GP Advice: Fluad Quad 2020 Influenza Vaccine

WA Primary Health Alliance (WAPHA) and the WA Faculty of the Royal Australian College of General Practitioners (RACGP) have represented WA GPs in discussions with WA Health and the Communicable Disease Control Directorate (CDCD) to address the issues experienced by general practices in acquiring and maintaining sufficient supply of the 2020 influenza vaccine for patients aged 65 years or over.

Following concerns raised by practices with WAPHA and the RACGP as to the inability to acquire adequate vaccine supply, we comprehensively surveyed general practices across the State to assess the situation.  Overwhelmingly, the response was that practices are experiencing great difficulty in getting the stock they need to meet patient demand in the current (and unique) environment of COVID-19.

There has been some misinformation in the public arena regarding general practice closures and preferencing of Pharmacy providers over general practice.  CDCD will communicate, via regular briefings to the WA Minister for Health, that over 98% of WA general practices continue to undertake influenza vaccine administration, prioritising vulnerable population groups and running dedicated and proactive flu vax clinics.  Similarly, CDCD has provided reassurance that GPs have received approximately 90% of all 65 years and over vaccine distributed in WA.

Our meeting with CDCD and the WA Department of Health last week was very positive and highlighted a disconnect between the data recorded on the Australian Immunisation Register (matching supply and usage) and the experience of general practice in administering the 2020 influenza immunisation program for patients aged 65 and over.  We agreed that we need to balance the reliance on current Australian Immunisation Register data with what general practices are telling us is happening on the ground.

CDCD advised the following in regards to distribution and recording of the 65s and over vaccine in WA:

  • As at Monday 27 April, WA Health has distributed enough over 65s influenza vaccine to cover over 100% of the population in this age cohort;
  • CDCD has cleared all backorders;
  • The metropolitan warehouse will receive a very limited additional supply of this vaccine;
  • Given the record quantity of vaccine already distributed to immunisation service providers, CDCD encourages providers to share supply with others, where possible, please advise CDCD if sharing, for their records;
  • As at Sunday 26 April, up to 47% of doses distributed have been entered into the Australian Immunisation Register (AIR), and
  • CDCD reminds practices to enter the correct vaccine brand when entering instances of patient immunisation into the AIR.

According to the Australian Immunisation Register, 395,000 doses of influenza vaccines have been administered to people in WA with 176,000 doses to people 65 and over. Coverage is approximately 41% in this cohort which is 8 times higher than at the same time last year. In 2019, overall coverage was 62% in people 65 and older.  377,580 doses of Fluad Quad has been distributed to WA immunisation providers. There seems to be a delay between administration and when it gets to the Australian Immunisation Register by up to a week.

CDCD has advised that if practices have extra stock, they can share with those practices nearby that are needing additional supply.  An important part of this process is to always alert CDCD Vaccine Orders that the practice has transferred stock.  If preferred, practices can let CDCD Vaccine Orders know what vaccine they have excess of and how many doses they have.  CDCD will match this up with practices requiring additional supply.

CDCD currently has only 20,000 doses of Fluad Quad available for distribution to general practices across WA.  To ensure distribution of this limited remaining stock is equitable, and meets the needs of your patients aged 65 and over, WAPHA and the RACGP agreed the following approach with CDCD and WA Health:

  • The WA Health vaccine team will continue to review orders and work with general practices to ensure that the remaining Fluad Quad is equitably distributed;
  • The WA Health vaccine team will always review quantities received to date, as well as advise if other providers in the geographic area have excess stock;
  • When ordering, practices should place their routine order, and if ordering Fluad Quad, include a ‘note’ to substantiate their need for the required quantities;
  • Practices should also ensure the person ordering checks their inbox – two emails are generated from the system and are important:
    1. An approval email is generated from the system AFTER the order has moved to ‘approved’ status, and
    2. the ‘ready for distribution’ email which is generated when the order has been packed ready for distribution
  • Please refer to the recent WA immunisation providers FAQs – vaccine ordering and delivery communicated to providers, particularly as the Toll system does not generate tracking, and
  • If required, the ‘note’ process is outlined on Page 8 of the Toll System User Guide.

WAPHA and the RACGP are aware that there are issues for general practices with quantity and continuity of supply each influenza season.  We discussed with CDCD and WA Health improvements that could be made for 2021 and beyond.  These include:

  • WAPHA and RACGP to be engaged with CDCD early in the 2021 ordering and delivery process to ensure the needs of general practice and their patients are met;
  • CDCD to undertake a formal review of the ordering and delivery logistics (includes consideration of increased delivery);
  • Review of the Australian Immunisation Register data to ensure that we have better data captured, reflecting vaccine being used by WA providers, and
  • Reduce the wastage experienced in previous years (i.e. approximately $450,000 recorded in flu vaccine wastage in WA over the 2019 season).