Proposal to widen access to influenza vaccine
What we’re proposing
We are seeking feedback on a proposal to widen access to influenza vaccine from 1 April 2022 for Māori and Pacific Peoples from 55 to 64 years of age. This is to reduce the impact of influenza to high-risk populations during the COVID-19 pandemic. Widened access would only be available for the 2022 influenza season and continued funding for future seasons would be assessed as a separate proposal.
This proposal would mean that approximately 39,000 more Māori and Pacific peoples from 55 to 64 years of age, who are not already eligible for funded influenza vaccine through current access criteria, would be able to receive funded influenza vaccine. We also expect that it would reduce access barriers for some people who are already eligible, but may not have easy access to health care services to receive the required assessment to confirm eligibility.
Border restrictions and other COVID-19 related public health measures have resulted in very little influenza virus circulating in the community for the last two years. Our clinical advisors have told us that the lack of community exposure to the influenza virus is likely to have reduced the natural level immunity in the New Zealand population. With the opening of borders we are aware that this is likely to increase the risk of severe illness from influenza for people at high risk. The proposed introduction of aged-based criteria with earlier access for Māori and Pacific peoples for the 2022 season is a proactive move to address medicines access equity for population groups who are at high risk for poor outcomes such as hospitalisation or death from influenza, where there is already evidence of inequities in access to already funded influenza vaccine.
We would not usually propose a change to access criteria for influenza vaccine so close to the start of the influenza season (1 April 2022) and our clinical advisors have told us that a widened access programme could place additional strain on the sector which is already busy managing COVID-19 vaccination and cases in the community. The Ministry of Health is responsible for supporting the implementation of changes to the National Immunisation Schedule and has advised us about work it has underway to help manage the workload in this busy time.
Consultation closes at 5 pm on Friday, 18 March 2022 and feedback can be emailed to firstname.lastname@example.org.
What would the effect be?
The access criteria for influenza vaccine in Section I and Part II of Section H of the Pharmaceutical Schedule would be amended from 1 April 2022. The proposed amended access criteria are shown as they would appear in Section I (amendments in bold):
Influenza vaccine inj 60 mcg in 0.5 ml syringe (quadrivalent vaccine)
- INFLUENZA VACCINE – people 3 years and over
is available each year for patients aged 3 years and over who meet the following criteria, as set by Pharmac:
- all people 65 years of age and over; or
- person is 55 to 64 years of age (inclusive) and is Māori or any Pacific ethnicity; or
- people under 65 years of age who:
- have any of the following cardiovascular diseases:
- ischaemic heart disease, or
- congestive heart failure, or
- rheumatic heart disease, or
- congenital heart disease, or
- cerebo-vascular disease; or
- have either of the following chronic respiratory diseases:
- asthma, if on a regular preventative therapy, or
- other chronic respiratory disease with impaired lung function; or
- have diabetes; or
- have chronic renal disease; or
- have any cancer, excluding basal and squamous skin cancers if not invasive; or
- have any of the following other conditions:
- autoimmune disease, or
- immune suppression or immune deficiency, or
- HIV, or
- transplant recipients, or
- neuromuscular and CNS diseases/disorders, or
- haemoglobinopathies, or
- are children on long term aspirin, or
- have a cochlear implant, or
- errors of metabolism at risk of major metabolic decompensation, or
- pre and post splenectomy, or
- down syndrome, or
- are pregnant; or
- have any of the following cardiovascular diseases:
- children 3 and 4 years of age (inclusive) who have been hospitalised for respiratory illness or have a history of significant respiratory illness;
Unless meeting the criteria set out above, the following conditions are excluded from funding:
- asthma not requiring regular preventative therapy,
- hypertension and/or dyslipidaemia without evidence of end-organ disease.
- Contractors will be entitled to claim payment from the Funder for the supply of influenza vaccine to patients eligible under the above criteria pursuant to their contract with their DHB for subsidised immunisation, and they may only do so in respect of the influenza vaccine listed in the Pharmaceutical Schedule.
- Contractors may only claim for patient populations within the criteria that are covered by their contract, which may be a sub-set of the population described in paragraph A above.
The same amendment would be made to the access criteria in Part II of Section H of the Pharmaceutical Schedule.
We would not normally propose a change to access criteria for influenza vaccine so close to the start of the influenza season (1 April 2022). However, our clinical advisors have told us that there is likely to be low immunity to influenza in the community due to border restrictions and other public health measures to manage COVID-19. With the opening of borders we are aware that this is likely to increase the risk of severe illness from influenza for people at high risk. Our clinical advisors have also told us that COVID-19 has had a major impact on the workload of General Practitioners, pharmacists and other organisations that are involved in providing vaccination services. They told us that this proposed change would be challenging for vaccination providers to implement a targeted recall programme to reach the right people.
We acknowledge that this proposal, if approved, could put additional strain on vaccination providers when they are already busy administering COVID-19 vaccine and managing many COVID-19 cases in their communities. While we acknowledge this issue, we consider the number of additional people who would be eligible under the new criteria is relatively small, so many providers would not have a large number of additional eligible people as a result. We think it is important to reduce health system access barriers where possible for groups who are at higher risk of poor outcomes from influenza such as hospitalisation and death.
The Ministry of Health is responsible for supporting the implementation of changes to the National Immunisation Schedule. The Ministry of Health has advised us that it considers that the start date of the campaign could coincide with high levels of Omicron in the community and appreciates how busy DHBs, pharmacies, general practice and other providers are in the current environment.
To support the Influenza Immunisation Programme this year, and being aware of the pressures the sector is facing, the Ministry of Health has advised that following changes, currently underway, would support the traditional service delivery model for influenza vaccinations:
Expanding workforce capacity
The Ministry is progressing two options to increase the capacity of the workforce to support vaccinations, including Flu and MMR. Currently there are limitations on who can deliver vaccinations. The aim of this work is to provide greater opportunity and greater choice for those needing vaccination by enabling an expanded workforce to deliver a broader range of vaccines to a wider age group The new roles will be enabled in a way that supports them to be able to practice in any setting/provider type.
District Health Boards
DHBs are considering how to leverage the systems and processes that they have established for COVID-19 vaccinations, to support delivery of flu vaccinations as and where needed to suit local demand.
National Immunisation Solution
The National Immunisation Solution (NIS) is a replacement to the National Immunisation Register (NIR) and will be available for providers for the 2022 Influenza Immunisation Programme. Implementing the NIS will allow all influenza immunisations, both public and private, to be recorded in a database and will give a national and regional picture of influenza immunisation coverage.
General practice will have the option of moving to direct entry into the NIS via “flu form” but will not be required to do so. If a general practice continues to submit data to the NIR directly from electronic systems for flu, this information will be picked up and placed into the NIS.
Training and support will be provided for new users of the NIS.
You can contact email@example.com if you have further questions about the implementation of changes to the National Immunisation Schedule.
Who we think will be interested
- Māori and Pacific peoples from 55 to 64 years of age and their whānau
- Doctors in general practice, pharmacists, nurses and vaccinators
- Suppliers and wholesalers
- Organisations with an interest in immunisation
About influenza vaccine
Influenza can be a serious illness that is sometimes fatal. Infection with the influenza virus may lead to a stay in hospital for people of any age, but particularly if you are elderly or have an ongoing medical condition. Influenza can worsen existing medical conditions such as asthma or diabetes.
Influenza vaccine is funded each year for a range of people, including those 65 years and older, in pregnancy, and for people with medical conditions such as heart disease, respiratory conditions, diabetes, renal disease, and autoimmune diseases. Over 1.4 million people are usually vaccinated annually (funded and privately purchased).
The Afluria Quad and Afluria Quad Junior are the only funded influenza vaccines for the 2022 season and this proposal relates to only the Afluria Quad vaccine. It is a quadrivalent vaccine, which means it protects against four strains of influenza virus. For the 2022 season, the strains included are: A/Victoria, A/Darwin, B/Austria and B/Phuket.
Why we’re proposing this
As noted above, influenza vaccine is currently funded for all people 65 years of age and older, however, vaccination rates are much lower for Māori and Pacific peoples compared to the wider non-Māori, non-Pacific population. Māori and Pacific peoples have a younger age distribution than other population groups and a high incidence of comorbidities (additional health conditions). Our clinical advisors have told us that Māori and Pacific peoples are at increased risk from seasonal influenza.
Many Māori and Pacific peoples from 55 to 64 years of age may already be eligible for funded influenza vaccine if they have other serious health conditions such as asthma, diabetes, or heart disease. Earlier access at a younger age would mean that more Māori and Pacific peoples could benefit from funded influenza vaccination as fewer reach the age of 65 years than other population groups.
Introducing aged-based criteria with earlier access for Māori and Pacific peoples would also reduce health system barriers to accessing funded influenza vaccination as eligible people would not need to have already accessed health services to receive a diagnosis of a qualifying condition.
We are proposing to introduce aged-based criteria with earlier access for Māori and Pacific peoples as a proactive move to address medicines access equity for population groups who are at high risk of poor outcomes such as hospitalisation or death from influenza, where there is already evidence of inequities in access to already funded influenza vaccine.
To provide feedback
Send us an email: firstname.lastname@example.org by 5 pm 18 March 2022.
All feedback received before the closing date will be considered by PHARMAC’s Board (or its delegate) prior to making a decision on this proposal.
Your feedback may be shared
Feedback we receive is subject to the Official Information Act 1982 (OIA). Please be aware that we may need to share your feedback, including your identity, in response to an OIA request. This applies to anyone providing feedback, whether they are providing feedback themselves or for an organisation, in a personal or professional capacity.
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