The value of flu vaccination is revisited almost every year by health leaders in the UK to determine the benefits of investment. In her article ILC’s Senior Health Policy Lead, Esther McNamara, sets out how we currently value seasonal influenza vaccination at a societal level. She argues for a clearer understanding of what we lose when people are unwell with flu; and for incorporating this into future cost-effectiveness calculations.

“The development of current and new vaccination programmes provides an opportunity to reduce the burden of infectious disease in future older adult populations.”

This excerpt from Sir Chris Whitty’s annual report 2023 published today emphasises the importance of immunisation to support healthy ageing at a population level. The Chief Medical Officer’s Health in an ageing society report provides a welcome focus on preventative interventions and a clear long-term perspective on demographic change often missing from discourses around health infrastructure in the UK.

With winter fast approaching, the 2023-2024 flu season is underway. Vaccination against flu is key to preventing transmission, hospitalisation, and deaths from influenza and related complications – particularly amongst the oldest and youngest in society. When making decisions about seasonal vaccination, policy makers should be cognisant of the social and economic benefits we accrue when we prevent ill health with immunisation.

A different approach to flu vaccine cost-effectiveness will hopefully form part of a wider shift towards prevention instead of cure. Prevention has social and economic benefits that will only increase as our society continues to age (see ILC’s programme of work on Prevention). The public also has a role to play and should continue with the infection control measures we have become so familiar with in recent years: seeking out vaccination, practising good hand hygiene, and staying home when unwell.

ILC-UK’s ongoing programme of work on the cost effectiveness of life course immunisation has made clear the overall social and economic impact of flu should not be underestimated. In recent years ILC-UK has produced research demonstrating a range of efficacy and vaccination coverage scenarios are not just cost-effective, but cost-saving. ILC’s report Lost Time: Productivity and the flu found that up to 91 million people around the globe get flu every year, and flu saw around 159 million missed working days in 2018 in the 50-64 age group alone. Most of the Missing Million – people over 50 who leave the workforce prematurely, many due to ill health – are in this age group. We know that flu vaccines are cost-effective when we take account of the wider full socioeconomic context of ill health; the impact on work, pay, volunteering, unpaid care, and spending. We also know that the flu vaccine works, but we’re not currently protecting as many people as we could through vaccination.

The Chief Medical Officer’s report outlined the further progress we can expect in flu vaccine development. In particular, mRNA-based developments will support better matches of strains in the population to strains included in the vaccine, and improved immune responses post-vaccination.

So far in 2023, the first three weeks of influenza vaccine uptake for 2023-24 show similar uptake compared to the same time last year.

While uptake is not seen to decline this year, there is still a way to go to ensure that those most vulnerable to the impact of the flu virus are protected. By the end of October, the figures showed that 16.1% of under-65s in a clinical risk group; 12.5% of all pregnant women; 45.3% of 65+; and 17.9% and 16.4% of all 2- and 3-year-olds respectively had been vaccinated. There is still time to vaccinate more people in these and other groups, which could have a significant impact on the number of cases, hospitalisations, and deaths from flu this year.

To manage the additional burden of flu across the winter months, it is vital that the public remain engaged and aware of the benefits of immunisation to promote uptake. Awareness measures should target those who currently do not receive NHS-funded vaccines (generally those between 18-64 without underlying conditions) and who may need to pay for the flu vaccine themselves. Employers should consider reimbursement or organising in-house vaccination programmes for flu and COVID-19. Health leaders should also continue to emphasise other infection control measures such as hand hygiene and staying at home when unwell. Adherence to these varies, and we saw throughout COVID that employees who lose pay when they stay home sick (if statutory sick pay is lower than their salary) were disincentivised from self-isolating when necessary.

Although the Joint Committee on Vaccination and Immunisation (JCVI) agreed vaccinating low-risk 50- to 64-year-olds has “clear health benefits”, it questioned the cost-effectiveness of NHS funded flu jabs for this cohort. There are, however, significant social and economic benefits of vaccinating this age group. Beyond the paid work missed, this age cohort has almost 2 million people providing informal care across the UK. When a carer is unwell, it affects not only themselves and the person they care for, but their family and community networks who must step in to fill the gaps. Although formal volunteering activity has declined in this age group in recent years, our research has found unpaid work by older people across the EU and Türkiye could be worth as much as 1.4% of GDP – more than their respective defence budgets.

The failure to implement calls for action from the Health Select Committee to make use of medical and nursing students, and retired clinicians, to deliver vaccinations and improve uptake is concerning. Increasing ease of access to vaccinations, and access to clinicians who can answer questions and advocate for vaccination where appropriate, is key to improving uptake.

There is so much that can be done to improve seasonal vaccination; ensuring that the public has straightforward access to vaccines on demand is key. Changing public perception of vaccination is also crucial in the long term. At present many adults don’t know which vaccines are available to them, or what the benefits of vaccination would be. As evidenced in the Chief Medical Officer’s report, vaccination is a key intervention to supporting healthy ageing as meet the challenges and opportunities of demographic change.