Flu and Covid co-administration ‘may not be practical’ for the NHS, says deputy CMO

Combining the flu and Covid booster programme may not be ‘straightforward’ or even practical, the deputy chief medical officer has admitted.

Speaking in a televised briefing about the booster campaign on Monday, Professor Jonathan Van-Tam said that ‘giving the booster jabs with flu vaccines at the same time is ‘safe’ and ‘does not affect an individual’s immune response to either vaccine’.

But, while he said that ‘Covid-19 booster doses may be given at the same time as flu vaccines’, he added that this was not only ‘subject to availability of both products’ but also comes with practical considerations.

GP leaders told Pulse that while they would like to be able to co-administer the vaccines, it was wrong to leave up to GP practices ‘to sort out’ the practicalities.

JCVI guidance issued on Monday stated: ‘It is not the intention of JCVI that the 2021 Covid-19 booster vaccine programme should disrupt or delay deployment of the annual influenza vaccination programme. Both of these programmes are important for individual and public health, especially over winter 2021 to 2022. Where operationally expedient, Covid-19 and influenza vaccines may be co-administered.’

And in guidance issued yesterday, NHS England said that GPs should ‘use their discretion’ to delay flu jabs for co-administration if this would boost uptake – especially ‘where it improves patient experience and uptake of both vaccines, reduces administrative burdens on services or to reduce health inequalities’.

Professor Van-Tam said: ‘[T]he MHRA has looked at the data from the trials on giving flu in one arm and Covid in the other at the same time, and the antibody response to both of those vaccines is not impaired by doing so, and the tolerability of doing that at the same time is also fine.’

However, he added: ‘I would add that there is a practical reality to add on top, which is for the NHS to consider in more detail, that it may not always be the case that it is possible to co-administer those two vaccines in every single patient.

‘Sometimes it will be possible, and we should, you know, gain efficiencies by doing that where we can. But remember that, if you’ve ever been for your flu jab, it’s quite a kind of rapid process to get down the line. There is a 15-minute waiting period with Covid-19 vaccines – an observation period – and meshing those two together, in practical terms, won’t always be straightforward.’

Therefore, he said ‘people need to understand’ that ‘if they are offered the chance of two together’ they should do so but ‘by the same token, they may not be through practical realities’.

A press release from the Department of Health and Social Care yesterday also stressed that patients invited for one jab should delay neither their Covid nor their flu vaccine in the hope that they could have both at the same time.

In the same briefing, JCVI Covid immunisations chair Professor Wei Shen Lim also specified that going forward flu and Covid vaccination can be administered at the same time, although ‘usually’ in different arms.

He said: ‘We have heard from the MHRA and from clinical trial data that, if it so happens that somebody is called up to have the Covid vaccine, and a flu vaccine on the same day, then it is safe to have both vaccines co-administered, usually in different arms, but it can be co-administered on the same day.’

But Kent LMC chair Dr Gaurav Gupta said: ‘The Government should do everything they can to facilitate co-administration rather than put that burden again on general practice to try and make these difficult decisions.

‘Co-administering is absolutely preferable because these are the most vulnerable patients. We would not want vulnerable patients to have to come to practices twice because it increases the risk for them to get not just Covid but other infections as well.’

He also urged the Government to ‘support general practice’ which ‘is not happening at all at the moment’.

Dr Gupta said: ‘If we are going to start doing another massive vaccination campaign again, like we did last year, we need to have some relief from other work pressures that are being put on us, so for example we are still being expected to do QOF while we are trying to do vaccinations and deal with pandemic.

‘We need some urgent respite from NHS England from some of this work so we can get on with the most important work of seeing the country through the pandemic.’

Dr Kieran Sharrock, Lincolnshire LMC medical director, said: ‘Practices might find it difficult especially if they get a mixed supply, as in we know that Seqirus haven’t delivered the vaccines to practices when they should have done or when they promised they would, so it might be very difficult for practices to plan.

‘If we do have both vaccines in the building at the same time it makes sense to do both, particularly for house-bound patients’.

Health secretary Sajid Javid yesterday said the Covid booster campaign should begin ‘next week’, while accepting the JCVI’s recommendation, also made yesterday, that all patients in groups 1-9 of the first phase of the Covid vaccination campaign should have a booster jab, no sooner than six months after their second dose.

NHS England guidance issued on 1 July, which had asked vaccinators to prepare for a campaign launch on 6 September, said boosters and flu jabs should be ‘co-administered in a single appointment where supply and eligibility of cohorts align’.