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For the first time a national shingles immunisation programme (NSIP) is underway, targeting two cohorts - people aged 70 and 79. Stock shortages, however, mean the campaign has had an inauspicious start.
Although proposed in 2010 following a recommendation by the Joint Committee on Vaccination and Immunisation, the scheme has waited until sufficient supplies could be guaranteed at a cost effective price.
Based on assurances of continuity of supply from the manufacturer, Sanofi Pasteur MSD, national distribution of the Zostavax vaccine began on 1st August and the scheme officially launched in September 2013 - but just as it was due to go live, Zostavax vaccine stock levels were hit by production problems.
As a result, DDA members have reported receiving only restricted initial supplies - in the region of a third or less of their orders. GPs have also been told that further supplies would be restricted to five vaccinations per week, although this figure subsequently has been revised upwards.
The impact has been felt mostly on those practices which have had to rearrange appointments or to reschedule drop in clinics because of insufficient stock. Particularly hard hit are those practices who have tried to combine administration of the shingles and flu vaccines (as recommended by the Department of Health). "We have an eligible population of 270," said one dispensing doctor. "We were told we could only order 50 vaccines, and subsequently five each week. This is madness. We can't organise a campaign for these people, or sort out our staffing properly to deal with this work in one chunk, as we (and the patients) would prefer. We also still have all the ‘non-eligible' group (71-78) to reassure."
Adding to the frustration is that supply has been haphazard. Despite being told that subsequent supplies would be restricted to batches of five, one practice actually managed to get an order for 100 through the system - "somehow," the dispensing doctor said. That then impacts on storage as the vaccine needs to be refrigerated.
DDA members' concerns were put to the Zostavax supplier Sanofi Pasteur MSD (SPMSD) as well as Public Health England, the Department of Health, and NHS England.
Last week, SPMSD confirmed that it is experiencing some delays in shipping the vaccine. A company spokesman explained: "We are required to complete a number of tests before a vaccine can be distributed in the European Union. Unfortunately, we regret that this testing is taking longer than anticipated."
However, the company would confirm that production of shingles vaccine is on-going and doses committed for Year One of the NSIP will be delivered. Overall, the NSIP will not be affected by changes in the delivery schedule for the vaccine."
Along with the Department of Health and NHS England, PHE acknowledges that the best laid plans can go awry. In a joint response on the stock shortage this week, the agencies said: "The current Zostavax shortage is due to delivery failures into the UK from the sole manufacturer, SPMSD. While every effort is made to source a secure supply, vaccines have complex manufacturing processes and batch failures can and do happen."
They emphasise that: "A significant volume of Zostavax has already been distributed throughout the UK, allowing many clinics to go ahead as planned. However, practices are currently able to order, via Immform, 25 doses per week, per practice; this is on top of the stocks practices already hold."
Importantly, the statement adds: "The shingles vaccine for this year's [patient] cohorts can be given at any time between September 2013 and August 2014. We do not expect this temporary supply issue will impact the overall programme to immunise 70-year-olds and 79-year-olds over the forthcoming year."
And, this, perhaps, explains the root cause of GPs' frustration at the organisation of the shingles campaign: different expectations about the vaccination campaign timeframe.
GPs, in England, at least have been encouraged to provide the shingles vaccination alongside the flu vaccination to save patients a trip to the surgery.
The advice in England states: "GPs are encouraged to offer the shingles vaccination when patients are called for the seasonal influenza vaccine and 23-valent pneumococcal polysaccharide vaccines (PPV). However, scheduling of the appointment should not delay the administration of any of the vaccines."
However, the following caveat should also be noted: "The shingles vaccine can be administered outside of the influenza vaccine season where the two vaccines have not been given together."
In Scotland patients have been told: "While people can have this vaccine at any time of the year, for many people it will be offered at the same time as the seasonal flu vaccine."
As the DDA reported in August Scottish practices were told to liaise closely with vaccine holding centres "to ensure sufficient vaccine availability prior to the scheduling of immunization appointments." Stock holding of two to four weeks only was advised, too.
The paragraph on the campaign timing in the guidance for Wales makes no mention of the flu vaccination campaign at all.
Although it is still too early to evaluate the shingles campaign, the PHE/DoH/NHSE view is that next year it will recommend giving the shingles vaccine at the same time as the flu vaccination: "Yes, next year there will be a similar emphasis on offering the shingles and flu jab together to eligible [groups]. As highlighted, this gives the opportunity to administer both vaccines together meaning one less appointment. This approach benefits both the patient and GP practice."
It should be noted that from the outset it was acknowledged that stocks would be limited to a degree: the campaign specifies two cohorts of 70-year-olds and 79-year-olds, rather than targeting all people in their 70s.
But with such a shaky launch, GPs might be wondering what sort of planning went on. What methodology, for example was used to determine how the Zostavax stock should be allocated to GP practice?
The PHE/DH/NHSE response is that the supply of vaccine procured "for the national programme is sufficient to cover the intended cohorts this year" but it stresses that "vaccine batch failures cannot be predicted".
A spokesman told DDA Online that as soon as the shortage was known, restrictions were applied to avoid over-stocking. The spokesman said: "Restrictions on doses being ordered per week can be put in place for a number of reasons: to balance stocks where there is more than one vaccine available, and to slow the quantity of stock being distributed where over-ordering is found to be commonplace."
DDA Online has also learned that in some practices non-eligible patients have offered to buy the shingles vaccine on private prescription - but they have been told that supplies are not available for supply via this route.
While PHE acknowledges that there are going to be occasions where a GP identifies a clinical need to vaccinate a person outside the two age-group cohort, it says that: "[PHE] is not responsible for, and is not able to comment on the availability of the shingles vaccine for use outside the national programme." The spokesman added: "PHE is in regular dialogue with the SPMSD regarding supplies for the purpose of the NHS programme and we would advise others to contact the manufacturer direct for updates on supplies.
The SPMSD spokesman would add only that the company remains "committed to supporting this new initiative in public health immunisation and will update on the shingles vaccine supply situation as it develops."