Prioritise elderly and health workers for influenza vaccine, says UN health agency

Amid a potential global shortage in influenza vaccines and the ongoing COVID-19 pandemic, the UN health agency has advised countries to protect the elderly and health workers first.

“There has in fact been an increased demand and we’re hearing now that countries that are trying to get influenza vaccine cannot get it,” said Dr Ann Moen, Chief, Influenza Preparedness and Response at the World Health Organization (WHO).

The updated recommendations from the WHO come as the northern hemisphere braces for the seasonal bug, which claims hundreds of thousands of lives from respiratory-related causes every year.

The aim of the announcement is to prevent national health care systems from becoming overwhelmed and to prevent “confusion” when treating people for respiratory diseases that can be difficult to tell apart, Dr Moen told journalists in Geneva.

“This year … the Strategic Advisory Group of Experts on Immunization (SAGE) have endorsed a set of interim recommendations for influenza vaccination during COVID-19. Based on a set of considerations, including alleviating added burden on health care systems and vulnerable populations and managing potentially limited supplies of influenza vaccines, SAGE has recommended and endorsed in the last week, among the five risk groups, health workers and older adults are the highest priority groups for influenza vaccination during COVID-19 pandemic.”

Previously, SAGE has identified five key at-risk groups for inoculation: pregnant women (the highest priority), children, older adults, those with underlying medical conditions and health workers, in no particular order.

If possible, all these groups should continue to be vaccinated as “the best way to reduce disease”, Dr Moen said, adding that the protective measure has been used for 50 years with no known adverse side-effects.

Although the influenza jab would not protect people from coronavirus - a new disease for which there is no cure - “it keeps you out of hospital”, she continued.

The WHO official noted that seasonal influenza affects individuals in every country and results “in up to one billion cases, three to five million severe cases, and on average 290,000 to 650,000 deaths, respiratory-related deaths annually”.

Indications that there might be a potential influenza vaccine shortage date back to April, when countries placed orders with pharmaceutical manufacturers, conscious of the increased burden that the COVID-19 pandemic might place on their health care systems.

Responding quickly to increased demand for vaccines can be relatively slow, Dr Moen explained, as the most common way to produce it involves large numbers of chicken eggs.

“Annually, we know that are around 500 million doses of vaccine are produced – and I think that these are produced on demand,” she added. “Based on those pre-orders – and there are some margins - we have heard that from our industry associations, they have been able to increase some of the orders for some of the countries and they’ve made additional vaccine that they’ve been handing out, but overall it does seem to be there’s a higher demand than there is numbers of vaccines.”

The development comes amid “historic lows” of influenza in the southern hemisphere, which the WHO official attributed to COVID-19 protection measures, including travel restrictions.

“There really just is not a lot of flu,” in the global south, Dr Moen said, adding that testing usually indicated a 10 to 30 per cent infection rate among the population, but that this year, just one per cent of tests were positive.

“This really is historic lows in terms of (in)flu(enza) circulation,” she said. “And we feel confident this is not due to lack of testing or lack of surveillance.”

Despite the lack of an apparent threat, countries in the global north should remain vigilant, amid rising infection rates across many countries and regions, Dr Moen insisted.

“Everybody’s maybe seen some in the news about the really record low circulation of influenza in the southern hemisphere, in Australia, New Zealand, South America and South Africa and we think really that this is in part due to all those social measures and physical distancing, travel restrictions and some of those measures that have been put in place over the past, since the beginning of the pandemic.”

She added: “If this follows suit and influenza also is low circulation in the northern hemisphere, we may see - we may see - less infections and we also hope to see less infections due to the very high uptake of influenza vaccine. We also - but we are seeing some sporadic outbreaks in some areas of the world and so we really fully believe that as society opens back up, we’ll probably start to see (in)flu(enza) circulate again back to more normal proportions.”

1. Exterior wide shot, Palais des Nations flag alley, nations’ flags flying, a cloudy day.
2. Wide shot, podium with speakers in a near-empty Room XIV in line with COVID-19 distancing measures, Palais des Nations.
3. SOUNDBITE (English) — Dr Ann Moen, WHO Chief, Influenza Preparedness and Response: “Yes, there has in fact been an increased demand, and we’re hearing now that countries that are trying to get influenza vaccine cannot get it.”
4. Medium shot, journalist sitting with conference listening device in foreground, UN staff members and TV camera operators to rear, Room XIV III, Palais des Nations.
5. SOUNDBITE (English) — Dr Ann Moen, WHO Chief, Influenza Preparedness and Response: “Each year, as a reminder, seasonal influenza affects individuals in every country and results in up to one billion cases, three to five million severe cases, and on average 290,000 to 650,000 deaths, respiratory-related deaths annually”.
6. Medium shot, journalist taking a picture with her phone in foreground, UN intern listening to rear, Room XIV, Palais des Nations.
7. SOUNDBITE (English) — Dr Ann Moen, WHO Chief, Influenza Preparedness and Response: “This year however, the Strategic Advisory Group of Experts on Immunization have endorsed a set of interim recommendations for influenza vaccination during COVID-19. Based on a set of considerations, including alleviating added burden on health care systems and vulnerable populations and managing potentially limited supplies of influenza vaccines, SAGE has recommended and endorsed in the last week, among the five risk groups, health workers and older adults are the highest priority groups for influenza vaccination during COVID-19 pandemic.”
8. Medium shot, cameraman filming the audience in a near-empty Room XIV, Palais des Nations.
9. SOUNDBITE (English) — Dr Ann Moen, WHO Chief, Influenza Preparedness and Response: “Annually, we know that are around 500 million doses of vaccine are produced – and I think that these are produced on demand, based on those pre-orders – and there are some margins, we have heard that from our industry associations, they have been able to increase some of the orders for some of the countries, and they’ve made additional vaccine that they’ve been handing out, but overall it does seem to be there’s a higher demand than there is numbers of vaccines.”
10. Close up, hand holding pen, writing on paper, Room XIV, Palais des Nations.
11. SOUNDBITE (English) — Dr Ann Moen, WHO Chief, Influenza Preparedness and Response: “Everybody’s maybe seen some in the news about the really record low circulation of influenza in the southern hemisphere, in Australia, New Zealand, South America and South Africa and we think really that this is in part due to all those social measures and physical distancing, travel restrictions and some of those measures that have been put in place over the past, since the beginning of the pandemic.”
12. Medium shot, journalist taking notes, while using conference listening device, Room XIV, Palais des Nations.
13. SOUNDBITE (English) — Dr Ann Moen, WHO Chief, Influenza Preparedness and Response: “If this follows suit and influenza also is low circulation in the northern hemisphere, we may see, we may see less infections and we also hope to see less infections due to the very high uptake of influenza vaccine. We also - but we are seeing some sporadic outbreaks in some areas of the world and so we really fully believe that as society opens back up, we’ll probably start to see flu circulate again back to more normal ”
14. Close-up, hands typing on laptop, Room XIV, Palais des Nations.
15. Wide shot, Room XIV, TV camera operators, podium to rear, Palais des Nations.
16. Medium shot, WHO official speaking on podium, side view, Room XIV, Palais des Nations.