in the winter after a Europe-based Rugby World Cup (albeit this year’s Rugby World Cup in France is one that Australia look unlikely to win, unlike in 1999).

Meanwhile, the new COVID-19 Eris variant — a sub-variant of the Omicron strain — is starting to cause concerns as case numbers began to rise in mid-August.

The 25% cut to the COVID-19 vaccination fee

With narrower vaccination eligibility criteria and a heightened risk of flu and COVID-19 overwhelming the health service this winter, NHS England should be making the most of the defences available.

Instead, the fee that NHS England is paying GP surgeries and pharmacies to deliver COVID-19 vaccines has been reduced from £10.06 in 2022 to £7.54 this year. This is not the first cut in the COVID-19 vaccination fee either: the original payment was £12.58 in 2020.

Although NHS England told The Pharmaceutical Journal that “the revised fee will sufficiently cover the average cost of vaccinating someone against COVID”, this 25% cut is significant.

Alastair Buxton, director of NHS services at Community Pharmacy England, said the cut would “inevitably make pharmacy owners think twice about whether the service can be provided in an economically viable way”. However, local community pharmacy representatives have said that many may feel forced to sign up regardless because of persistent financial pressures.

Like every other sector of the economy, pharmacy has seen cost inflation run amok over the past 18 months, making it hard to explain the non-inflation of the flu vaccine fee too.

NHS England caused further uproar after proposing to delay 2023’s flu vaccination season until early October, with the major pharmacy bodies calling on the health secretary to intervene.

After agreeing to fund pre-booked vaccination appointments from 1 September, NHS England’s instructions are that “to maximise and extend protection during the winter and through the period of greatest risk in December 2023 and early January 2024, systems must commence vaccination for care home residents and care home staff from 2 October 2023, and other eligible flu and COVID cohorts from the 7 October”.

There may be clinical logic to a later start date to flu vaccinations this year, but to have these announcements coming in early August does not suggest fabulous communications or organisation by the key decision-makers. It sits ill with the House of Commons Health and Social Care Select Committee’s recent report advocating that community pharmacies — which administered more than 5 million flu vaccinations in England last year — be more involved in routine vaccinations.

Certainly, the handling of all this does little to inspire confidence that pharmacy’s rhetorical esteem among politicians and national leaders is translating into tangible support.

Andy Cowper is the editor of Health Policy Insight, where his long-running weekly column ‘Cowper’s Cut’ analyses and charts the politics and policy of the English NHS