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Some are raising concerns that those aged 65 are being offered a less effective vaccine than they were last year. (Image: Archi Banal)
Some are raising concerns that those aged 65 are being offered a less effective vaccine than they were last year. (Image: Archi Banal)

SocietyApril 14, 2022

Are over-65s getting a less effective flu jab than last year?

Some are raising concerns that those aged 65 are being offered a less effective vaccine than they were last year. (Image: Archi Banal)
Some are raising concerns that those aged 65 are being offered a less effective vaccine than they were last year. (Image: Archi Banal)

It’s more important than ever to get vaccinated against the flu this year and, as always, over-65s are particularly at risk. But a vaccine developed specifically for them, which was free in 2021, is no longer funded. 

You might have already started adding a merino layer under your outfits and popping an umbrella in your bag as you get ready for work. You’re probably craving warming soups and cosy nights at home more and more. Winter is coming, and that means flu season is upon us. 

It’s always a good idea to get the flu vaccine but this year, it’s even more important than in previous winters. Over the last two years, restrictions to slow the spread of Covid-19 have kept us all healthier. They’ve also meant that the regular circulation of bugs that act like natural boosters when flu season hits have dwindled. Now, as Covid-19 restrictions are eased and borders begin to open up, experts say it’s vital we get our jabs – and the more of us who do the better. 

For over-65s, people with particular health conditions, pregnant people and, since this flu season, Māori and Pasifika over-55s, the flu vaccine is fully funded – which means it’s free. The risk of influenza-related hospitalisation is greater for older people compared with healthy adults aged under 65 years. Increasing levels of frailty and the presence of chronic conditions like diabetes or heart, kidney, neurological or respiratory diseases add to the risk for this group. 

However, some are raising concerns that 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.

An over-65 Italian man gets his free flu shot in Milan in 2020 (Photo: Alessandro Bremec/NurPhoto)

Last week an Auckland woman, who described herself as “well over 65”, told The Spinoff she went to get her flu vaccine. 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. She could afford it, and “naturally enough, I wanted the best to protect me”. Instead, 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.

“I’m just indignant on behalf of all the poor immunocompromised or elderly people who either could not afford or who are not informed about this option,” she said.

When contacted by The Spinoff, Pharmac’s chief medical officer Dr David Hughes said in an emailed statement that in 2020, the Immunisation Advisory Committee advised the agency “there was limited evidence and no direct comparison to show the difference between Fluad Quad and Afluria Quad’s effectiveness”. For that reason, 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.

“For people who are most at risk of complications, like Māori and Pasifika, it would be good to see the best vaccine available for these groups if we want to be genuine about reducing inequity.”

It’s difficult to know what our flu season will look like this year, but there are concerns across the board that Aotearoa will be hit hard by the virus in the coming months. Hughes said he wanted to “encourage all who are eligible for the free flu vaccine to book their vaccination as soon as possible”, adding that “the funded flu vaccine, Afluria Quad, is an effective layer of protection against this season’s flu”. 

Like the Covid-19 vaccine, flu vaccines are “about community protection, not individual protection”, said Turner. Thankfully, we can apply the same practices we’ve learnt from reducing the spread of Covid-19 to help protect those most vulnerable to the flu, and ease the burden on our health system, which is already under strain because of Covid-19. That means getting vaccinated (especially if you’re around older adults) and staying home if you’re sick. “Flu vaccines do help stop the spread, and that’s more effective when we immunise collectively,” said Hughes.

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Image: Getty Images; additional design by Archi Banal
Image: Getty Images; additional design by Archi Banal

OPINIONSocietyApril 13, 2022

We need a welfare system that works better for people with disabilities

Image: Getty Images; additional design by Archi Banal
Image: Getty Images; additional design by Archi Banal

Indie* has had cerebral palsy since birth, and it will be with her her whole life. She shouldn’t have to regularly prove that to Work and Income to receive support, she writes. 

Recently, after receiving a call from Work and Income I’d waited two days for, I was left crying in my wheelchair, in a public space where I study.

I had no money, but was told they could not help me, and that I had to prove I had a doctor’s appointment to prove, once again, that I had a lifelong disability. Even though I provided this evidence only a year ago. I received no letter. Just an “expired” note on my online portal, with no explanation, and no warning that this was about to happen.

Mistakes can happen. But when a mistake affects someone to the point that they’re unable to buy food, pay their rent or travel, it becomes very hard to bear. This was also a mistake that made me feel like I wasn’t trusted. I trust the medical professionals who have made it very clear that my disability is permanent. However, the permanency of a lifelong disability has not translated into lifelong support. To be so bluntly told by Work and Income that their mistake was my problem to fix gave me serious concerns about the attitudes of public servants towards people with disabilities and health conditions.

I have cerebral palsy, a physical disability that was caused by a brain haemorrhage and hydrocephalus. I had two brain surgeries before I was even six months old. I use a wheelchair some of the time, mainly because of the pain. I am a student and also work in education.

Only now, at 23 years old, have I discovered that there’s a minute possibility that a medical error could have contributed to my disability. If this were the case, I would be eligible for support through Accident Compensation Corporation (ACC). This would mean I wouldn’t need to prove my lifelong birth injury every two years (or less, as the case has been for me). Should our eligibility rules for ACC really be designed in this way, leaving people with different levels of assistance depending on whether they can prove an error decades ago?

People who experience injury and are covered by ACC can get access to private specialists, and therefore shorter wait times when accessing healthcare. A person who experiences disability not as a result of an injury is likely to wait a longer period to access support through a public health system.

Last year I finished a dissertation on how the End of Life Choice Act can impact people with disabilities. I realised that the cost of disability to individuals, whānau and communities is far greater than just the cost of treatment and care. Disabled people are scrutinised for factors that they cannot control. Disabled people are then paying for this with money, their health, their relationships, and in many cases, their self-worth. 

Another thing that has been clear to me in both my own life and in the research I have done is that disabled people, especially those who have been disabled from birth, are being excluded from conversations that directly affect us. Proposed changes to ACC to cover birth injuries do not include people in my situation who have a birth injury – which concerns me because of what it is implying about the worthiness of disabled lives in Aotearoa. 

The ACC Amendment Bill currently in progress is a significant step towards providing support to individuals who have been affected by birth injuries. While the focus is on injuries sustained by parents during childbirth, it is still pertinent that babies who experience injuries through birth, such as through the use of forceps, receive adequate support. Whether you receive support through ACC or the public health system, everyone should be entitled to treatment that is sufficient, suitable, and doesn’t require constant administration.

The government has announced a new Ministry for Disabled People, which is meant to improve the participation of disabled people in policy-making. But for that to happen effectively, we need to listen to the experiences of disabled people, and acknowledge that these experiences are valuable, important and worthy of support.

The question is: where to from here? It is clear to me that we need ACC, and we need it to operate in a way that supports people who require financial assistance. But we still need to do better. 

We need a system where no person’s disability makes them less worthy than another disabled person. A system that acknowledges lifelong disability, and doesn’t demean individuals through asking for proof of such a lifelong injury every two years, sometimes less. A system that doesn’t leave people who rely on it in tears, in their workplace, in public. A system that includes disabled people fully in the development of policy.

Equitable support for people with disabilities is vital, and something that Aotearoa is capable of achieving. Validating disability that has been caused by injury or accident, as well as other non-injury causes, will result in fairer outcomes for those who need healthcare and welfare services. All disabled people are valuable people. Government support ought to be dignifying, and committed to working towards a fairer and more just society.

* Not her real name

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