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Influenza and coronary vaccination: – NIPH turns after one month

On Friday, the National Institute of Public Health informed the country’s municipalities, health trusts and state administrators that they now recommend prioritizing setting a refresher dose with coronavina vaccine over influenza vaccine for people over 65 in Norway.

This is stated in a information letter which FHI published on Monday morning. The letter was sent about a month after FHI recommended the municipalities to prioritize influenza vaccination in front of the refreshing dose for the elderly. The letters are signed by vaccine manager Geir Bukholm and department director Are Stuwitz Berg.

When FHI initially recommended prioritizing influenza vaccination, it was informed, among other things, that the distribution capacity used for refrigerated transport of corona vaccines in October would be used for the distribution of influenza vaccines.

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FHI: No problem

Chief physician Preben Aavitsland at the National Institute of Public Health tells Dagbladet that re-prioritization in many municipalities will not be a problem.

– If a municipality has limited vaccination capacity, we ask them to first vaccinate the elderly over 65 years with a refreshing dose of corona vaccine before they vaccinate the same with the flu vaccine, says Aavitsland and continues:

– In many municipalities, this is not a problem as GPs take care of influenza vaccination, as they have done for many years while coronary vaccination takes place at a municipal vaccination center.

Aavitsland says that the number of set refreshment doses will increase rapidly.

– More than 100,000 refreshment doses have already been given, and the number will increase rapidly in the coming weeks as the municipalities get people called in and the municipalities get vaccines delivered.

FHI expects lower support for a refresher dose in Norway compared with the first two doses. Among other things, they have found that as many as 30 percent of healthcare professionals are negative or insecure on whether they will accept an offer of a refreshing dose.

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– That was right

The reason why FHI recommends the municipalities to re-prioritize is that the spread of influenza virus is delayed, while the spread of covid-19 is increasing rapidly. At the same time, recent data, according to FHI, show that the vaccines’ ability to prevent the spread of infection decreases somewhat over time, and that the risk of becoming seriously ill may be higher for the very elderly even if they have been fully vaccinated.

Despite the fact that FHI has now turned around, Aavitsland believes that they made the right choice.

– We believe it was right to run one and a half million flu vaccines and that the municipalities started the vaccination in October so that the risk groups and health personnel received their flu vaccine in case the flu season should start earlier, as the RS virus epidemic did. Fortunately, the flu epidemic did not come earlier than normal, says Aavitsland and continues:

– Now we can use all transport capacity, and the municipalities can use almost all vaccination capacity for a refreshing dose of corona vaccine for the elderly.

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Get support

Researcher Gunnveig Grødeland at the University of Oslo (UiO) believes that FHI made the right choice.

– I am of the clear opinion that it was right to prioritize flu vaccination before a third dose of corona vaccine. Absolutely all we have of available data confirms that two doses of coronavina vaccine provide very good and long-lasting protection against serious illness and death, says Grødeland to Dagbladet and continues:

– In the very oldest, the effect of the vaccines is typically somewhat worse than for others, and the third dose will be able to give them better protection. Nevertheless, we know that two doses actually also provide good protection against serious illness in the very oldest and most vulnerable groups.

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Expert: Correct and sensible

Professor Anne Spurkland at UiO describes the decision as correct and sensible.

– I think it makes sense to prioritize the flu vaccine first. It is two years since the previous flu season, and we can expect that this year’s flu epidemic may be more extensive than usual. This is because people have a somewhat weaker immune system against the virus, since there was no recurrence of the virus last year during the infection control restrictions in the pandemic, Spurkland tells Dagbladet and concludes:

– It is better to be careful when it comes to offering influenza vaccination to the most vulnerable. The corona vaccine still protects well against serious illness and death, so I think a few weeks’ delay in the refresher dose is justifiable when the various considerations are to be weighed against each other.

Demanding flu season

Grødeland states that congestion in the health care system is one of the biggest threats we face in Norway. She says that it is possible that this year’s flu season will be extra demanding, such as the flu season four years ago, when 7,600 people were hospitalized with the flu and 1,400 people died.

– This was a year with extra strong seasonal flu, but every single year thousands of elderly people are admitted to Norwegian hospitals with the flu. When prioritizing flu vaccination, this was very important because it could reduce the number of elderly people who need hospitalization, says Grødeland and continues:

– It will reduce the pressure on the health care system, and thus enable us to better deal with all the viruses that are now circulating and causing disease.

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