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

Lloydspharmacy suspended its NHS flu service for a day this week
Lloydspharmacy suspended its NHS flu service for a day this week

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.

7 Comments
Question: 
Have you managed to source enough Fluad to deliver the flu service this year?

Leon The Apothecary, Student

My real concern over this entire experience has been how many people have gotten ill with influenza because of the delay of supply that could have been prevented. When I think of it like this, I am disappointed at the unquestionably bad decisions that took place to get to this stage.

Farhat Ahmed, Locum pharmacist

In the timeline it states that wholesalers were selling Fluad, anybody manage to get any from a wholesaler because Sequirus customer services quite enfatically told me that the only place Fluad would be available to purchase was directly through Seqirus

C A, Community pharmacist

Of course there is no anecdotal evidence of surgeries using Quad vaccines because they haven't got Fluad either *wink* *wink*

Will be interesting to see the fallout from that one, and how level the playing field is.

Suman Merag Shah, Community pharmacist

GP, NHS contracts.

Suman Merag Shah, Community pharmacist

sorry, NHS, go contracts((not BP)

Suman Merag Shah, Community pharmacist

Pharmacy flu vaccination is OFFICIALLY granted on 1/9/2018. This makes it very risky to preorder vaccines in March 2018. The psnc should make sure they the contract is in place long before preorders have to be made, just like the NHS,BP contract for flu vaccines

 

Ryszard Cygan, Superintendent Pharmacist

The decision by the DOH to go with one supplier is clearly one to be questioned. We have over the years seen whole batches of vaccines from individual manufacturers fail during production causing shortages in the market place. However, there have always been alternative suppliers available. Although the manufacturer Segirus assures us that they will be able to supply the whole market on time, this remains to be seen. The evidence so far might cast some doubts.

Most pharmacists are aware of the timeline above and that pre-orders should have been made back in March, but realistically, which pharmacy is able to predict the demand for the vaccine so far in advance? The news about problems some of the large multiples are facing suggests that even with their buying power, it means no guarantee. Unlike GP's who are required to place their orders between November and March of the previous season for next year, Pharmacists don't have "guaranteed" patient lists to work from, thus guaranteeing take-up. In most cases they will even be offered a portion on a 'sale-or-return' basis and so can place the order safe in the knowledge that they won't be left with stock.

It is clear that the current arrangement was always going to work against pharmacy. The GP's received their stock well ahead of the mainline wholesalers giving them a clear advantage in getting their patients vaccinated quickly. 

This is not a question of being a pharmacist or a GP, but clearly patients are disadvantaged as they don't have the choice. What has really surprised me is the number of patients, and particularly over-65's who want to be vaccinated at the pharmacy. As availability was short, we were directing them to their surgery as we were unsure when we would have stock, and all said they preferred to wait! An interesting situation.

Clearly, some sort of inquiry should be made into the whole farce and confusion that has occurred this year. There are still signs suggesting that we may still not receive enough vaccine whether in GP surgeries or pharmacies. Only time will tell. But certainly, the PSNC and everyone involved in negotiating the contract on behalf of pharmacy should take a long hard look at how they ensure in the future that only the profession gets a fair crack at flu vaccination but also ensure greater take up and patient choice.

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