Editorial: Looking ahead to this winter's flu jab crisis

The early warning of a flu vaccine shortage for this year can be seen as good or bad news.

Certainly, it is better to know now about potential problems and to try to avoid the unseemly scrabble for supplies in October and November experienced in recent years.

However, because of the lack of progress towards a national flu vaccine distribution system for the UK, GPs might still face uncertainty over their supply and will bear the brunt of the problems associated with shortages.

Flu ordering at a practice level is always going to be, to some extent, a matter of educated guesswork. Will uptake levels be similar to last year or will it be a year when people forget, leaving your practice with a surplus? When ordering, do you try to compensate for the risk of a shortage?

During last year's problems, PCT flu immunisation co-ordinators were told to identify practices with surplus supply and have that vaccine redistributed to practices in need. But this is just bolting the fridge door after the supply has been used.

If regional co-ordinators managed supply on the basis of weekly need and use, it should be possible to smooth out some of the problems, thus reducing the pressure on GP practices and allowing them to concentrate on patients rather than administration.

Distribution issues aside, this year's early warning of shortages came with a sting in the tail for GPs. The DoH's director of immunisation Dr David Salisbury - the man who famously accused GPs of vaccinating the wrong people last year - warned that GPs would have to prioritise who received the jabs. The over-65s should be first in the queue and, as more vaccine becomes available, at-risk younger patients should be next, followed by healthcare workers and other carers.

Such prioritisation will leave GPs and their staff with moral dilemmas.

Should you use some of your limited supply on the apparently healthy 66-year-old with no history of chronic disease? Or save it for a more frail 80-year-old? Or even vaccinate the immunocompromised 40-year-old asthmatic?

GPs may find themselves having to tell patients who are entitled to a flu jab: 'Yes, we have the vaccine. Yes, you are due to have a jab. No, you can't have it today.'

These are the tough decisions that come with medical practice but it seems that, year after year, we are faced with problems with the flu campaign and GP practices continue to bear the brunt of the fall out.

Not every production or supply problem for the vaccine can be solved but the DoH needs to put much more effort into minimising the effects of these problems on the clinicians on the front line.

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