Boosting Flu Vaccine Uptake

The 2023-24 flu vaccine programme is now well underway, having commenced in schools and for those most at risk alongside the Autumn 2023 COVID-19 booster programme in early September 2023. Flu vaccines play a crucial role in helping to safeguard individuals, communities and in protecting our National Health Service (NHS). Healthcare professionals can all help to play an important role in advocating, promoting and delivering the flu vaccination campaign. Even those who aren’t directly involved in the service. However ensuring flu vaccine uptake rates are high can often be a challenge. Here we will explore some of the reasons why it is important to maintain high levels of flu vaccination uptake. We will also look at strategies that can be taken to help improve these rates.

So let’s recap- who exactly is eligible for flu vaccine this year?

For the 2023/24 flu season the groups eligible to receive flu vaccine include:

• aged 2 and 3 years on 31 August 2023
• eligible school aged children (Reception to Year 11)
• those aged 6 months to under 65 years in clinical risk groups
• pregnant women
• all those aged 65 years and over
• those in long-stay residential care homes
• carers, those in receipt of carer’s allowance or main carer of an older or disabled person
• household contacts of immunocompromised individuals
• frontline health and social care staff

It is important to encourage everyone who falls into one of these risks groups to take advantage of the flu vaccination, and, if eligible, schedule their COVID-19 autumn booster at the same time.

Why is it important to have the flu vaccine?

All age groups are susceptible to the flu. However individuals with chronic medical issues, the elderly, young children, and pregnant women are at the most risk of developing complications. To protect people most at risk from severe illness and it’s consequences, it is crucial to maintain high vaccination rates and boost uptake rates in these populations.

In actual fact, flu can be more serious than sometimes it is commonly perceived. Many people in high-risk groups may require hospitalisation, and in some cases, it can be fatal. We had a severe flu season last year. In fact, flu put a greater strain on hospitals than COVID-19. The number of extra winter deaths attributed to the flu, at 14,000, surpassed the number of deaths caused by COVID-19 during the same time period.

The UK Health Security Agency (UKHSA) released data from the 2022–2023 flu season, which indicated that whilst it was a particularly bad flu season, vaccination actually avoided almost 25,000 hospital admissions in England. However, this figure could be significantly higher if everyone who was eligible came forward for their vaccination,

Why should we try to increase flu vaccine uptake rates?

The NHS is under enormous strain during the winter months, therefore increasing flu vaccine uptake can help to reduce the number of flu-related hospitalisations and deaths. This can help to save valuable resources for patients who have other critical medical needs. Flu season is also accompanied by other winter respiratory illnesses like COVID-19 and Respiratory syncytial virus (RSV). Individuals who contract both the flu and COVID-19 at the same time, for example, may be more at risk of severe complications. There is also concern that if a flu and COVID-19 outbreak occur at the same time, the NHS will be overwhelmed. We can help to mitigate the impact of any potential “twindemic” by increasing flu vaccine uptake and reducing strain on our healthcare systems.

Who are the risk groups we need to target?

In order to look at how we can improve uptake rates, it is first helpful to explore the uptake rates from previous years so that we can ensure that as organisations and professionals, we are focusing our efforts in the right area.

Unfortunately the facts are that during the 2022-23 flu season, uptake rates actually fell across all eligible risk groups. Pregnant women had the lowest uptake rate, with only 35% of those eligible receiving the vaccination. Those in clinical risk groups also fell far short of the target rate of 75%, with only 49.1% receiving their vaccination. Out of the clinical risk groups, those who are morbidly obese or have a learning disability have the lowest uptake, highlighting the importance of promoting vaccination to these vulnerable populations.

Other risk groups with falling uptake rates include children, in particular those aged 2-3. Children and young children in particular should be encouraged to take up the vaccine as it helps to protect not only themselves but the spread to those who are vulnerable around them. However the reality is that in fact, there were around 10,000 children admitted to hospital with flu last year. Nonetheless, last year’s data on vaccination effectiveness revealed that flu vaccines reduced the risk of hospitalisation in children by two-thirds. Getting this information across to parents and carers of young children is critical for promoting the importance of vaccination for their children, with more work needed to address uptake rates in these groups.

Providers should be expected to make a 100% offer to eligible groups and should strive to match or beat vaccine uptake rates from the previous season, especially in individuals in these risk groups with historically low uptake rates.

The importance of timing of vaccination

The timing of flu vaccination is crucial. Healthcare professionals should encourage early vaccination, ideally before the flu season begins. This year it was decided that flu vaccines should be brought forward and started in schools and care homes in September. It is believed this approach would help to:

• reduce transmission in children earlier in the season
• ensure greater efficiency in delivery for providers
• maximise uptake for both flu and COVID-19 vaccinations by making it easier for patients to get at the same time
• maximise clinical protection and thus resilience of health and care services over the later winter months and through the period of greatest risk in December 2023- January 2024 when flu and COVID-19 are most likely to be prevalent

Ensuring vaccinations for individuals before the onset of winter is crucial. This not only alleviates the strain on the NHS during the winter season but also provides the highest level of protection against severe illness when infection rates are at their peak.

Increasing flu vaccine uptake rates in healthcare professionals – let’s lead by example

To protect staff and vulnerable patients, one objective of the 2023-2024 Commissioning for Quality and Innovation (CQUIN) is to vaccinate more than 75% of healthcare professionals. However worryingly, just 49.4% of all frontline healthcare workers received their flu vaccination last year, in comparison to 61.4% and 76.8% respectively the previous two years.

Offering vaccinations to healthcare professionals is about more than just protecting the individual; it is also about protecting the vulnerable people with whom they work and maintaining a healthy workforce that can continue to care for patients during a critical time. As healthcare professionals, we are frequently regarded as reliable sources of information for our patients. By getting vaccinated ourselves, we can help to serve as role models by demonstrating our trust in the flu vaccine’s safety and efficacy.

Employers should ensure convenient access to flu vaccination for their staff and actively support vaccine coverage. Additionally, they should provide education to healthcare workers regarding the significance of their own vaccinations, emphasising the role it plays in safeguarding themselves, their families, the individuals they care for, and their colleagues.

Boosting flu vaccine uptake: what more can we do

When considering strategies for enhancing vaccine uptake, especially within groups that had historically low uptake rates, numerous factors must be taken into account:

1. Staff responsibilities

Each practice should designate a lead member responsible for overseeing the flu vaccination campaign. Staff members must receive current and up to date training, understand their roles and responsibilities clearly and have access to UKHSA resources. Encouraging and involving all staff in actively promote the vaccine message to patients is essential. Regular meetings should be conducted to keep the staff informed about the vaccination campaign’s plans and progress.

2. Education – let’s get the right message out there!

Healthcare professionals must ensure that they can confidently have conversations with patients and be able to provide accurate, evidence-based information. It is important therefore that healthcare professionals, particularly those who are in contact with the eligible groups are educated themselves. They should be aware of relevant guidelines and definitions for who is eligible for flu vaccine, as well as the benefits of vaccination, particularly for those who are at high risk for flu and its complications. Training should ideally also be extended to all healthcare and social care workers directly encountering eligible groups, including practice nurses, health visitors, community pharmacists, midwives, and specialist nurses.

Education is key for patients to understand the importance of the vaccine. There are lots of resources available on the NHS and UKHSA website which can be provided for patients. This includes leaflets, posters and online resources that can be used to help explain the benefits and safety of the vaccine for different risk groups.

3. Effective communication

Effective communication is critical to the delivery of healthcare services. As healthcare professionals we must engage with our patients, and help to address any questions or concerns that they may have. If we can provide accurate and easy to understand information we can help to empower our patients to make informed decisions. We should be able to confidently address concerns and discuss vaccine safety and side effects to help build trust and dispel any common myths to help provide reassurance.

Vaccine hesitancy is thought to be one of the top 10 biggest threats to global health according to the World Health Organisation (WHO). Healthcare workers can help to foster trust and address patient concerns while promoting broader vaccine acceptance by educating eligible individuals about the importance and benefits of the flu vaccine.

To ensure our message reaches a wider audience, we can implement strategies like targeted messaging tailored to specific groups. Placing posters and leaflets in reception and waiting areas is a practical approach. These resources can be ordered for free from the gov.uk website.

When choosing communication channels, it’s essential to consider the most effective method for reaching individuals. This may involve using written reminders (such as text messages, letters, and email), phone calls, or a combination of these methods to contact eligible groups who are due or overdue their flu vaccine. Tailoring the approach to the individual is crucial. For example, when dealing with parents or caregivers of young children, a phone call might be more effective than a letter, and text messages can serve as useful reminders. Additionally, timing considerations, such as reaching out when working parents are more likely to be available, can also enhance communication effectiveness.

4. Be opportunistic

Take advantage of face-to-face interactions to inform and invite eligible groups to receive their flu vaccine. Identify these opportunities where you can actively promote the flu vaccine, for example a patient who has recently had a confirmed pregnancy or those with a newly diagnosed condition placing them at in a clinical risk category. Identify patients attending outpatient or GP appointments, people visiting community pharmacies to pick up prescriptions, or when parents bring their children for appointments. Use these opportunities where possible to discuss the benefits of flu vaccination and the risks of not being vaccinated during routine appointments or when attending for other routine vaccinations. Being proactive in recommending and providing vaccinations is a key aspect to help increase uptake.

5. Consider accessibility and provide multiple opportunities

It’s important that we make it as convenient as possible for patients to get their flu vaccination. This can be achieved by extending the operating hours of flu clinics, including evening and weekend services within primary care settings. Offering family-friendly appointment times, such as after school or Saturday mornings, can further enhance accessibility. To promote uptake, it’s crucial to provide multiple opportunities for eligible individuals at times and locations convenient for them. This can include community pharmacies, GP surgeries or clinics they attend regularly. Additionally, exploring outreach initiatives for underserved communities should be considered.

6. Ensure a collaborative approach

Successful flu vaccine campaigns require collaboration. As healthcare professionals, we must work closely with community organisations, local authorities, pharmacies, and schools to target vulnerable populations and promote vaccination in underserved areas. Consider including in your planning health visitors, midwives, chemists and other healthcare professionals associated with your practice. Connect with statutory and non-profit organisations that work with vulnerable risk groups to help identify those who haven’t been vaccinated. Try to engage with local community groups such as pre-school nurseries, children’s centres, libraries and toddler groups in the area. Providing informational posters and leaflets in these settings can contribute to enhancing the vaccination rates among young children.

7. Feedback and monitor

Finally, regular monitoring is important to track progress of coverage within patient populations. Examining vaccination rates and launching targeted campaigns based on this information can help to significantly boost uptake rates. Input should be sought from patients, staff and community partners to make necessary improvements. Consider making mid-season campaigns to help re-emphasise the importance of vaccination.

When setting practice goals, aim higher than the previous season and subsequently assess your uptake rates against these objectives. Ensure that you are continually measuring uptake and evaluating progress toward your target rates. Keep offering vaccinations even after you’ve achieved your practice and campaign objectives. Then, at the end of the season, review uptake rates, reflect on lessons learned, and contemplate how you can make it even better next year!

Conclusion

The significance and impact of increasing flu vaccine uptake in vulnerable populations should not be understated. As healthcare professionals we have a unique opportunity to make a profound and positive impact and influence flu vaccine uptake rates in individual patients and in the wider communities. To do this we must work in a collaborative way, ensuring patients have easy access to appointments in a timely manner. We must take every opportunity to promote flu vaccination and ensure that individuals understand the value of the flu vaccine and it’s benefits. By leading by example, educating patients, and being able to talk confidently and address concerns, we can lead in ensuring that vaccination rates remain high, ultimately safeguarding our patients and reducing the burden of illness and pressures on the NHS.

Flu vaccination training

Interested in learning more? Head over to The Flu Hub for more information on flu training for the 2023-24 flu season for individuals and organisations.

Additional resources

There are lots of great resources out there on the NHS and UKHSA website that can be useful to use as a tool to provide information for patients.

Click on the image on the right for an NHS guide to flu vaccination: who should get it and why. This information outlines how patients can protect themselves and their children from the flu this winter. It includes information for children, eligible adults, and pregnant women, as well as explaining why it’s critical for those at high risk of flu, or who care for someone who is, to get their free flu vaccination every year.

The Gov.uk website contains useful posters you can display to help encourage uptake from pre-school through to secondary schools and a helpful guide for parents and carers on protecting their children from flu. Did you know? You can also get free stickers which can be used for those aged 2-11 who receive their flu vaccine either through their GP practice or at primary school.

Leaflets can be a helpful means of communicating with patients, ensuring that they understand the benefits of the vaccine and can provide informed consent. Accessible versions are crucial for expanding and strengthening uptake in underserved regions. Further resources can be found on the UKHSA flu vaccine programme.