Protecting lung health through vaccination this winter

Thursday, November 30, 2023

Respiratory Futures recently heard from Dr Kay Roy, Respiratory Physician at University College London Hospitals NHS Foundation Trust and Chair of the BTS Infection Specialty Advisory Group. In the interview below, Dr Roy shares information on the importance of encouraging patient vaccination this winter and tips on how to best share this messaging.

With winter approaching, why is it important as a health professional to encourage patients to get vaccinated against flu/COVID?

As we have emerged from the pandemic armed with knowledge even of the exact batch number of our vaccines, are we in fact fully armed against COVID-19 and influenza for the coming winters?

Many have now shifted to the opposite end of the spectrum and vaccine fatigue1 appears to have set in across the globe for COVID-19 for numerous reasons and many of those who did not take the influenza vaccine earlier, are no further swayed this winter.

But it is important we return to the essential reasons for vaccination and the primary aim of the UK programme remains the prevention of severe illness (hospitalisation and death) arising from COVID-19. The objective is to continue to focus the offer of vaccination on those at greatest risk of serious disease and who are therefore most likely to benefit from vaccination2

Data show that the flu vaccine prevented over 25,000 hospitalisations last year in England alone.

It is important that those eligible this year come forward for their vaccinations just in time, November to December, before the season peak hits us, as protection fades over time, and the virus that causes Influenza can change from year to year. COVID-19 which has a more undulating course through the year requires twice yearly vaccination.

Last year, the NHS carried out its second biggest ever flu vaccination campaign, with more than 21 million flu vaccinations given to adults and children, while more than 17 million COVID-19 jabs were also delivered.            

It remains important that the right people get vaccinated due to the impact both on the individuals and the NHS at large for both viruses at the time when the NHS is most at stress and stretched due to winter pressures. Although not always easy to draw upon exact cost effectiveness, the numbers do send a compelling message with bed days saved and excess mortality avoided by vaccination. Data show that the flu vaccine prevented over 25,000 hospitalisations last year in England alone.Are there any patients or communities who may especially benefit from vaccination?

The WHO 3, JCVI2, GOV UK and Green Book4 all specify that the risk of developing severe COVID-19 continues to be strongly associated with increasing age and underlying health conditions and hence it is really these groups we need to dedicate our attention and efforts towards. Most other people will already have built sufficient immunity from previous boosters and contracting COVID-19 naturally too. Although the following are eligible, we must in fact focus on the clinical groups most at risk considered highest priority as many will have acquired immunity naturally or from previous boosters.

JCVI advises that for the 2023 autumn booster programme, the following groups should be offered a COVID-19 vaccine:

- residents in a care home for older adults

- all adults aged 65 years and over.

- persons aged 6 months to 64 years in a clinical risk group, as defined in tables 3 and 4 of the COVID-19 chapter of the Green Book

- frontline health and social care workers

- persons aged 16 to 64 years who are carers, as defined in the Green Book, and staff working in care homes for older adults.

- persons aged 12 to 64 years who are household contacts, as defined in the Green Book, of people with immunosuppression.

Currently, most Healthcare Support Workers (HCSWs) are no longer at much greater risk of severe COVID-19 compared to the rest of the population and vaccination is of limited benefit in protecting against transmission. There remains potential benefit in offering vaccination to HSCWs to protect health services from staff absences due to COVID-19 during the winter months and system pressures. Similar considerations apply to carers (as defined in the Green Book).

Protection against symptomatic infection alone is less durable and protection against transmission of infection from one person to another is accordingly limited. These immunity related factors mean the rationale for vaccinating people to reduce the risk of transmission to other vulnerable people is less compelling.

It is estimated that by the end of August 2022 over 99% of adults in England had SARS-CoV-2 antibodies, generated either after natural infection or vaccination or both.

What are some ways respiratory professionals can support and encourage their patients to take up flu/COVID vaccinations? Do you have any practical tips for how to go about sharing this messaging?

I would discuss with patients, the impact of morbidity especially around the festive season and Christmas, caused by influenza and COVID-19 which can disrupt celebrations. It is worthwhile often engaging social prescribers as patients can be more receptive to them than a 10 minute out-patient consultation, and reinforcing information through different healthcare providers is important too so that we are providing a united message, based on the national guidance, without adding to confusion and apprehension. When patients are reluctant to take up the offer of vaccination, finding out the reasons and working our way through any fears and concerns is vital to help support and encourage vaccine uptake. If patients fall within a grey area about suitability for vaccination, reassuring them that their case will be discussed with the wider team and the guidance consulted more carefully, will help build confidence in the decision-making process.

Engaging community groups and social prescribing is also a powerful way to get message across and received more effectively in target groups, and so investing in education here and finding out more about local resources is key.

Wherever possible, vaccinations for flu and COVID-19 should still be offered at the same time, making it easier and more convenient for people to get protection from both viruses ahead of winter.

Where is more information on vaccination available that can be shared with patients?

It is not just the details around vaccination which should be shared accurately, but in fact the way the information is conveyed and accessed in a format that is understood well by patients from all backgrounds to ensure we address the wider population as this may impact vaccination uptake which has been the case previously.

GOV UK5 and the NHS6,7 provides leaflets and information in 30 languages, Braille, BSL, large print and simple text to gain access to the wider population and avoid some of the barriers of health inequality related to ethnic background or special needs. Engaging community groups and social prescribing is also a powerful way to get message across and received more effectively in target groups, and so investing in education here and finding out more about local resources is key.

As in previous years, the NHS will let people know when bookings open. Adult flu and COVID-19 appointments will be available through the NHS App and website as well, or by calling 119 for those who cannot get online. Flu vaccines will also be available through local GP practices and pharmacies who may hold their own communications campaign through text messages and letters. Health and social care workers will also be invited for their vaccines through their employer.