elderly getting less effective flu vaccine?

Rae from Maungaraki

Age Concern advise those aged 65 and over are being offered a potentially less effective vaccine than they were last year.
Under a four-year supply agreement for the 2020 to 2023 influenza seasons, independent drug-buying agency Pharmac is funding the flu vaccine Afluria Quad – making it free for the eligible groups. But last year, supply delays of Afluria Quad meant that for over-65s, Pharmac temporarily funded an alternative. Called Fluad Quad, it’s the only available flu vaccine that works with an immune enhancer or adjuvant – an ingredient that improves the immune response to the vaccine in people aged 65 and over. But Pharmac hasn’t yet agreed to fund it permanently, meaning those who want Fluad Quad this year must pay for it.
Last week an Auckland woman, ahead of her vaccine, which was advertised as free, she was asked “did I want the free one, or the one specially made for older people who may need help making the antibodies?” That vaccine, Fluad Quad, would cost $35. “I was told that it was the one given free last year,” she said.
She paid the $35 for Fluad Quad and said her concern is not that she personally had to pay for the vaccine but that she’s worried “that this seems like a two-tier system: one for those with money to choose, and one for those without”. She’s also concerned that others may not be informed of the choice or variation between the vaccines.
Pharmac’s chief medical officer Dr David Hughes said in an emailed statement that in 2020, Fluad Quad was placed on the “cost-neutral list”, which, according to the Pharmac website, means “it may get funded if we can negotiate a deal that saves money, or at least doesn’t cost more than something already funded”.
In 2021, “the supplier marketed it as a more effective vaccine”, said Hughes, “but it has only been recently that they have supplied more evidence to Pharmac to support their application for Fluad Quad being more effective than Afluria Quad in people over 65 years of age”. The Immunisation Advisory Committee that advises Pharmac will be considering the more up-to-date evidence and providing advice on it at their meeting next month, he said.

The data to date on the Fluad vaccine suggests it does to some extent give the best immune response for elderly, explained professor Nikki Turner, the director of the Immunisation Advisory Centre at the University of Auckland. Because the traditional flu vaccine is less effective in older adults than in younger people, the Fluad vaccine has an enzyme specifically designed to make it more effective for elderly. But, “it’s tricky”, said Turner. “We can’t simply say this vaccine is better than this vaccine.” Turner would like to see Pharmac continue reviewing the data to “better quantify the gains for the cost”.
The data to date on the Fluad vaccine does show it ‘to some extent’ gives the best immune response for elderly (Photo: Getty Images)

Associate professor Helen Petousis-Harris, a vaccinologist at the University of Auckland, agreed, saying the decision to not fund the potentially more effective vaccine was a symptom of budget constraints within the drug-buying mechanisms. “I like the idea that you have the best vaccine available, but it’s difficult when you have a constrained budget,” she said.
Studies that compare the enhanced Fluad vaccine with the regular vaccine “consistently show that it provides extra protections”, she said. But Petousis-Harris wanted to reassure over-65s that the difference between the vaccines is only slight. “What’s most important,” she said, “is that the vaccine is a match with the flu that’s circulating”. Both the Fluad and Afluria vaccines protect against the four strains of the virus identified by the World Health Organisation as circulating this year.
“It’s important people know they have other options,” Petousis-Harris added. However, even if they were notified of the difference, “it’s inequitable because people can’t afford it”, she noted.
At the same time as this "SpinOff" item I got a Greypower email with a two page Min Health leaflet stressing importance of flu vaccines this year but not a word about two vaccines. A two tier system indeed We need a welfare system that works better.