As we enter this year’s flu season in the UK, the outlook for health professionals and for the public is vastly different to the situation we faced 12 months ago. At the end of October last year the government announced a second national lockdown as rates of Covid-19 rocketed and we approached the winter months.
The principles of social distancing, isolating when unwell, restricting travel and maintaining good hygiene are indiscriminate approaches to prevent transmission of communicable diseases. So while the restrictions we have seen in place over the past 18 months have been implemented to stem the spread of Covid-19, they have also been impactful in preventing the spread of other viruses, including influenza.
The inverse of these circumstances holds just as true. When lockdown restrictions lifted in July of this year we saw an explosion in Covid-19 infection rates, and we can similarly expect to see high levels of seasonal flu in the coming months. Viruses such as Covid-19 and influenza are passed from person to person through the air when we breathe out, speak or sneeze. When people spend more time indoors and in closer proximity during the winter months we see a correlative spike in infection rates.
With Covid-19 having dominated news agendas across the globe for the past two years it is important to remember that flu still poses a serious threat to health in the UK and globally, causing nearly 11,000 deaths in England in an average year. Better public awareness of actions we can all take to prevent infectious diseases such as Covid-19 is a good thing, but we must not become distracted from our efforts to tackle other serious communicable diseases such as flu.
The impact of Covid-19 restrictions on reducing rates of flu during the 2020 and 2021 season means there is less immunity within the population, leading to the potential for more people to be susceptible to illness from the flu this year. As well as the immediate threat this poses to the health of those infected and the people they come into contact with, it may also lead to increased pressure on an under-resourced NHS, which is still struggling to cope with the many impacts of Covid-19. And just as we expect to see flu rates rise during the colder months, we are also likely to see Covid-19 rates rise, leading to even further pressures on NHS services.
The risk stratification for influenza is similar to that of Covid-19, with those who are older or in other vulnerable categories facing a significantly higher risk of severe illness or death from flu. This year, following the advice of the Joint Committee on Vaccination and Immunisation, we see an extended influenza immunisation programme, with all those aged 50 and over invited to receive a vaccine and all children aged two to 15 also eligible. Just as with Covid-19, immunisation against flu is the most important measure that we can take to stop the spread of this potentially deadly virus.
This year, more than ever, it is vitally important that those who are offered a flu vaccine book their appointment as soon as possible to protect the health of themselves and those around them. Alongside this year’s flu vaccination programme, those in vulnerable categories are now also being offered a Covid-19 booster vaccine to “top up” their immunity against the virus.
As well as supporting underfunded public health and NHS services to protect health going into the winter, the government must also act to support people to get vaccinated. Covid-19 both exposed and exacerbated the deep inequalities in our society, and we see these inequalities mapped in, and driven even further by, differing levels of vaccine uptake. Marginalised and excluded communities – including those in minority ethnic groups, those living in socio-economically deprived areas, or those living with disabilities – have seen a comparatively low rate of vaccination uptake. For example, the uptake of Covid-19 vaccines is 27 percentage points lower among people aged 50 or over who identify as “Black Caribbean” compared with those identifying as “White British”.
Government must take steps to remove barriers to access to ensure that both flu and Covid-19 vaccine uptake rates are bolstered in groups that are already at greater risk of ill health and death. There must be deeper community engagement – including dissemination of easily accessible information on vaccines and dialogue with community leaders and institutions – and better financial support where necessary to support those who simply cannot afford to take time off work or travel to a vaccination centre. If government does not take concerted action to reduce these inequalities we will continue to see poor health outcomes within these groups and a further compacting of disadvantage.
The experiences of the Covid-19 pandemic have shown the importance and power of everyone in society “playing their part” to protect their friends, families and communities. While our approach to influenza differs to that of Covid-19, it is similar in more ways than it is not. Both are serious illnesses that pose a significant threat to at-risk groups, both are limited in their transmission by public health measures in which the population is now wellversed, and both combine to pose a potential risk to NHS services in the coming months. The most important way we can protect ourselves and those around us is to continue to follow guidance and get vaccinated if eligible.
Maggie Rae is the president of the Faculty of Public Health