COVID immunisation schedule may complicate flu jab rollout

Australia’s coronavirus vaccine rollout is expected to begin next month, initially with around 80,000 doses per week, before ramping up as part of what has been described as a ‘wartime effort’ to immunise as many people as possible in the shortest amount of time.
 
While welcome news, concerns have been raised as to the potential impact this massive undertaking will have on the seasonal influenza vaccine program, which typically begins around April.
 
As recently as last week, Immunisation Coalition (IC) boss Kim Sampson was quoted in The Australian as suggesting the coronavirus vaccine rollout could be suspended or slowed in April and May to allow for the flu vaccinations to take place, due to potential logistical and medical challenges.
 
‘I doubt whether we would be wanting to have both vaccines pushed out at the same [time],’ he said.
 
‘We don’t know whether that is doable, whether you can roll up your sleeve and have the flu vaccine in your left arm and the COVID vaccine in your right arm.
 
‘There are still a lot of unknowns there … but the one thing we do know is that people have to be vaccinated against influenza and there is a finite period of time in which to do that in April–May. So it would seem to me let’s get that out of the way first.’
 
However, GP and IC Chair Dr Rod Pearce told newsGP that Mr Sampson’s views are not necessarily accurately represented in the initial report, and clarified that the coronavirus vaccine should take precedence.
 
‘It seems appropriate to be going with COVID first because that’s around with all of its problems, and the flu vaccine – based on the fact that we haven’t had a bad year [in 2020] and the type of social distancing and masks and washing hands means there’s not much around early in the year – would be second,’ he said.
 
‘[Mr Sampson’s] on leave, but I spoke to him when I heard this article [in The Australian] came out, and we think it’s kind of a little bit different than what he said … the complexity adds to what’s already a difficult planning exercise, but we’re not suggesting you delay them.  
 
‘He was trying to say there are logistical and evidence issues that we just need to be conscious of when we roll it out … we need to be aware of what we know, what we don’t know and what risk we’re taking.’
 
However, while it ‘might complicate’ the monitoring of side effects, Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC), told newsGP he would prefer to see both vaccines rolled out simultaneously, once available.
 
‘Many vaccines are administered together so it makes sense for the GP-administered COVID-19 vaccine program to undertake simultaneous delivery of influenza immunisations,’ he said.
 
‘Societal benefits are likely to outweigh this problem [of potential interactions] … but clear advice with evidence and explanation for GPs will be essential once decisions are made.
 
‘The flu vaccine seems to be a lower priority than the COVID vaccine, given low transmission rates of influenza when we are following COVID advice. Plus COVID impacts are so dramatic that it would seem wrong to interrupt the rollout of any COVID vaccination once it’s been approved and is available.’ 
 
According to Dr Pearce, trials involving the simultaneous administration of influenza vaccines and some coronavirus vaccine candidates are underway, but the data is still not available and there is conflicting information as to whether it is safe and effective to do so.
 
‘The complexity is that there’s some advice that they can’t be given together, so we need further clarification on that,’ he said. ‘You have to have the data to show that if you give them at the same time, you don’t change the efficacy.
 
‘Obviously, with COVID, getting that sort of data is pretty thin on the ground. So all of that stuff needs to be looked at and evaluated, then needs to be managed.’
 
Further complicating the issue is the fact that the southern hemisphere’s incredibly mild flu season has made it difficult for the northern hemisphere to determine which strains it should attempt to protect against.
 
Fortunately, it seems the increased emphasis placed on good hygiene and physically isolating when ill due to COVID has so far also resulted in low flu rates in the northern hemisphere winter. But that does not mean influenza vaccination is less important this year, Dr Pearce cautioned.
 
‘If people are wearing masks and physically distancing, then flu will become less of a risk. But, remember, one of the things that might have [also] helped low flu rates is that we had huge numbers vaccinated,’ he said.
 
‘If we took away the vaccine and just said, “We’re doing the distancing”, we may not have seen a complete, almost eradication of flu. Most of us think that the vaccine will provide additional protection to the masks and the distancing.
 
‘We’re in a whole lot of new territory. The assumptions we make and how we eventually advise people needs to be based on what science is around, experience in the northern hemisphere, when the vaccines are available, and what’s available.’
 
Dr Pearce says once more detail is released from clinical trials investigating the simultaneous administration of the vaccines, combined with information from the mass rollouts already occurring in the US, Israel and Europe, it may be possible to administer both on the same day.
 
‘But we don’t want any confusion, we don’t want to be taking any risks that we don’t need to, and we just need to be conscious of the fact that it’s a complex matter,’ he said.
 
‘COVID vaccines are going to be here late February … [and] the predictions are at this stage that the flu vaccine will be going first of April – but that could be plus or minus three or four weeks.
 
‘Then we will have to be working out how we add [the flu vaccines] and that just adds another challenge … but our job is to be up to it and work through it and support people dealing with [it].’
 
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