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The pandemic restrictions have been relaxed. However, while masks and social distancing were inconvenient for many, they did result in much lower levels of coughs, colds and flu for the last two years. We have seen a rapid rise in cases of influenza A – which is known to cause more severe epidemics – in Australia since June, a good predictor of what we can expect here this winter. With little natural flu infection over the past two years, and a cohort of children who’ve never been exposed to it, the UK will start with lower herd immunity.
There’s also a concern that the vaccine hesitancy seen for the Covid vaccines could mean more people question the safety of flu jabs too. There was a reduction in uptake of the flu jab last winter: worryingly, among healthcare workers, it was down from 77 per cent in 2020/21 to 61 per cent last winter when offered with the Covid booster. The safety and efficacy of co-administering vaccines is a topic that needs to be addressed and is an area where pharmacy staff could help educate the public.
More people are... enquiring about vaccination, but uptake continues to be lower in clinical risk groups
Matt Barclay, director of operations, Community Pharmacy Scotland, has this advice for pharmacists: “There are two aspects of preparation for winter this year: firstly, public health messaging and engagement with patients, those who are at risk and vulnerable. If you’re not offering the vaccinations, there is still an important role in highlighting the benefits of getting them when those opportunities present. Secondly, for pharmacy teams, as key health and social care workers, to get the vaccinations to protect themselves.”
Judy Thomas, director of contractor services at Community Pharmacy Wales, says: “Community pharmacies have proved their value in vaccination services over the last few years during Covid, and their role in flu vaccination is well established, forming part of the new Clinical Community Pharmacy Service (CCPS), with nearly every pharmacy in Wales providing it this winter. I’d encourage pharmacists to ensure they have completed the accreditation process as early as possible.”
Alastair Buxton, Pharmaceutical Services Negotiating Committee director of NHS services, says: “We are now entering a third year of combined Covid and flu vaccination programmes, with contractors and pharmacy teams wanting to build on their achievements in previous years. Service developments in recent years, coupled with the impact of the pandemic, have seen the public and other healthcare professionals come to rely on community pharmacies.
“More people are thinking ahead and enquiring about vaccination, but the uptake continues to be lower in some of the under-65 clinical risk groups. Pharmacy teams may want to focus on increasing the number of people they vaccinate in these groups, including by raising the opportunity to be vaccinated when prescriptions are dispensed for these patients.”
Gerard Greene, Community Pharmacy Northern Ireland chief executive, says: “For pharmacy teams, it will be about planning vaccination clinics, ensuring staff are fully aware of eligible patient cohorts and supporting patients coming forward for vaccines. We expect a big demand for vaccination services through community pharmacy this year.”
Winter flu vaccine campaigns
The JCVI subsequently recommended that those aged 50-64 not in an ‘at risk’ group could be vaccinated from October 15. They also added secondary school children in years 7-9 (with any remaining vaccines to go to years 10 and 11).
With health matters devolved across the UK, the groups eligible for reimbursable flu vaccine on the NHS differ across the four nations. Common to all are: pregnant women, people living in care homes, close contacts of immune-suppressed people, carers, primary school children and those in clinically ‘at risk’ groups aged six months and above.
England has now come into line with Scotland, Wales and Northern Ireland by reducing the age limit for a flu jab to 50 (including those who turn 50 by 31 March 2023), although the 50-64 age group can only be jabbed from 15 October to maximise access to higher priority groups first.
In England, the programme will also cover children aged two or three on 31 August 2022, the frontline staff of social care providers and secondary school-aged children (years 7, 8 and 9 first, with any remaining vaccine offered to years 10 and 11).
To improve uptake in groups who were more than 5 per cent lower than the national average, NHSE&I is considering use of the national call and recall service used in the last two seasons.
All frontline healthcare and social care workers should be offered the vaccine by their employer. The free NHS offer for primary care staff has not been extended for this season.
Last year, Scotland’s vaccine uptake for over 65s was 90.3 per cent, the highest ever for this group. This season, the vaccine will again be offered to the extended groups who were eligible in 2021/22: NHS independent contractors, secondary school children, nursery, primary and secondary school teachers and support staff, the prison population, officers and support staff, health and social care workers. Also included are children aged two to five.
“As always, community pharmacy will play an important role in public health messaging and supporting patients in the community through services such as Pharmacy First and in some cases in vaccination itself,” says Mr Barclay. “Given uptake last year, I would suspect it will be a busy flu season again. Pharmacists should be informing themselves of the eligibility criteria and understanding local pathways for vaccination.”
The number of flu vaccines given in Wales last year was the highest ever recorded. “Some 669 pharmacies provided vaccines and 166,640 doses were provided, compared with 604 pharmacies pre-pandemic and 64,094 doses,” says
Ms Thomas. “This year, with the launch of the new contract in Wales, more pharmacies than ever will be offering the vaccination.”
role of community pharmacy as the primary self care facilitator...has become one of the pillars holding up our health service
This year in Wales, the vaccine will be offered to: staff in nursing and care homes, staff providing frontline NHS/primary care services and healthcare workers with direct patient contact, staff providing domiciliary care, homeless people, people with a learning disability, people with a severe mental illness, children aged two and three, and secondary school children in years seven to 11.
To support the integration of flu and Covid-19 vaccines under the Winter Respiratory Vaccination programme, the remit of the Vaccine Equity Committee has been expanded to include flu. Co-administration of flu and Covid vaccines should take place where possible, and especially for those with COPD.
In Northern Ireland, secondary school pupils in years eight to 12 will be eligible for the jab, alongside pre-school children, and frontline health and social care workers.
“The public understand the acute pressure on the health service in Northern Ireland and early vaccination against influenza and Covid is a key objective in public health messaging,” says Mr Greene. “Pharmacies will play their part, with information on vaccination services being prominently displayed and promoted in pharmacies.”
Winter campaign news
National Self Care Week will run from November 14-20 this year on the theme of ‘Exercise Self Care for Life’. The awareness week can be used to promote a range of health and wellbeing messages in the pharmacy. It can also be used to highlight the need for vaccinations.
Libby Whittaker, manager of the Self Care Forum, has put together some ideas on how pharmacies can get involved here: www.selfcareforum.org/wp-content/uploads/2022/06/2022_SCW_Ideas_Pharmacy.pdf
Ade Williams, Self Care Forum trustee and pharmacist, says: “Over the last two years, the important role of community pharmacy as the primary self care facilitator in the NHS has become one of the pillars holding up our health service. The value of the work done by the Self Care Forum is irrefutable, yet now more than ever, we must rally together to sustain and build on this. Community pharmacies can begin by getting involved in Self Care week.”
At Numark, Cathy Crossthwaite, OTC business development executive, says: “Our winter OTC campaign runs from October, offering members product ranges and supporting point of sales materials to showcase their winter offering to customers. Numark also supports on the services side, with training and campaign packs to help launch new seasonal services.”
Covid booster campaign programmes 2022/23
The NHS is the first healthcare system in the world to use the new bivalent Covid vaccine for its autumn booster campaign, which began in September. These vaccines contain two different antigens based on the two dominant Covid variants. People will be offered the new vaccine where appropriate (subject to sufficient supply). The Joint Committee on Vaccination and Immunisation (JCVI) and Medicines and Healthcare products Regulatory Agency (MHRA) have stressed that the original vaccines continue to provide great protection and people should come forward regardless of the vaccine offered.
England As with previous campaigns, the oldest and most vulnerable will be called first and able to book online or through 119 as long as it has been three months since their last dose. The JCVI advises the following groups should be given a booster:
- Residents and staff in care homes for older adults
- Frontline health and social care staff
- Adults aged 50+
- Five to 49 year olds in clinical risk groups
- Five to 49 year olds who are household contacts of immuno-suppressed
- Carers aged 16-49.
Director for vaccinations and screening Steve Russell says: “This winter will be the first time we see the real effects of both Covid and flu in full circulation as we go about life as normal. We know that our GPs and community pharmacies have been integral to the success of the NHS vaccination programme due to their locations and relationships with local communities, so it is fantastic that so many have opted to be part of the latest phase of the campaign.”
Scotland Booster doses will be offered to all those advised by the JCVI guidance (see above). Where possible, they will be given at the same time as the flu jab. First in line are over 65s and frontline health and social care staff.
Wales The Covid booster is being offered to all groups advised by the JCVI by the end of November. The target is 75 per cent take up for both Covid and flu vaccines, and 80 per cent for people with COPD. A campaign will continue through the autumn to encourage those eligible to come forward. This includes outreach work, mobile delivery vehicles, pop-up clinics and home visits.
Northern Ireland Booster doses will be offered to all groups as advised by the JCVI guidance, given with the flu vaccine where possible. Media campaigns, social media and in-pharmacy messaging will help increase uptake.
Market update
Market analyst Mintel sees the coming winter season as an opportunity for brands to reinvent themselves. “Throughout the pandemic, the cough, cold and flu remedies market suffered large losses, but as pre-pandemic lifestyles return and cases of these illnesses rise, so too will value sales of remedies. The impact of Covid-19 signals a need for OTC brands to reposition to cater to consumers’ new-found holistic view of their health and immunity. This means there is an opportunity for OTC brands to pivot to become providers of wellbeing,” says Mintel in its OTC analgesics, cough, cold and flu remedies, 2022 report.
“The OTC market is on the road to recovery following two difficult years which impacted value sales of cough, cold and flu remedies. In the coming years, as consumers’ budgets are stretched by inflation, value shopping will come to define the market. However, value can be defined as more than the price of a purchase, and instead can encompass expert or unique claims to dissuade customers from trading down,” says Mintel analyst Georgia Stafford.
“Not only are we seeing consumers continue to prioritise their own overall health post-pandemic, but there is now increased awareness of our impact on the wider community,” says Clare Campbell, Olbas brand manager. “This increased consumer attention to health and immunity should support strong sales for the cold and flu category as consumers stock up on essential relief products.”
Jakemans brand manager Elizabeth Hughes-Gapper says: “The ‘care at home’ trend will give the OTC category a boost as consumers feel more confident to treat common ailments at home. Cold and flu symptoms can be self-medicated and often treated without seeing the GP.”
The cold and flu decongestants category saw a 67 per cent rise in value sales in the 12 months to August 2022, according to IRI data. “In terms of likely growth areas, we are seeing consumers seeking out products that offer dual benefits, such as wellbeing properties. Some 41 per cent of consumers are interested in a cold or flu remedy that could improve their sleep,” says Ms Campbell.
As inflation rises, consumers will reassess spending and look at own label or special offers, says Mintel. The analyst adds that while consumers are familiar with ingredients in analgesics, they are less knowledgeable about active ingredients in cold and flu remedies. This is something pharmacy staff could help with.
Olbas is being supported with a new TV campaign backed by a £1.5 million investment this season. The campaign has been directed by Anthony Farquhar-Smith, who worked on Corpse Bride and Fantastic Mr Fox and has directed one of the iconic John Lewis Christmas adverts. The campaign will also benefit from a strong PR programme to ensure the brand and retail sales are well supported throughout the peak cold and flu season.
Jakemans packaging has been refreshed this season, with a new logo and labelling (see Brand Insight story, left). The new look is designed to make the brand easier for customers to recognise in store, with pack sizes changed to reflect the trend for smaller pack sizes to use on the go. The classic flavours are now available in a 73g format, while the top three selling varieties also come in 160g bags.
Category advice
“A heavy cold and flu season is anticipated this year and as such, it’s important pharmacy teams are prepped,” says Ms Crossthwaite. “Pharmacists should ensure staff are up-to-date on the latest product offerings and how best to support customers with the most relevant advice. Product availability will be imperative to compete with other retailers this flu season. And with the advantage pharmacy has in being able to support customers with higher strength doses and larger pack sizes, teams should place emphasis on this point of difference.
“When looking for cold and flu remedies, customers are often suffering and expect to spend little time searching the fixture. This makes signposting crucial. The category should be broken into four core segments making it easier to browse: decongestion, cold and flu relief, cough, and throat. It’s also important to think about category adjacencies. For example, place vitamins alongside as customers may be looking for immunity or energy support.”
“Many brands offer paediatric products in the range so it’s important to offer the full range. Placing these alongside the adult remedies will enable parents to quickly identify the best product for all the family,” says Ms Campbell.
“Lozenges are vital products to stock to soothe the symptoms of a sore or tickly throat and keep airways clear. There is also greater demand for ‘on the go’ solutions as consumers continue a more normal lifestyle. Pre-dosed, smaller sized products and pocket formats are all seeing growth,” says Ms Hughes-Gapper.
Views of the P3pharmacy category panel
“We anticipate a very busy season and are stocking up earlier than usual so we don’t get caught out by a sudden surge. Sudafed does well for us as a range, as do Benylin, Lemsip, Day and Night Nurse. Nasal saline sprays have become popular. Otrivine is a popular choice for blocked noses, along with Olbas Oil. Have products on display so customers can pick them up and ask questions. We are selling lots of lateral flow tests at the moment; people are asking what to do now if the result is positive. We do Covid and flu vaccinations and will be offering them together where possible.”
Lila Thakerar, Shaftesbury Pharmacy, Harrow
“With lockdowns and social distancing behind us, our biggest seasonal category will be back. We’re geared up for Covid-related questions – prevention, treatment of symptoms, vaccinations. With CPCS running via NHS 111 and GPs, I see a rise in general cough and cold advice. Historically, the Robitussin range does best since it is sugar-free; we recommend Robitussin Dry Cough for all coughs, Day and Night Nurse products for all-round relief. Tempo BreathEasy tissues do well. Increasing sales (and providing value to customers) is more to do with link selling (e.g tissues) and cross selling to other services.”
Gareth Evans, Wansford Pharmacy, Peterborough
“I find cough and colds a year-round issue, although most prominent during the winter. Most questions are directed towards finding the best treatment for specific symptoms. Actifed is a great option for bouts of nasal congestion and a runny nose. Benylin Mucus is good for a chesty cough and Robutussin Dry for dry cough. Covid has made a significant difference: the first question is now ‘have you tested for Covid?’ I tend to treat symptoms directly with single ingredient products. The patient will benefit from a treatment targeted to their symptoms, and it provides flexibility, especially if they are taking other medicines.
Ellis Nugent, Davaies Chemist, Gurnos, Swansea
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