Questions concerning flu vaccination programmes: FOI release

Information requested

1. adjuvanted trivalent inactivated flu vaccine (aTIV) to ascertain its exact contents;

2. cell based quadrivalent inactivated vaccine (QIVc), again to know the exact contents;

3. the 'live' attenuated influenza vaccine (LAIV) as offered to schools; exact contents required.

If I have missed any influenza vaccine that is being used please list them and provide their exact contents

4. I also wish to know the cost of each vaccine at single unit cost per vaccine as purchased by NHS Scotland; then the overall total costs of vaccines purchased in Scotland in total and importantly,

5. how much income is generated by each Doctor's surgery and or hospital for each vaccine provided to the public. For example if a Doctor's surgery give 500 vaccines to patients how much income will the Surgery accrue for this?

6. I would like also to know from scientific evidence, what the expected efficacy of each vaccine is anticipated to be. ie is it expected to help with 45% of patients or more?

7. Also, what strains of Flu are the vaccines expected or anticipated to be effective with?

8. Most importantly I am looking to establish if any of these vaccines contain animal tissue within their contents and if so what type of animal tissue was used. Furthermore, if aborted foetal tissue formed part of the vaccine contents I would like to know this. So I would like access to the manufacturer's contents, something the public never sees and are never offered access to.

9. Could I also ask why the NHS never takes the precaution of testing blood levels of Vitamin D given that if the blood level of D status is very low the chances of a patient creating antibodies is low.

Response

1, 2, 3. Under section 25(1) of FOISA, we do not have to give you information which is already reasonably accessible to you. All the information on flu vaccines contents are in public domain in the patient information leaflet on the links attached.

aTIV – 1 (medicines.org.uk)
QIVc – pil.666.pdf (medicines.org.uk)
LAIV – FLUENZ Tetra, INN-influenza vaccine (live attenuated, nasal) (medicines.org.uk)
QIVe - pil.666.pdf (medicines.org.uk)

4. While our aim is to provide information whenever possible, in this instance the Scottish Government does not have the information you have requested. This is because NHS National Procurement are responsible for the purchase of vaccine on behalf of the NHS. This is a formal notice under section 17(1) of FOISA that the Scottish Government does not have the information you have requested.

Advice about how you can submit a Freedom of Information request to NHS National Procurement is available on their website: Freedom of Information :: NHS National Procurement (scot.nhs.uk)

It may be helpful to know that information on the award contracts for each of the flu vaccines is available online at the links below.

aTIV and QIVc: Login - Public Contracts Scotland
QIVe: Login - Public Contracts Scotland

5. The Scottish Government does not hold information on how much individual GP practices will be or have been paid for delivering the flu vaccination programme. This year, due to the implications of COVID-19, responsibility for delivering the Seasonal Flu Vaccine in 2020/21 rests with Health Boards and Integration Authorities. Therefore this information would be held by Health Boards.

This is a formal notice under section 17(1) of FOISA that the Scottish Government does not have the information you have requested.

However, you may be interested to know that historically GP practices were paid under the arrangements below (PCA(M)(2019)09 - Influenza and pneumococcal immunisation directed enhanced service: summary. (scot.nhs.uk)).

Influenza for those aged 65 and over:

• If up to or equal to 40% of the over age 65 group who are on a contractor’s Influenza, and Pneumococcal Scheme Register were immunised, a contractor qualified for a payment of £7.17 per immunisation;

• If more than 40% and up to or equal to 75% of the age group were immunised, a contractor qualified for a payment of £8.85 per immunisation; and

• If more than 75% of the age group were immunised, the contractor qualified for £9.39 per immunisation.

These different payment rates applied to all immunisations given, not just those above the threshold. Influenza for those in other target groups a flat fee of £7.67 was paid per immunisation.

Childhood Influenza:

• a flat rate of £7.67 was paid per dose and totalling £15.34 per course, where two doses were needed (at risk children under 9 years of age who have never received influenza vaccination, and healthy children under 9 years of age who have never received influenza vaccination and required the injected, inactivated vaccine);

• and an additional fee of £2.12 was paid per immunisation for the national mop up arrangements.

These arrangements meant that two practices which each immunised 500 patients could earn differing amounts depending on who those patients were, how many patients the practices had in the over 65 group, or whether the patient should have been vaccinated elsewhere. The minimum that could be earned for 500 vaccinations would be £3,585 and the maximum would be £4,895 although each of these would be unusual.

The requirements of social distancing and PPE associated with COVID-19 meant that the level of vaccination activity that most practices could reasonably undertake without impacting on other services to patients or substantially increasing practice workload would be severely curtailed this year. Therefore the Scottish Government published arrangements PCA(M)(2020)14 - Influenza and Pneumococcal Vaccination (Coronavirus Outbreak) (Scotland) Directions 2020 for the conversion of historic practice activity into a time commitment in exchange for a single payment based on an average of previous payments.

Scottish Government had intended to announce a fee for practices carrying out vaccinations above those carried out during that time commitment however the Scottish Government and the Scottish GP Committee of the BMA (SGPC) later recognised PCA(M)(2020)15 - Influenza and Pneumococcal DES update (scot.nhs.uk) that most Health Boards had agreed fees with their Local Medical Committees, which represent GPs locally, and that setting a nationally agreed fee could undermine local fees which must be sensitive to local arrangements.

This means that the amount a practice earns this year from vaccinating 500 patients will vary depending on its previous activity and extent of its participation in local arrangements.

6. Each year, at the end of every flu season, Public Health England publishes overviews of influenza surveillance results in the UK, from the winter period. This season’s report is yet to be published, therefore this is a formal notice under section 17(1) of FOISA that the Scottish Government does not have the information you have requested. However you can access last year’s report on the link below.

Surveillance of influenza and respiratory viruses, UK: Winter Winter 2019 to 2020 (publishing.service.gov.uk)

7. For the 2020/21 flu season (northern hemisphere winter) it is recommended that cell based quadrivalent vaccines contain the following strains:

• /an A/Hawaii/70/2019 (H1N1)pdm09-like virus;

• an A/Hong Kong/45/2019 (H3N2)-like virus;

• a B/Washington/02/2019 (B/Victoria lineage)-like virus; and

• a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.

For the 2020/21 flu season (northern hemisphere winter) it is recommended that egg based quadrivalent vaccines contain the following strains:

• an A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus;

• an A/Hong Kong/2671/2019 (H3N2)-like virus;

• a B/Washington/02/2019 (B/Victoria lineage)-like virus; and

• a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.

For further information and the full report please see: https://www.who.int/influenza/vaccines/virus/recommendations/2020- 21_north/en/

8. As mentioned earlier, all the information on flu vaccines contents are in public domain under the Patient Information Leaflet. Under section 25(1) of FOISA, we do not have to give you information which is already reasonably accessible to you.

9. There is no evidence currently to suggest Vitamin D deficiency impacts on the severity of COVID-19, therefore the Chair of the Clinical Cell advised that at present there is no routine testing for vitamin D. However there are various guidelines around Vitamin D testing and supplementation out with the context of COVID so to suggest it is never checked is incorrect.

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