Rhaglen frechu’r gaeaf yn erbyn feirysau anadlol 2024 i 2025 (WHC/2024/033)

Statws:

Cydymffurfio / gweithredu.

Categori:

Iechyd y cyhoedd.

Teitl:

Rhaglen frechu'r gaeaf yn erbyn feirysau anadlol 2024 i 2025.

Dyddiad dod i ben / adolygu:

Amherthnasol.

Angen gweithredu erbyn:

Amherthnasol.

I'w weithredu gan:

• brif weithredwyr byrddau / ymddiriedolaethau iechyd
• arweinwyr imiwneiddio byrddau / ymddiriedolaethau iechyd
• cydgysylltwyr imiwneiddio byrddau iechyd
• arweinwyr gweithredol brechu byrddau / ymddiriedolaethau iechyd
• cyfarwyddwyr meddygol byrddau / ymddiriedolaethau Iechyd
• cyfarwyddwyr gofal sylfaenol byrddau / ymddiriedolaethau Iechyd
• cyfarwyddwyr gweithredol nyrsio
• byrddau / ymddiriedolaethau iechyd
• cyfarwyddwyr therapïau a gwyddorau iechyd
• byrddau / ymddiriedolaethau iechyd
• prif fferyllwyr byrddau / ymddiriedolaethau iechyd
• cyfarwyddwyr iechyd y cyhoedd
• byrddau / ymddiriedolaethau iechyd
• cyfarwyddwyr gwasanaethau mamolaeth byrddau iechyd
• cyfarwyddwyr y gweithlu a datblygu sefydliadol
• byrddau / ymddiriedolaethau iechyd
• Cyfarwyddwr Gweithredol Iechyd y Cyhoedd Iechyd Cyhoeddus Cymru
• Cyfarwyddwr Nyrsio Iechyd Cyhoeddus Cymru
• Pennaeth Rhaglen Frechu yn erbyn Clefydau Ataliadwy Iechyd Cyhoeddus Cymru
• Cyfarwyddwr Cynllunio Rhaglen Frechu Cymru
• ymarferwyr cyffredinol
• fferyllwyr cymunedol
• Iechyd a Gofal Digidol Cymru

Er gwybodaeth i:

• Fforwm Partneriaeth GIG Cymru
• Cyngor Ymarferwyr Cyffredinol Cymru
• Coleg Brenhinol yr Ymarferwyr Cyffredinol
• Y Coleg Nyrsio Brenhinol
• Coleg Brenhinol y Bydwragedd
• Coleg Brenhinol Pediatreg ac Iechyd Plant
• Cymdeithas Ddeintyddol Prydain
• Y Gymdeithas Fferyllol Frenhinol
• Fferylliaeth Gymunedol Cymru
• Arolygiaeth Gofal Cymru
• Prif Weithredwr Cymdeithas Llywodraeth Leol Cymru 

I'w anfon ymlaen at:

• Gyfarwyddwyr Gwasanaethau Cymdeithasol Awdurdodau Lleol
• Cyfarwyddwyr Diogelu'r Cyhoedd, Awdurdodau Lleol
• Cyfarwyddwyr Addysg Awdurdodau Lleol
• Gofal Cymdeithasol Cymru
• Addysg a Gwella Iechyd Cymru

Anfonwr:

Dr Keith Reid, y Dirprwy Brif Swyddog Meddygol (Iechyd y Cyhoedd).

Enwau cyswllt yn Llywodraeth Cymru:

Yr Is-adran Frechu,
Llywodraeth Cymru,
Parc Cathays,
Caerdydd.
CF10 3NQ.
E-bost: llc.timyrhaglenfrechu@llyw.cymru

Dogfennau amgaeedig:

Dim.

Dear colleagues,

I am writing to set out the detail of the Winter Respiratory Vaccination Programme (WRVP) 2024 to 2025 and our expectations for the coming season.

The WRVP brings together the COVID-19 and influenza (flu) vaccination programmes. Its purposes are as follows:

• to protect those at greatest risk from these respiratory viruses
• to reduce their circulation in our communities
• to support the resilience of the NHS and care system through the winter period

To implement the WRVP 2024 to 2025 effectively, health boards are expected to develop plans for a coordinated and coherent programme for both vaccines. Wherever possible, delivery models should be aligned to allow for co-administration to maximise efficiencies and reduce vaccination inequity.

Vaccination Programme Wales (VPW) will provide NHS oversight and assurance of planning and delivery for the programme. Health boards are expected to develop (and share with VPW) plans identifying how the ambitions set out in this circular will be achieved. This should include all relevant equality impact assessments. Public Health Wales will continue to provide expert vaccination and vaccine preventable disease advice and guidance, clinical leadership, epidemiology and surveillance.

Priorities for the WRVP 2024 to 2025

NHS organisations are expected to ensure plans for the WRVP are underpinned by the principles of the National Immunisation Framework. In particular, health board operational plans should clearly derive from the approaches set out in their vaccination equity strategies and incorporate targeted actions to reduce inequity in a measurable way.

In commissioning services, health boards should be assured that (where appropriate) primary care contractors have robust mechanisms for call/recall as well as communicating eligibility and the benefits of vaccination. Working with Public Health Wales, health boards should ensure communication and engagement resources are suitable for primary care settings and made available in a timely way.

Flu

As set out in WHC/2023/047 there will be a phased start to this year’s flu programme.

Starting in September, 2 and 3 year olds and school aged children / young people should be vaccinated as quickly as possible. Health boards have previously been asked to develop plans to reach 75% uptake for these groups by the end of 2025 to 2026 season. There is an expectation that those plans will be further developed this year and the actions identified which will help realise this ambition.

The Joint Committee on Vaccination and Immunisation (JCVI) has recommended the adult flu programme should commence in October.

The Welsh Government uptake target for all eligible adult groups is 75%. The World Health Organisation (WHO) has set 75% as the target for adults aged 65 years and older. In 2023 to 2024, the uptake for this cohort fell below 75% across most health board areas. This trend is a matter of significant concern and it is vitally important that coverage meets or exceeds the target this season. Health boards are expected to work closely with primary care contractors to help ensure uptake meets or exceeds the 75% target for this group. They should also ensure all flu vaccines are recorded on GP systems regardless of where they are administered.

Health boards should make every effort to encourage health and social care staff to come forward for a flu vaccine by removing barriers and ensuring the benefits of vaccination are effectively communicated.

COVID-19

The JCVI continues to review COVID-19 epidemiology and vaccine effectiveness data and has issued updated advice for the upcoming season.

The committee continues to recommend that people aged 65 years and older, and those at clinical risk aged 6 months to 64 years, will benefit from vaccination, helping to reduce the risk of serious illness and hospitalisation.

However, the committee has not recommended the inclusion of the following groups:

• frontline health and social care workers
• unpaid carers
• household contacts of the immunosuppressed

The committee has advised that on the balance of evidence it does not believe there is a clinical benefit to offering the vaccine to these groups. Nevertheless, owing to the late communication of this advice, Welsh Government has adopted a permissive approach in relation to these groups (details set out at Annex A).

The Welsh Government uptake target for the following groups is 75%:

• residents in a care home for older adults
• all adults aged 65 years and older
• persons aged 6 months to 64 years in a clinical risk group, as defined in tables 3 and 4 of the COVID-19 chapter of the 'green book'

The remaining groups identified as eligible in annex A should be able to access the vaccine, but health board resources should not be channelled towards maximising uptake for these groups.

Where a health board’s uptake figure for a specific cohort (either flu or COVID-19) fell significantly below the 75% target in the 2023 to 2024 season, programme plans should identify a pathway to meaningful improvement for the 2024 to 2025 season.

Programme information

Programme specific information for the influenza vaccination programme has been published separately in Welsh Health Circulars WHC(2023)047 and WHC(2024)028.

Programme specific information for the COVID-19 vaccination programme can be found in Annex A to this letter.

I encourage you to share this information with all those involved in delivering the programme in your area.

Conclusion

Finally, I would like to thank all those who will play a role in delivering the WRVP 2024 to 2025. The protection afforded by our winter vaccination programmes helps safeguard our citizens and our health and social care services through the challenging winter period.

Yours sincerely

Dr Keith Reid
Deputy Chief Medical Officer (Public Health)

Eligibility

Groups eligible for a COVID-19 vaccine in autumn 2024

For autumn 2024, the following groups will be eligible for a single dose of COVID-19 vaccine:

• people aged 6 months to 64 years in a clinical risk group, as defined in tables 3 and 4 of the COVID-19 chapter of the green book (which includes pregnant women and the immunosuppressed)
• residents in a care home for older adults
• people aged 65 years and older (age on 31 March 2025)
• all adult residents in Welsh prisons
• unpaid carers
• frontline health and social care workers
• staff working in care homes for older adults
• people experiencing homelessness

In addition, health boards are permitted to (and should reimburse primary care contractors who) vaccinate household contacts of the immunosuppressed who request vaccination. However, no proactive offer should be made to this group.

The vaccine should usually be offered no earlier than around 6 months after the last vaccine dose, although operational flexibility around the timing of vaccination in relation to the last vaccine dose is considered appropriate (with a minimum interval of 3 months between doses). More information on operational flexibility will be provided in the COVID-19 chapter of the green book.

Prioritisation and future eligibility

Unlike in 2023 to 2024, JCVI has not advised that frontline health and social care workers, staff working in care homes for older adults or unpaid carers be included in the 2024 to 2025 programme. However, with the programme due to commence shortly, Welsh Government has decided to allow these groups to access COVID-19 vaccination as part of the national programme for the final time in the 2024 to 2025 season. Assuming JCVI advice does not change, these groups, as well as household contacts for the immunosuppressed, will not be eligible for COVID-19 vaccination as part of the national programme.

Whilst frontline health and social care workers, staff working in care homes for older adults and unpaid carers should be able to access a COVID-19 vaccine during the 2024 to 2025 programme if they wish to, health board resources should not be channelled towards driving uptake of this vaccine amongst these groups. I would however like to emphasise the importance of these groups taking up the offer a of a flu vaccine to help protect themselves and those they care for from becoming seriously ill with flu.

Individuals who have not yet had a primary course

Only those who meet the eligibility criteria for a COVID-19 vaccine continue to be eligible for a primary course. For the Autumn 2024 to 2025 campaign, the primary course consists of a single dose of COVID-19 vaccine. Further details regarding exceptions to this advice, such as for those who are immunosuppressed, will be set out in chapter 14a of the 'green book'.

Deployment

Timescales

Following the recommendation from the JCVI (the details of which are set out in WHC/2023/047) for the adult flu programme to start in early October, the expectation is that the COVID-19 programme will commence at the same time.

As with the flu programme, where a primary care contractor does not have confidence that it will be possible to vaccinate their entire eligible adult cohort between October and early December, they should inform their health board. In this event, the health board can agree (subject to vaccine availability) for vaccination to begin in September, rather than risk failing to complete the programme in a timely way.

Health boards should aim to complete the delivery of the programme by early December. Mop up activity should conclude as early as possible in 2025.

Vaccine products

For the autumn 2024 COVID-19 programme, the following COVID-19 vaccines are available and advised (please refer to the COVID-19 chapter of the Green Book for more details).

For all individuals aged 18 years and over:

• Moderna mRNA (Spikevax) vaccine. Dose: 50 micrograms
• Pfizer-BioNTech mRNA (Comirnaty) vaccine. Dose: 30 micrograms

For young people aged 12 to 17 years:

• Pfizer-BioNTech mRNA (Comirnaty). Dose: 30 micrograms

For children aged 5 to 11 years:

• Pfizer-BioNTech mRNA (Comirnaty). Dose: 10 micrograms

For children aged 6 months to 4 years:

• Pfizer-BioNTech mRNA (Comirnaty). Dose: 3 micrograms

Call and recall

Welsh Government expects that all those who are eligible will be offered the opportunity to be vaccinated. Health boards and those they commission should use a proactive approach, adopting robust call and reminder systems, aimed at maximising uptake for groups recommended for inclusion in the programme by the JCVI. Co-administration of the COVID-19 and the flu vaccines should occur where effective and efficient to do so.

To align with outpatient guidance, three appointment offers should be made to an individual; an initial offer and then two more offers if an initial appointment is not taken up.

Patient Group Directions (PGDs) and national protocols

PGD templates and supporting content will be available prior to the commencement of the programme, and should be reviewed, ratified, and authorised locally by the health board / trust for local use. National protocols will be available before the start of the programme to support mixed workforce and flexible delivery models.

These patient group directions documents will be available on the Welsh Medicines Advice Service website.

Training and resources

The COVID-19 green book chapter (14a) contains detailed clinical guidance on COVID-19 and COVID-19 vaccination.

Healthcare practitioner information and guidance to support the implementation of the COVID-19 programme, including training slide sets, are currently being updated and will be available on the COVID-19 information for health professionals webpage here:

• resources for health and social care professionals: Public Health Wales (nhs.wales)

COVID-19 vaccine specific eLearning modules will be produced by UKHSA and will be available to access here:

• COVID-19 vaccination: Public Health Wales (nhs.wales)

Healthcare professional information and guidance for the COVID-19 vaccination programme produced by UKHSA is available at COVID-19 vaccination: information for healthcare practitioners - GOV.UK (www.gov.uk).

Consent

Guidance on informed consent can be found in chapter 2 of the green book.

Reporting suspected adverse reactions

Health professionals and those vaccinated are asked to report suspected adverse reactions through the online yellow card scheme, by downloading the Yellow Card app or by calling the yellow card scheme on 0800 731 6789 9am to 5pm Monday to Friday.

Planning and commissioning

Health boards and trusts are expected to share their winter respiratory vaccination programme plans with vaccine programme Wales, stating how they will achieve the uptake and performance targets (including relevant equality impact assessments). This should include plans to commission primary care contractors utilising the Primary Care (Contracted Services: Immunisations) Directions 2021 (C19) (PCCS:I) .

Public information and communications

Public information

Public information is available at:
COVID-19 vaccination information, Public Health Wales (nhs.wales).

Resources will be available to order from:
health information resources, Public Health Wales (nhs.wales).

Communications campaign

Working closely with health board operational and communications colleagues Public Health Wales will design and deliver a national communications and engagement campaign for WRVP 2024 to 2025.

Digital

In line with the PCCS:I a clinical record of immunisation with a COVID-19 vaccine must be entered onto the Welsh Immunisation System (WIS). This includes appointments and stock management, with an expectation that WIS is updated in real time.

Surveillance

Surveillance of vaccination programmes is carried out by the Public Health Wales Vaccine Preventable Disease Programme (VPDP). Surveillance of the COVID-19 programme in those eligible due to age, clinical risk and NHS staff will be carried out utilising data from WIS. Uptake in pregnant women will be estimated using a data linkage approach using data from WIS and centrally held maternity outcomes data.

Uptake will be reported on a weekly basis throughout the programme, with surveillance reports at national level, health board level, local authority level, primary care cluster level and GP level published on the VPDP Sharepoint site (access restricted to NHS):

Summary information at national level and health board level will be published through the Public Health Wales COVID-19 vaccination interactive report (publicly available):

A mid-programme and end of programme analysis of equality of uptake in COVID-19 vaccination will be carried out by VPDP working with Swansea University SAIL (Secure Anonymised Information Linkage) team, to estimate uptake at levels of: sex, ethnic group, quintile of deprivation and rural or urban classification.

Public Health Wales VPDP surveillance team will continue to work with other UK nations to carry out surveillance of COVID-19 vaccine effectiveness.