Twindemic fears increase flu vaccine demand and trigger shortages in Europe

Major pharmacies have halted flu shot appointments. Doctors’ offices are putting people on waiting lists — or telling them to call back in December. Although the government has urged calm and said more supplies are on the way, a survey of general practitioners in Britain found that only a quarter expect to have enough flu vaccine to last the winter. 

The story is similar in many countries across Europe. As coronavirus cases rise, urgings from public health officials about the need to avoid a “twindemic” has upped demand for flu vaccines — and, in some places, triggered shortages. Governments are rationing flu shots to those most vulnerable, while they scramble for supplies.

In a limited way, it’s a trial run of what governments may face if and when coronavirus vaccines are available. It may also be an early indication that, even in countries traditionally skeptical of vaccines, large swaths of the population will be willing to get inoculated for covid-19.

Ann Moen, World Health Organization’s chief of influenza preparedness and response, has acknowledged that some Northern Hemisphere countries are having trouble sourcing additional flu vaccines. The United States says it has plenty of doses stocked, but many countries in Europe don’t.

This past flu season was relatively mild in the Southern Hemisphere. Australia, New Zealand, Chile and Argentina all glided through with low numbers. South Africa barely had any cases at all. But Europe is worried that even an average flu season, combined with the stresses of covid-19, could be disastrous.

The vaccine supply problem stems in part from orders placed in 2019, before anyone knew that the second wave of a global pandemic might coincide with the northern flu season.

Still, public health experts have been surprised by the eagerness for flu shots this year, both in vaccine-embracing countries such as Britain, where more than 70 percent of people over 65 normally get a flu jab, and in nations where uptake is usually low.

Poland, for instance, has a reputation for rejecting vaccines and distrusting pharmaceutical companies. Last year, only 4 percent of the population got flu vaccinations and 100,000 doses went unused. But this fall, Poland’s health minister said the country is facing a flu vaccine shortage and trying to negotiate new shipments, amid increased demand.

In Italy, the country’s regional health authorities have placed orders for 17 million shots, almost 50 percent more doses than last year.

“We were preparing for an increase, but not such a significant number,” Massimo Scaccabarozzi, president of the association that represents Italy’s pharmaceutical companies, told the Guardian newspaper. “It’s a big challenge.”

In Britain, Prime Minister Boris Johnson’s government promised an unprecedented campaign, to double last year’s effort and deliver flu vaccines to 30 million people in England — more than half the population — including free shots for anyone aged 50 and over.

“There is no national shortage of the flu vaccine. . . . It is completely wrong to suggest otherwise,” said a spokesman for the Department of Health and Social Care, who is not named by government protocol.

“The vaccine is already being delivered for those in at-risk groups, including the over-65s,” the spokesman said. “And this will continue throughout the winter months, so there is still time for those eligible people to get their vaccinations.”

But with even high-risk people ending up on waitlists, there are doubts about whether the government can deliver.

“It certainly looks like demand is outstripping supply quite considerably,” said Martin Marshall, chair of the Royal College of General Practitioners, who is monitoring the flu vaccine program.

“There is a lot of uncertainty at the moment,” Marshall said. “Will we in general practice have enough vaccine to deliver to those to greatest need? When will new supplies come through? Will the public be patient and understanding with need to wait in line while those with the greatest need get it?”

He said people were already showing understandable frustration.

“They have been told they are going to be vaccinated. They were expecting it, wanting it. Many are going along to their GPs and pharmacies saying, ‘Here I am. Can I have it?’ And now are having to be told, ‘Please be patient. Hold on, because you might be a priority group, but you’re not a top priority group.’ ”

Britain and the rest of Europe don’t traditionally encourage flu vaccines for everyone, as the United States and Canada do. Instead, Europe aims to vaccinate a substantial portion of the most at-risk groups: primarily the elderly, people with chronic conditions, pregnant women and health-care workers. This year, there was talk of going broader. But most of that talk was short-lived.

In Belgium, the health ministry declared in June that “it is more crucial than ever to be able to vaccinate people at risk as widely as possible to avoid overloading the health-care system, given the possible risk that the flu season will coincide with a peak of covid-19.”

The ministry proposed expanding the target group to people aged 50 to 64.

But while Belgium had increased its vaccine order for this year, to 2.9 million doses, that’s far short of the 4 million doses it would need to execute the ministry’s proposal.

“Vaccinating people who fall outside the priority group, such as workers in good health, is out of the question,” Lieven Zwaenepoel, a spokesman for the Belgian Pharmaceutical Association, told the country’s De Morgen newspaper. “Everyone will have to show solidarity.”

That means most of the country will remain unvaccinated.

Likewise, German Health Minister Jens Spahn was among those who called for broader flu vaccinations this year, amid fears the health system could be overloaded.

“Anyone who wants to have themselves and their children vaccinated can and should,” he told Germany’s Welt am Sonntag newspaper in August. That’s why Germany had acquired additional doses, he said. Other health experts called for teachers to be covered as fully as possible.

But even having purchased more flu vaccine than usual, with 25 million doses, Germany won’t be able to cover the 40 million people considered highest risk, much less the entire population of 83 million. Ultimately, the county’s vaccine commission recommended that only high-risk groups get inoculations.

About half of those eligible in Germany say they plan to do so. That’s higher than in typical years; about a third of people 60 years and older and 20 to 50 percent of people with chronic illness received a flu vaccination last winter.

But health experts worry it’s still not enough.

“It is frightening that almost every second person who belongs to a risk group wants to forgo the flu vaccination,” said Fritz Becker, chairman of the Federal Union of German Associations of Pharmacists, in a recent statement.

“The vaccination is safe and well-tolerated. Those who are vaccinated not only protect themselves, but also others from infection. That should be enough incentive,” Becker said.

And people skeptical of the well-established flu vaccine may be even more nervous about the prospect of a brand new coronavirus vaccine that is tested, approved and produced in record time.

Luisa Beck in Berlin and Michael Birnbaum in Riga, Latvia, contributed to this report.

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