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  • @ Cynthia Adina Kirkwood

The Unexpected This Flu Season

Updated: Nov 28, 2020



I have been on the prowl for a flu vaccine.


To no avail, I have made a few weekly visits in Portugal's Beiras to the village pharmacy in Ervedal da Beira, a large pharmacy in the town of Oliveira do Hospital, and the health center in Ervedal since November.


I am one of the many undercounted in the Northern Hemisphere who are waiting for

and despairing about getting the vaccine due to aggressive marketing campaigns during the

COVID-19 crisis.


Friends in Lisbon, who usually get the flu vaccine, have decided to forgo it, this year, as the

search itself becomes a risk in crowded clinics and elsewhere. On the basis of safety, a flu

vaccine could be slipping out of its place as a priority, especially since this is likely to be a mild flu season.


Portugal acquired 2.5 million seasonal flu vaccines. When these doses are administered, it will not be possible to buy more because supply is not infinite, Portuguese Minister of Health, Marta Temido, told PS Politica com Palavra podcast as reported in Sabado (November 18).


The flu vaccine campaign is not over yet,” said Temido.


According to current estimates, another 200,000 influenza vaccines will arrive between the end of this month and the beginning of the next, she said.


In the meantime, COVID-19 vaccine trials have pushed aside news of the scarcity of the flu

vaccine.


Hopefully, mistakes that were made with the flu vaccine will not be repeated in the COVID-19

vaccine campaign.


Portugal bought a total of 2.510 million flu vaccines (2.070 million for the National Health

Service and 440,000 for pharmacies). Pharmacies have dispensed 205,996 doses, which is

not even half of the order, but it is all that has been delivered thus far.


The 2,449 pharmacies, which are certified to vaccinate, have received 160,000 fewer vaccines as compared with last year, according to SAPO24 (November 25). Doses have been trickling in since October 19.


The population of the at-risk age group of 65 and older recommended to have the inoculation is already more than 2 million. So, why were not more vaccines ordered for a population that was strongly encouraged to get the flu vaccine?


Graça Freitas, the directorate-general for health, said that the purchase of vaccines was made at the beginning of the year “before the pandemic” arrived in Portugal, according to Sabado. Later, when Portugal tried to increase the order, it could not do so because the availability of flu vaccines on the world market had been exhausted.


This month, the pharmacist in Ervedal said that she received less than half of her order. The pharmacist in Oliveira do Hospital said that she received only one-third of her order. She added that the drug company has not kept its promises. SIC News had reported that the last shipment of flu vaccines would be arriving at pharmacies this week.


It did not happen.


Mylan, a global pharmaceutical company domiciled in the Netherlands, produces Influvac,

which is the brand delivered to pharmacies. It said that the company has fulfilled its order to pharmacies and the National Health Service in Portugal for the 2020/20121flu season. It also said that it delivered more doses to the Portuguese market as compared with last year, according to SAPO 24.


Aside from Mylan, a French multinational drug company called Sanofi is also supplying the

National Health Service. Its vaccine is called Vaxigrip.


Usually, unused flu vaccines are left on the market. In the past, most of the vaccines in Portugal were used by people, said SAPO24. Interestingly, vaccines cannot be returned or sold the following year because, each year, the inoculations contain three different strains of inactive viruses, which cause the production of antibodies, in accordance with the recommendations of the World Health Organization (WHO).


Every February in the Northern Hemisphere, WHO reviews the types of flu that have been circulating around the world and chooses the ones which will go into the vaccine for the following autumn, according to the Vaccine Knowledge Project, which is run by academics from the University of Oxford. This allows time for the vaccine to be made, but it also gives the flu virus time to change before vaccination begins in the autumn. Therefore, sometimes the flu vaccine may not be a good match for all the circulating strains of flu.


Scientists are researching ways to develop a flu vaccine that protects against all the many different varieties of flu. If they are successful, it will mean that people will only need a single

flu vaccine for lifelong protection, instead of having an annual vaccine.


In July, the European Commission strived to avoid the risk of hospitals being overwhelmed by flu patients as well as COVID-19 patients, reported Reuters (July 19) It urged member states to buy more shots against influenza and get more people vaccinated than before. It also encouraged countries to begin vaccinating in July, though the period of the vaccine’s incubation is unclear.


Health Commissioner Stella Kyriakides said that governments should fight “Vaccine hesitancy”, referring to people’s skepticism about vaccinations which led to the resurgence of certain diseases, such as measles, prior to COVID-19.


Apparently, the European Commission’s directive has been too successful for its own good.


Portugal is not the only country suffering a shortage of flu vaccines. Germany reported frustrated people unable to find vaccines, according to Stimme.de (November 27). In France, waiting lists are overflowing, said Ladepeche.fr (November 27).


In the Netherlands, because of a shortage, Public Health State Secretary Paul Blohius asked

healthy people older than 65 to refrain from getting the vaccine to allow more available for the more vulnerable, said deVolksrant (October 27). The demand for flu shots has crept up over time. However, this year, demand exploded with even staunch vaccine naysayers lining up for a shot.


Jan De Belie, of the Pharmaceutical Group of the European Union, said that shortages are

challenging for healthcare workers, including pharmacists, who face angry patients and customers.


“We are often confronted with verbal aggression when people don’t get their flu vaccines,” he

said.


Vaccine makers have stepped up production significantly, with some expecting to continue delivering vaccines weeks or months after the usual peak in demand, said Vaccines Today.eu. (October 27). Flu vaccination may even be available in December or January. According to Vaccines Europe, a trade association, its members increased supply to Europe by an average of 30 percent.


Unfortunately, there are limits to the possible number of additional vaccines. Vaccines are biological products, and there are a limited number of companies with the expertise and facilities to make them. Making flu vaccines takes between 12 and 18 months, which means that the vaccines arriving at pharmacies today began production last year.


In a joint statement, Vaccines Europe and the European Healthcare Distribution Association

(GIRP), a group representing 750 drug wholesalers, called for earlier engagement with

governments to enable more accurate forecasting of demand for future flu seasons.


Yet, surely, these companies were aware of COVID-19 and the European governmental

campaigns to increase flu vaccinations. This year, simply, has been an unusual year. Previously, flu vaccination rates were low. All European Union countries had fallen short of their target to vaccinate 75 percent of older people. Probably, drug companies and governments underestimated demand.


In China, a surge in demand for flu shots has caused long serious shortages, long lines and triple mark-ups on vaccines by scalpers selling them online, according to The Guardian (October 7). Cities had launched a full-scale vaccination program to prevent twin epidemics of flu and COVID-19.

The number of flu vaccine doses is expected to double from last year to 50 million, according to the government-linked Global Times (October 8). The Guardian (October 7) reported that China usually has a low vaccine rate of 2 percent compared with 50 percent in the United States. Experts believe that China’s rate should double to 4 percent this season.


In the United States, a record number of flu vaccine doses were on the way -- between 194 million and 198 million -- seemingly plenty considering last year just under half of adults got vaccinated in a population of 328.2 million, and there usually are unused vaccines. Occasionally, some people are finding drugstores or clinics out of stock, said The Associated Press on October 1.


“This year, I think, everyone is wanting to get their vaccine and, maybe, wanting it earlier than usual,” Dr. Daniel Jernigan of the U.S. Centers for Disease Control and Prevention told The Associated Press. “If you’re not able to get your vaccination now, don’t get frustrated” but keep trying.


Because of the vaccine flu shortage, the World Health Organization Strategic Advisory Group of Experts (SAGE) is urging national governments to prioritize older people and health care workers, according to Vaccines Today. This advice is new. Previously, the WHO listed five risk groups: pregnant women (the highest priority), children, older adults, those with medical conditions, and health workers, in no particular order.


There is some good news.


This flu season is likely to be milder than any in living memory, according to experts. The

reasons are simple: quarantines, mask-wearing, handwashing, and social distancing reduce the spread of the new coronavirus and other respiratory infections.


In the Southern Hemisphere, the incidence of flu cases was exceptionally low. Testing usually suggests infection rates from 10 percent to 30 percent, said Dr. Ann Moen, Chief of Influenza Preparedness and Response at WHO in Vaccines Today (October 27). This year, only 1 percent of influenza tests have come back positive. Data from the Northern Hemisphere shows a similar pattern, although it is still very early in the flu season.


“This really is a historic low in terms of flu circulation,” Dr. Moen said. “And we feel confident

this is not due to a lack of testing or surveillance.”


Perhaps, the successful flu vaccine campaign will lead to more people getting a COVID-19

vaccine than would have before.







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