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Are you ready for winter?

With the cough and cold season on the horizon, it is time to stock up on OTC winter remedies and prepare for what looks likely to be a busier vaccination schedule than ever before.

Key facts 

  • The winter vaccination programme starts this month with pharmacies on the frontline of delivery once again
  • In a world first, early adopter pharmacies  in England are also taking part in a RSV vaccination scheme 
  • Consumers trust pharmacies as a source of self-care advice and treatments for common winter ailments

Learning objectives

After reading this feature you should be familiar with:

  • Who is eligible for free NHS vaccinations this winter
  • How to help patients book their flu, Covid, RSV and other vaccinations
  • How to support customers with OTC self-care products and advice for common winter conditions.

As shorter and darker days herald the arrival of the cold and flu season, it is time for community pharmacies to start offering winter vaccinations again — and this year there is more to consider than just flu and Covid-19.

The sector has been providing seasonal flu vaccinations under a nationally commissioned service since September 2015, with the number administered by community pharmacists under the NHS advanced service in 2023/24 reaching a staggering 3,773,929. The end of last year also saw community pharmacy hit the milestone of providing 40 million Covid-19 vaccines.

Company Chemists’ Association modelling suggests that pharmacies could deal with a further 10 million vaccination appointments a year.

Chief executive Malcolm Harrison says that in time, pharmacies could become the natural home for all vaccinations. “Now is the time for policymakers to explore this enhanced role and build on the NHS vaccination strategy,” he says.

Flu and Covid outlook

World Health Organization (WHO) surveillance data for the week ending August 4, 2024 shows that flu rates in northern hemisphere countries remained at “interepidemic levels”, with activity elevated in a few countries in Central America and the Caribbean, Middle Africa, Western Africa, Southern Asia and South East Asia. The data shows that flu A(H3N2) viruses were predominant, except in Western Asia, South East Asia and Southern Asia, where A(H1N1)pdm09 viruses predominated.

In the Southern hemisphere, WHO data shows that flu activity remained elevated in a few countries in South America, Eastern Africa and Oceania, but was stable or decreasing in all reporting countries. Flu A(H3N2) viruses predominated, except in Eastern Africa, where A(H1N1)pdm09 viruses were predominant.

SARS-CoV-2 activity, reported from WHO surveillance in 62 countries, was elevated in most countries in Northern Europe and South West Europe, and a few countries in Eastern Europe, Western Asia, Southern Asia, South East Asia, Eastern Asia, Central America, and the Caribbean and Tropical South America. Increasing activity was reported in a few countries in Eastern Europe, Western Asia, Eastern Asia, and Central America and the Caribbean.

Here in the UK, Superdrug recently reported a 319 per cent spike in sales of its Covid lateral flow tests, alongside a 297 per cent increase in cold and flu relief products, suggesting a surge of illness across the nation this summer from the so-called FLiRT variant.

Lifesaving impact

A WHO/Europe study has set out the lifesaving impact of vaccines. It says that the known Covid death toll since the start of the pandemic in the WHO European region of 2.2 million might have been as high as 4 million without the vaccines that were introduced in December 2020.

Countries that implemented early vaccination programmes covering large parts of the population (such as Belgium, Denmark, Iceland, Ireland, Israel, the Netherlands, Malta and the United Kingdom) saw the greatest benefit in terms of overall number of lives saved. Most of those saved were aged 60 years or older, the group at highest risk of severe illness and death from SARS-CoV-2.

However, the study’s author, Dr Margaux Meslé, warns: “It is impossible to predict how the virus will behave for the remainder of 2024. Multiple waves could be possible as countries in the region have transitioned from crisis management to sustainable, integrated, longer-term disease management.”

Vaccination timings

Community Pharmacy England recently sent out a reminder of NHS England’s flu vaccination start dates. Like last year, these have once again been subject to change. The key changes for this season’s service are:

  • Programme start date for pregnant women:  September 1
  • Start date for other eligible adults, including frontline healthcare workers: October 3.

NHSE says the decision to push back the start date is based on evidence that the vaccine’s effectiveness can wane over time in adults. The Joint Committee on Vaccination and Immunisation therefore advised moving the start of the programme for most adults to the beginning of October. This is on the understanding that most vaccinations will be completed by the end of November, closer to the time when the flu season commonly starts. Pregnant women are an exception, in order to protect women and babies during pregnancy, and to protect babies in the first few months of life. Babies aged under six months are at high risk of complications from flu.There are no changes to the eligible cohorts for the 2024/25 season.

From September 16, NHSE’s National Booking System will open for all participating sites to post Covid and flu appointments. It will open for bookings from the public from September 23.

The last available appointment date will be December 20 for both flu and Covid vaccinations (apart from outreach activities).

Flu vaccines

Sanofi’s recombinant quadrivalent flu vaccine (QIVr) will not be available for the 2024/25 flu vaccination programme.

Instead, the seasonal flu vaccines for 2024/25 for at-risk adults aged 18-64 years (including pregnant women) are cell-based quadrivalent influenza vaccines (QIVc). People aged 60-64 years will be offered this or, for the first time, a new high-dose quadrivalent influenza vaccine (QIV-HD). Egg-grown quadrivalent influenza vaccine (QIVe) may be offered only when every attempt to use QIVc or in the case of 60-64 years also QIV-HD has been exhausted – evidence of this may be requested by the commissioner before reimbursement is agreed.

All adults aged 65 years and over will be offered adjuvanted quadrivalent influenza vaccine (aQIV) or high-dose quadrivalent influenza vaccine (QIV-HD). NHSE says cell-based quadrivalent influenza vaccine (QIVc) may be offered only when every attempt to use aQIV or QIV-HD has been exhausted – again, evidence of this may be requested by the commissioner before reimbursement is agreed. It is also recommended that aQIV is offered off label to those who become 65 before March 31, 2025.

Pharmacy technicians – missed opportunity?

In a welcome expansion to their role, when NHSE approved the patient group direction to be used by community pharmacies during the 2024-25 flu vaccination season, it was updated to enable pharmacy technicians to provide the vaccinations. However, concerns have been expressed that the service specification presents something of a “roadblock”.

The specification states: “Vaccinations should be administered under the supervision of a pharmacist trained in vaccination (including a clear understanding of this advanced service)” and continues: “Where vaccinations are undertaken off the pharmacy premises, the pharmacy contractor must ensure there is an on-site pharmacist supervising delivery.” 

Numark chairman Harry McQuillan says he is “surprised, to say the least” that the specification has not been updated to allow suitably trained and experienced pharmacy technicians to undertake flu vaccination services in the absence of a flu-trained pharmacist. “This is counterintuitive to me,” he says, “especially after the enabling legislation was introduced earlier this year aiming to maximise the skills of the network’s registered and regulated healthcare professionals – a situation welcomed by many pharmacy owners.”

McQuillan says he hopes this has been an oversight on NHSE’s part. “After all,” he asks, “why go through a consultation and legislative change process to amend regulations to allow pharmacy technicians to operate independently only to put a roadblock in the way at the first opportunity? That would be a very worrying prospect, should that be the case.”

Covid vaccinations

In May this year, NHSE opened a new expression of interest process for pharmacy owners wishing to take part in Covid vaccination campaigns between September 2024 and March 2026.

Vaccine uptake for last year’s autumn booster programme for those aged 65 years and over was around 70 per cent. Those who received a vaccine were around 45 per cent less likely to be admitted to hospital with Covid from two weeks following vaccination, with protection lasting for around four months.

Eligible groups for the 2024 Covid vaccine are:

  • Adults aged 65 years and over
  • Residents in care homes for older adults
  • Individuals aged six months to 64 years in clinical risk groups (as defined in tables 3 or 4 in the Covid-19 chapter of the Green Book)
  • Frontline NHS and social care workers, and those working in care homes for older people.

Eligibility is the same across the four nations of the UK. CPE says that NHSE is maintaining the fee paid for Covid-19 vaccinations at £7.54. Alongside this, pharmacy owners who vaccinate a housebound patient in their home will be able to claim an additional £10 fee.

RSV programme

In a further move to protect public health, the UK has become the first country in the world to launch a nationwide respiratory syncytial virus (RSV) vaccination programme. The rollout, which began in August in Scotland and on September 1 in England, Wales and Northern Ireland, includes a vaccine for women over 28 weeks pregnant and a one-off campaign for people aged 75 to 79 years followed by a routine programme for those aged 75 years and over.

Each year in the UK, RSV accounts for around 30,000 hospitalisations in children under five years of age and is responsible for 20 to 30 infant deaths, as well as around 9,000 hospital admissions in people over 75 years.

The new vaccination programme is being commissioned from general practice as an essential service and NHSE says it is also looking to commission around 50 community pharmacies to deliver it in England. An invitation to tender published by NHSE on July 22 said the 50 pharmacies will be part of an “early adoption phase” and will receive a £9.58 fee for each vaccine administered to an eligible patient.

Self-care opportunities

PAGB’s 2024 Self-Care Census Report shows that coughs and colds lead the way in the self-treatable conditions the British public are most confident in dealing with themselves. The survey of 4,000 adults also found that confidence in community pharmacies is high, with 76 per cent of respondents saying that they see their pharmacist as a trusted health information source.

“Community pharmacists are integral to ensuring a supportive self-care environment, providing people with specialist support and advice on the most suitable and effective OTC treatments as well as equipping people with the information and tools they need to self-care,” says the report.

Karen Baker, expert pharmacist for the Care brand, says it is important for pharmacies to be proactive here. “Topping up stocks of cold, flu and even chicken pox remedies in advance of the flu season starting will be crucial, as well as ordering in a variety of different brands to cater for all price ranges,” she says. “In addition, refreshing knowledge of winter ailments is always helpful ahead of the cold and flu season, and something all pharmacy teams should be encouraged to do.”

Statista valued OTC cough, cold and sore throat treatments in the UK at more than £583m in 2023 – just 2 per cent up on 2022. Mintel notes that the cost of living crisis has encouraged “savvy shopping” behaviours, and Elizabeth Hughes-Gapper, senior brand manager for Jakemans, agrees. “Rising inflation rates, which averaged 6.1per cent for pharmaceutical products in 2023, coupled with the increasing cost of living, are likely to lead consumers to re-evaluate their spending habits,” she says.

To maximise seasonal OTC sales, Hughes-Gapper advises stocking a diverse range of remedies, and dual siting key winter products like lozenges at the till and on-shelf to leverage impulse purchases. “Flavour variety remains a critical factor in consumer preference,” she adds. “There is a growing interest in seasonal and limited edition flavours, driven by their ability to create a sense of exclusivity and urgency.”

Whooping cough

With data continuing to show that cases of pertussis (whooping cough) are increasing, the UKHSA has stressed the importance of timely vaccination. Figures released in August revealed that laboratory confirmed cases of the respiratory infection have surpassed 10,000 since the start of the outbreak in November last year, with 10 babies having lost their lives.

The UKHSA says: “Timely vaccination in pregnancy and in childhood are both important to protect vulnerable young infants from serious disease.” It adds that vaccination at the right time in pregnancy is “highly effective, giving 92 per cent protection against infant death”.

However, latest uptake data for the vaccination among pregnant women continues to decline – coverage in March 2024 was just 58.9 per cent. This compares with a peak of 72.6 per cent in March 2017.

Pharmacy teams should remind women that they can access the vaccine, which also protects against diphtheria and tetanus, through their GP or some antenatal services. Parents should also make sure that their children get protected in the first few months after birth as part of the routine NHS vaccine offer.

Future pharmacy plans

The WHO’s recent declaration that it now considers mpox to be a public health emergency
of international concern is another example of how national health concerns can quickly reach global
proportions.

It is therefore reassuring to know that NHSE’s pandemic response framework says the Government may decide to “stand-up” community pharmacy to deliver vaccinations in the event of future pandemics. This is a reminder, to anyone who may have forgotten, that pharmacists are an integral part of the NHS.

Vaccination resources

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