The Minister of Health, Carolina Darias, has already set a date for the start of the flu vaccination campaign. The appointments will begin in the second half of October and the groups with free vaccination do not change, they are the same as other years: over 65 years, population at risk for pathologies, health workers and pregnant women. The campaign will coincide with the death throes of the COVID-19 pandemic, whose restrictions made the flu a testimonial disease last winter.
Why achieving group immunity is not feasible
The Carlos III Health Institute has not published the annual report for 2020-2021, but the registered cases were much lower than in previous years. The World Health Organization warned that the data had to be interpreted with caution because hygiene measures (hand washing), distancing and masks also contributed to reducing the transmission of the influenza virus.
The last season before the pandemic, 619,000 confirmed infections were estimated in Primary Care, 27,700 hospitalized, 1,800 patients in ICU and 3,900 deaths attributable to the virus. In 2020-2021, the precautions imposed by the coronavirus also cornered the flu, the experts consulted agree. The question is what will happen this winter.
The scene is very different. Spain is leaving the pandemic behind, 77% of the population is vaccinated and, consequently, all communities have relaxed – to the point of almost making them disappear – restrictive measures (capacity, schedules …), except for the indoor mask. How is this going to affect the transmission of the flu? Does anything change in the vaccination campaign? Are we less immunized because last year the virus barely circulated?
More virus circulation and less natural immunization
There is no certainty about how intense the circulation of influenza viruses will be, although scientific evidence shows that “after seasons with low activity, others with greater activity follow.” It is the diagnosis made by the director of the National Center for the Flu, José María Eirós. “We do not have elements that allow us to predict clearly. In the previous season, not only in Spain but in Europe the circulation of viruses has been small. And that has meant that in the centers we have had less possibility of characterizing them. It adds uncertainty” , explains the also professor of Microbiology.
Nurse Inmaculada Cuesta, a member of the Health Ministry’s Vaccine Report, thinks that keeping the mask indoors and washing hands frequently this year can also cushion the impact of the flu. “Nobody has the crystal ball and it seems daring to make forecasts because influenza viruses behave differently every year. Undoubtedly the general containment measures (distance, mask, hand washing) are beneficial,” he points out in conversation with elDiario.es.
Eirós also points out that the scarce circulation of the virus makes the possibility of natural immunization less and therefore we are more vulnerable to contagion. “There was less natural infection, but nevertheless people were vaccinated more. It is good news,” he clarifies.
The same priority groups, despite the request of pediatricians
The flu vaccine is only subsidized for certain groups (by age, by pathology and by profession), but all the patients they want can get it. Yes, paying. Experts such as Inmaculada Cuesta advocate for universal access to the vaccine: “Those most at risk are identified, but the vaccine is a prevention tool for all people over six months of age.”
In his opinion, the inclusion of children between 5 and 59 months could have been considered, as recommended by the Spanish Association of Pediatrics. “If they are not included, it is due to a matter of economic resources. Children suffer from the disease and transmit it. Normally it is not complicated at those ages but they can infect people at risk in their environment, such as the coronavirus,” says Cuesta. Eirós adds that “children are an age segment where the flu has an important activity”, recalls that “they are the subject of vaccination programs” in other countries such as the United Kingdom and supports the criteria of the group of pediatricians.
Buying the vaccine individually, upon payment, was not easy last year because “the pharmaceutical companies were focused on developing the injection against COVID-19,” Cuesta concludes with the unknown of what will happen this season.
Recruit health workers and people at risk to get vaccinated
“Adherence is relatively good in people over 65 years of age. Below, however, in priority risk groups it is low or bad,” explains Cuesta. The utility sets the objective of “increasing coverage”, especially in toilets. “The percentage of vaccinated is a shame. We must have an exemplary behavior,” he says.
In 2019-2020, only 39.4% of health workers were vaccinated against the flu. A year earlier the percentage was even lower, 35%. The figures are far from what is recommended by the WHO: 65%.
The Public Health Commission is explicit in this regard in its recommendations, published in June: “The recruitment of people included in the age group greater than or equal to 65 years and in health and social health personnel should be strengthened”. And it is set as objectives “to reach or exceed vaccination coverage of 75% in the elderly – in the last year with data the percentage reaches 55% -, preferably from 65 years and in health and social health personnel, as well as exceed the 60% in pregnant women and in people with risk conditions “.
Eiros is more optimistic and expects an increase in coverage. “You have to look at the trend. We came from a situation of decreasing adherence percentages but in the last season, with the coronavirus, there was an increase in the prevalence of vaccination, it is very good news,” he argues.
The flu has historically put healthcare systems in check, if only for a few weeks. Images of hospital corridors full of beds in winter were common before the outbreak of the coronavirus pandemic. Experts predict that the arrival of flu and COVID-19 cases may confuse health workers, in a first diagnosis, because “they have very similar symptoms.” “The screening will be done through the PCR test”, ditch Cuesta, which clarifies that the evolution of the flu without complications is 2 or 3 days while the coronavirus lasts longer.
Is there a fear that the health system will be stressed again? “If the attendance of the emergency services increases, it seems evident that it can get complicated”, predicts Eirós. The microbiologist insists on the importance of making “a quality microbiological diagnosis” and for that the budgetary allocations must “be maintained.” “With this I mean that if you go to a hospital with pneumonia, do not send you home. That serious assessments of respiratory symptoms can be made,” he clarifies.
Cuesta agrees that in winter “there can be difficulties when organizing the system, so we must always insist on hygiene measures and vaccination of priority groups.”
Administer both vaccines at the same time
The Ministry of Health recommended that communities administer both the booster dose of the coronavirus vaccine to the elderly in residences and the flu injection. Scientifically this is called “co-administration” (one vaccine in each arm) and although it was recommended, since there is already scientific evidence that shows that there are no more adverse reactions than if they were put separately, the autonomous communities have begun to put third doses to institutionalized elderly without waiting for the flu campaign. Most have been rushed because they had a large number of doses stored in the refrigerator with the risk of expiring.
“People who have been given the third dose of the coronavirus first should not wait any time for the administration of the flu vaccine. Spacing is no longer recommended,” explains nurse Inmaculada Cuesta, very aware of the studies to create a vaccine that simultaneously protects against the two viruses. Moderna announced a few months ago that it was immersed in this process. “The studies are on the right track, but without definitive results and without authorization. In favor – he values - has that with a single puncture we would protect the person against two important diseases”. Regarding the possible cross immunity, that is, that those vaccinated against influenza may be more protected against COVID-19 “there is still not enough scientific evidence,” the expert concludes.