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Supply and demand: Is the Fluad fallout marring this flu season?

With one multiple suspending its flu service for a day, and other pharmacies struggling to source vaccines, C+D looks back at what went wrong.

On February 5, NHS England and Public Health England outlined in a letter to GPs and community pharmacies new guidance for the upcoming flu season.

Under the new guidance, pharmacies were told the “best option” for over-65s was the adjuvanted trivalent vaccine (aTIV). The only aTIV vaccine available in the UK – Fluad – is manufactured solely by Seqirus.

The original deadline to order the vaccine was less than two months later – March 29, NHS England said at the time. By March 1, Seqirus was warning pharmacies that the increase in orders following NHS England’s announcement meant it had already allocated all doses of the vaccine available for delivery in September.

At the end of March, the manufacturer announced that orders for the vaccine would be “re-phased, once they have all been placed, with the aim of giving all customers split deliveries across September, October and November”.

Despite this, August brought reports from contractors of supply problems and yesterday (September 19) Lloydspharmacy suspended its service for a day following confusion over the patient group directions (PGD) (see more below).

With the multiple warning that other providers are suffering "similar challenges", it looks like it won't be plain sailing for the flu service any time soon.

A timeline of the 2018-19 flu service issues

February 5

NHS England and Public Health England outline new guidance for the 2018-19 flu season in a letter to community pharmacies and GPs.

March 29

Seqirus announces its decision to “re-phase” vaccine deliveries, once orders have all been placed, “with the aim of giving all customers split deliveries across September, October and November”, according to the Pharmaceutical Services Negotiating Committee (PSNC).

August 2

In national guidance by NHS England, PSNC and the British Medical Association, pharmacy teams and general practices are advised to take a “three-phased prioritisation approach” to vaccinating patients aged over 65.

The guidance states that priority should be given to patients aged over 75 years or those in a care home, followed by those aged 65-74 years in a clinical risk group, then other patients aged 65-74.

August 28

Wholesalers tell C+D they will be unable to supply additional Fluad vaccines to pharmacies who missed the order deadline, after contractors raise concerns they will not receive their full order.

September 1

Community pharmacists are given the official go-ahead by NHS England to start providing flu vaccinations.

September 6

Seqirus admits it experienced “challenges” processing “a small number” of pharmacies' orders, due to the high volume of requests.

“However, we believe this impacted a relatively small number of orders and that the majority of issues have been resolved,” the manufacturer tells C+D.

September 19

Lloydspharmacy suspends its NHS flu vaccination service in all pharmacies in England and Wales for a day.

In an email to “all pharmacy colleagues”, Lloydspharmacy’s operations team explains it “became aware some teams were misinterpreting the NHS PGD – especially with regard to availability of aTIV stock”. “You will see that we have decided not to offer the QIV to patients who are 65 years of age and above regardless of the availability of Fluad,” it adds.

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