The autumn flu and COVID vaccination campaign has been brought forward by 2 weeks in response to the potential threat of a new Sars-CoV-2 variant (BA.2.86) known as Pirola, which was first detected in the UK on 18 August. According to the UK Health Security Agency (UKHSA) (2023a), the BA.2.86 variant is now more globally dispersed than other variants such as Eris and Fornax, which are of a similar age. This suggests that it is seeding through mass travel as well as the emergence of established transmission chains within many countries. While there appears to be little information about the BA.2.86 variant due to few reported cases to assess its comparative severity, there is some concern that it may dominate, just like the Omicron variant. However, it is the nature of viruses that they mutate over time, and that new variants will continue to emerge. GPs and pharmacists will be given £5 for each vaccination before the end of October and this will be doubled to £10 for vaccinating care home residents. This is in an attempt to ensure as many potentially vulnerable people are vaccinated prior to the high-risk months of December and January (NHS England, 2023).
Over the last 4 years, individuals will have built up varying levels of immunity depending on exposure to the Sars-CoV-2 virus and vaccination, although high levels of immunity appear to wane soon after an infection. The data indicates that there was a 70% uptake of the spring 2023 COVID-19 vaccination booster among those aged 75 years and over, which was lower than the autumn 2022 COVID-19 vaccination booster uptake (UKSHA, 2023b). This perhaps suggests a growing fatigue towards biannual COVID-19 vaccinations and a poor appreciation of the durability of protection from the COVID-19 vaccination when compared to other vaccinations such as those for measles, which give life-long protection. The Office for National Statistics' (ONS) (2022) analysis has indicated that, while the deaths with COVID-19 as an underlying cause has fallen, the number of deaths caused by it remain higher than for influenza or pneumonia.
Augusto et al (2023) have noted that about 20% of those infected with SARS-CoV-2 remain asymptomatic; this is possibly because about 10% of the population have a gene associated with an immunological response, which results in a rapid viral clearance. How many people are succumbing to COVID-19 is difficult to quantify completely in the absence of universal symptomatic and asymptomatic testing. However, UKHSA (2023c) publish regular national influenza and COVID-19 surveillance reports, which bring together different sources of data (Respiratory DataMart, primary care syndromic surveillance and sentinel swabbing, syndromic surveillance (Royal College of General Practitioners-participating practices and NHS 111 calls), testing of hospital admissions, COVID-19 intensive care unit/high-dependency unit admissions, and death certificates with any mention of COVID-19). The Week 39 report noted the infection rates were stable compared to those in the Week 37 report, with the usual seasonal levels of colds and influenza, and an increase in COVID-like illness attendance rates at emergency departments. This reflects the typical pattern of viral infections, with viruses spreading more easily with increased social contact in enclosed spaces as the summer weather draws to a close.
‘…the BA.2.86 variant is now more globally dispersed than other variants such as Eris and Fornax, which are of a similar age. This suggests that it is seeding through mass travel as well as an emergence of established transmission chains within many countries. While there appears to be little information about the BA.2.86 variant due to few reported cases to assess its comparative severity, there is some concern that it may dominate, just like the Omicron variant.’
The focus upon COVID-19 has perhaps caused a lack of attention towards the danger of influenza which killed more people during its peak than COVID-19 last winter and also caused more hospital admissions with more than 10 000 children requiring hospital care (UKSHA, 2023d). This year, there is particular concern that an H1N1 influenza strain which has been circulating in Australia (Australian Government, 2023), may be a precursor to a major flu outbreak in the UK during this winter flu season. Van Leeuwen et al (2023) have modelled the potential impact of influenza vaccination upon influenza transmission and a peak in influenza infections. They have been able to demonstrate that, while susceptibility to influenza affects the timing and the size of a potential influenza wave, the level of vaccination impacts the size of the peak of the influenza wave. There was increased susceptibility to influenza due to the suppression of the virus during the period of social distancing, which led to an earlier and larger influenza wave. However, there was evidence that the influenza vaccine efficacy controlled the size of the peak of the influenza wave. This provides a strong reason to advocate influenza vaccination to all those aged 65 years and over.
‘The focus upon COVID-19 has perhaps caused a lack of attention towards the danger of influenza which killed more people during its peak than COVID-19 last winter and also caused more hospital admissions with more than 10 000 children requiring hospital care…’
Therefore, the current imperative is the promotion of vaccinations, particularly among the vulnerable due to their age or health status, or both. However, it is noteworthy how not only are the vaccination uptake levels falling among the vulnerable [i.e. those whom the Joint Committee on Vaccination and Immunisation (Department of Health and Social Care, 2023) have identified as standing to benefit most from vaccination], but also among healthcare staff in contact with patients with the high uptake (90.2%) of at least one dose of the COVID-19 vaccination 2021/2022 falling to 68.5% for a third vaccination in the April 2022 data (UKSHA, 2022). Indeed, in June 2023 the UKSHA (2023e) also reported that only 49.4% of healthcare staff with direct patient contact in NHS Trusts received the influenza vaccine in England, which was a decrease of 11.1% compared with the 2021/2022 season (60.5%) and represents a second consecutive year of a decrease. It represents the lowest uptake since the 2012/2013 season. There was a wide range in the influenza vaccination uptake across NHS Trusts (11.5% to 82.3%) with only 8.8% of NHS Trusts achieving an uptake of 70% or more. It was noteworthy that in GP practices, nurses had the highest vaccination uptake at 73.6%; data were not collected separately for community nurses working within NHS Trusts.
It is difficult to identify how to overcome this diminishing recognition of the benefit of vaccination if healthcare staff are also not able to see the benefit of vaccination for both themselves and their clients. Indeed, it might be argued that healthcare staff have a professional duty to minimise their potential role as a vector of an infection to their clients as well as minimising their potential absence from the workforce due to an avoidable infection. Additionally, the opportunity to role model preventative health behaviours both to students and others in the workforce is missed. Another missed opportunity is the ability to provide a convincing and persuasive message to vaccination hesitant clients who may feel that the vaccination promotion message is undermined if healthcare staff do not exemplify the desired vaccination behaviours in their lives. As nurses, we need to consider to what extent The Code (Nursing and Midwifery Council, 2018) sets expectations about personal health behaviours, including the uptake of recommended vaccinations.