It's cold and flu season

Pharmacy staff have a vital role to play in encouraging vaccination uptake in customers who are eligible for flu and Covid-19 jabs, as well as helping them to protect their general health this winter. 

With Covid-19 still circulating, a recent report from Imperial College London forecasts a possible surge in respiratory illnesses this winter. 

According to the NHS, more people are likely to get flu this winter as fewer people will have built up a natural immunity to it during the pandemic. The NHS also points out that if someone is unlucky enough to get flu and Covid-19 at the same time, they are more likely to become seriously ill.

This year’s flu vaccination programme is therefore more important than ever in helping to protect the population from illness, as well as preventing the NHS from becoming overwhelmed by the pressure of extra demand. 

According to the Pharmaceutical Services Negotiating Committee (PSNC), requests for flu vaccinations are at an all-time high as people seek to protect themselves. Most pharmacies have ordered extra vaccine supplies in anticipation of the high demand. Indeed, in the first six weeks of this year’s flu vaccination programme, pharmacies in England vaccinated more than 1.8 million people – a 30 per cent increase on the same time last year. This means the sector could be on track to deliver a record 3 million flu jabs this winter – up from 2.6 million last winter.

Targets and eligibility

As we head into our first winter where most people have been vaccinated against Covid-19 (at the time of writing, 67.7 per cent of the UK population had been fully vaccinated), Government modelling has nonetheless suggested that the impact of flu this year could be up to 50 per cent larger than usual. This has prompted an expansion of the national flu vaccination programme.

As a result, more than 35 million people are now included in the eligibility criteria for a free flu jab in England. The Government says it is aiming for a minimum uptake of 85 per cent in those aged 65 years and older; a minimum of 75 per cent across the under 65 years clinically at risk group, pregnant women and those aged 50 to 64 years, and uptake of at least 70 per cent among children.

Last year, eligibility for a free flu jab was extended to 50 to 64 year olds, and this is continuing this year, as hospitalisation from Covid-19 is also know to increase from the age of 50 onwards. As a temporary measure, this year’s programme has also been extended to four additional age groups in secondary schools so that all those from years seven to 11 will be offered a flu vaccine nasal spray, in a bid to reduce transmission of flu in schools.

This means that this year’s eligible groups include: 

• All children aged two to 15 on 31 August 2021 
• People aged six months to under 50 years in clinical risk groups 
• Pregnant women 
• Everyone aged 50 years and over 
• People who live in long-stay residential care homes 
• Carers 
• Close contacts of immunocompromised people.

At the end of September, following pressure from PSNC and the Royal Pharmaceutical Society (RPS), the Government extended free flu vaccines to all frontline healthcare staff involved in patient-facing NHS services. This includes non-clinical counter staff "who play an integral part in patient-facing care on a day-to-day basis in primary care settings". 

The booster programme

The Joint Committee on Vaccination and Immunisation (JCVI) advises a preference for the Pfizer-BioNTech vaccine for the booster programme, regardless of which brand someone received for their primary doses. Alternatively, a half dose of the Moderna vaccine may be offered. Where neither of these mRNA vaccines can be administered – for example, due to allergies – the AstraZeneca vaccine may be considered for those who received it previously. 

Advice from the JCVI is that where possible, the seasonal flu vaccine should be offered alongside the Covid-19 booster dose in order to maximise efficiency for vaccination sites and minimise the number of attendances required for patients. 

Results from the recent ComFluCOV study, funded by the National Institute for Health Research, found that giving the flu vaccine at the same time as the Covid-19 vaccine produced no safety concerns.

Roles for support staff

Public Health England expanded the national protocol for flu vaccine administration in September. This means that in addition to pharmacists being able to vaccinate customers, pharmacy technicians may now also prepare and administer the jab, following appropriate training.

Members of the pharmacy team who are not able to vaccinate customers can significantly impact the uptake of vaccination services in many ways too – not just by helping customers to book appointments and fill in forms, but also by explaining the importance of vaccinations and dispelling any misconceptions and fears people may have.

“Pharmacy staff play a vitally important role in providing vaccination advice to patients,” says Naresh Rallmil, lead information pharmacist at Numark. "They are often the first point of contact for a patient visiting a pharmacy and are trusted for the accurate advice they provide. 

"It is therefore important that all pharmacy staff have undergone relevant training and have been fully briefed on winter health vaccination services on offer, so they can provide advice to patients enquiring about being vaccinated and dispel any myths surrounding vaccines."

Collaborative working

In order to reach the number of people who require a flu vaccine this year, the RPS and the Royal College of General Practitioners have stressed that a well co-ordinated, joint approach to vaccination is crucial across primary care. 

"Working collaboratively with local GPs and healthcare professionals is essential to the success of the flu vaccination campaign," says Vinay Patel, Alphega Pharmacy contract and services manager. "Historically, this has been a challenge – neither have wanted to miss out on this clear opportunity to bolster professional services income over the winter months. But most, if not all, GPs and community pharmacies are now aligned to a Primary Care Network (PCN) – a concept that encourages collaborative working."

Naresh adds: "As part of this collaboration, pharmacies should maintain regular contact with other local vaccination providers to understand vaccine stock levels so that patients can then be signposted easily to obtain the required vaccine."

Top tips fo running a flu vaccination service

The most effective way to recruit patients to a pharmacy’s flu vaccination service is to have marketing materials such as posters and leaflets available. The pharmacy’s website and social media channels are very useful too – especially if they allow patients to send messages direct to the pharmacy to book in. 

Naresh says that another way to promote a flu jab service is to use a booking app where patients can log in to search for a particular pharmacy service and book an appointment. "For those who have never attended their local pharmacy, this is a good way to attract new customers, promote services and increase footfall to the pharmacy,” he says. 

Pharmacy team members can flag eligible patients at every opportunity – during prescription reception, dispensing and handover. Vinay Patel says: "Simple measures go a long way. 'Don’t Forget Flu' stickers are excellent, so attaching these to prescriptions awaiting collection acts as a flag to members of the counter team to initiate a conversation with the patient, and reminds the patient picking up the prescription."

Above all, Vinay says: "Make it fun! Consider rewarding the top 'Flu Fighter' prize to the team member that recruits the most patients, as this will boost morale and really get the team behind promoting the service. If you are engaged, you are more likely to perform at your best and deliver a great service."

Should pregnant women have the flu jab?

Pregnancy affects the way in which the body handles infections such as flu, and catching flu increases the chances of pregnant women and their babies needing intensive care.

For this reason, the Government recommends that all pregnant women should have the flu vaccine to protect themselves and their babies. It can be given at any stage of pregnancy, from conception onwards.

The flu vaccine can:

• Reduce the risk of serious complications, such as pneumonia, particularly in the later stages of pregnancy
• Reduce the risk of miscarriage or having a baby born too soon or with a low birth weight
• Help protect the baby, who will continue to have some immunity to flu during the first few months of their life
• Reduce the chance of the mother passing the infection on to her baby.

Cold, flu or covid-19?

Colds, flu and Covid-19 are caused by different viruses, but they can have very similar symptoms and it is not easy to tell them apart.

Flu, in particular, has many symptoms in common with Covid-19, including headache, sore throat, fever, cough, a runny nose and shortness of breath. However, it’s unusual for flu to cause a loss or change in a person’s sense of taste and smell, which can happen with Covid-19.

People who are up to date with their Covid jabs are much less likely to become infected by the virus, but it is still possible. According to the ZOE Covid Study, the top five symptoms reported by people who have had two doses of the vaccine and catch Covid are:

• A headache
• A runny nose
• Sneezing
• A sore throat
• A loss or change in sense of smell.

British Heart Foundation research suggests that a new, continuous cough is not as common among those who have been vaccinated. 

The best advice is that people who have any of the above symptoms should self-isolate and get a PCR test.

OTC treatments

Colds are self-limiting conditions, so pharmacy staff can reassure customers that they will usually start to feel better within seven to 10 days. 

Customers can tackle coughs and colds themselves using a range of OTC products designed to treat different symptoms, as well as simple self care advice, such as resting and keeping hydrated.

The main OTC medications used to treat cold symptoms are:

• Painkillers – such as paracetamol and ibuprofen, which can help relieve aches, pains and a high temperature (fever)
• Decongestants – taken by mouth (oral decongestants), or as drops or nasal sprays. These can help to relieve a blocked nose. However, they’re generally only effective for a short period and can make a blocked nose worse if used for more than a week
• Cold medicines – containing a combination of painkillers and decongestants, these are generally safe for older children and adults to take, but are not suitable for some customers, including babies and children under the age of six, pregnant women, people with some underlying health conditions, and people taking certain medications. Check with your pharmacist if you are unsure before selling any treatments to customers.

Self care and prevention

Link selling is a good way to increase sales by offering customers other related products they may not have thought about. In winter, this could include tissues, throat lozenges, a vapour rub/inhalant, vitamins and dietary supplements – especially those which may help to support the immune system. 

One of the best defences against infection is a strong immune system, achieved through healthy diet and exercise or, for the times when this is simply not enough, taking a good quality supplement with immune health benefits.

"A little prevention can go a long way in supporting our immune system," says Fabienne Millet, PhD pharmacist at vitamins and supplements manufacturer Hello Day. "A balanced diet, physical activity and a healthy lifestyle are essential and we can also support our immune health with well-known natural solutions which are easily available in pharmacies, based on vitamin D, echinacea, zinc and vitamin C." 

"Gut health is also key to the immune system," says James Grey, healthcare services manager at central London pharmacy John Bell & Croyden, "so a supplement containing pre- and probiotics and live cultures is very good at this time of year."

Pharmacy staff may have to remind customers that antibiotics will not help to clear a cold or flu because they are viral infections and not bacterial. Antibiotics are only effective against bacterial infections, and using them too much may lead to unnecessary resistance and harm public health in the long run. To find out more about antibiotic resistance, take a look at the Public Health England website.

Hygiene is important

While it’s not possible to avoid coming into contact with everyone who might be harbouring a cold, flu or Covid-19, there are plenty of ways to advise customers on how to guard against infection through hygiene measures. 

A proper hand washing technique is an important way of minimising transfer of the viruses from hands to face. Wearing a facemask is also thought to help, as is maintaining a good social distance.

We know that the Covid-19 virus is airborne, so air quality and ventilation are also an important way of preventing infection. "Good air quality not only has the merit of potentially reducing the vulnerability of individuals to Covid-19, but also of generating wider benefit for public health, wellbeing and resilience," says Dr Chris Etheridge, medical herbalist and practitioner, and spokesperson for Puressentiel. "Improving air quality can help increase resilience against acute respiratory illnesses".