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21 December 2023
Influenza vaccines and eligible cohorts for the 2024 to 2025 season
Date of expiry / review:
For action by:
Chief executives, Health Boards/Trusts
Immunisation leads, Health Boards/Trusts
Immunisation coordinators, Health Boards
Vaccination operational leads, Health Boards/Trusts
Medical directors, Health Boards/Trusts
Directors of Primary Care, Health Boards/Trusts
Nurse executive directors, Health Boards/Trusts
Directors of Therapies and Health Sciences, Health Boards/Trusts
Chief pharmacists, Health Boards/Trusts
Directors of Public Health, Health Boards/Trusts
Directors of maternity services, Health Boards
Directors of Workforce and Organisational Development, Health Boards/Trusts Executive Director of Public Health, Public Health Wales
Nurse director, Public Health Wales
Head of Vaccine Preventable Disease Programme, Public Health Wales
Director of planning, vaccination programme Wales
Digital Health and Care Wales
For information to:
Welsh NHS Partnership Forum
General Practitioner Council, Wales
Royal College of GPs
Royal College of Nursing
Royal College of Midwives
Royal College of Paediatrics and Child Health
British Dental Association
Royal Pharmaceutical Society
Community Pharmacy Wales
Care Inspectorate Wales
Chief Executive, Welsh Local Government Association for onward issue to: Directors of Social Services, Local authorities
Directors of Public Protection, Local authorities
Directors of Education, Local authorities
Social Care Wales
Health Education and Improvement Wales
Action required by:
5 January 2024
Dr Frank Atherton, Chief Medical Officer / Medical Director NHS Wales
Welsh Government contact:
Vaccination Division, Welsh Government, Cathays Park, Cardiff CF10 3NQ
This Welsh Health Circular is being published to confirm:
- eligible cohorts for the 2024 to 2025 influenza (flu) season
- reimbursable vaccines for the 2024 to 2025 flu season
- changes to the start of the 2024 to 2025 adult flu vaccination programme (except for pregnant women)
This information is being issued at this time to enable plans for the delivery of next year’s flu vaccination programme to be put in place. A well-planned and executed programme which results in the timely delivery of vaccination is vital to ensuring the eligible population is protected before flu activity starts to increase during the winter months.
A further circular will be issued at the earliest possible opportunity with more detailed operational guidance and expectations for the 2024 to 2025 Winter Respiratory Vaccination Programme, which includes the flu programme alongside the COVID-19 programme on which Joint Committee on Vaccination and Immunisation (JCVI) is yet to advise.
Eligible cohorts for the influenza (flu) season in 2024 to 2025
The JCVI has not recommended any changes to the eligibility criteria which applied for the 2023/24 programme.
Therefore, the groups eligible for a flu vaccine in Wales as part of the routine national flu programme in 2024/25 will be as follows:
- children aged two and three years on 31 August 2024
- school aged children from reception to year 11 (inclusive)
- people aged 6 months to 64 years in a clinical risk group
- people aged 65 years and older (age on 31 March 2025)
- all adult residents in Welsh prisons
- pregnant women
- carers of a person whose health or welfare may be at risk if the carer falls ill
- frontline health and care workers
- people experiencing homelessness
- household contacts of the immunocompromised
Reimbursable vaccines in 2024 to 2025
Taking into account the vaccines recommended by the JCVI for the 2024/25 flu season, the vaccines eligible for reimbursement in Wales for the different age cohorts will be as follows:
Those aged 65 years and over [footnote 1]
Those aged 18 to less than 65 years (including pregnant women)
Children aged 2 to less than 18 years who are contraindicated/ decline LAIV
Children aged 6 months to 2 years in risk groups
aQIV - adjuvanted quadrivalent influenza vaccine
QIVc - quadrivalent cell culture influenza vaccine
QIVr - quadrivalent recombinant influenza vaccine
General practices, community pharmacies and health boards/trusts should ensure that flu vaccine orders are sufficient to facilitate high uptake. Orders should be submitted as soon as possible as manufacturers will start to produce volumes of vaccines shortly based on the orders they have received.
For the children’s programme, quadrivalent live attenuated influenza vaccine (LAIV) is the recommended vaccine for eligible children aged 2 to 17 years of age, unless contraindicated or declined due to gelatine content. Where there is a clinically determined need for a less invasive procedure, e.g. for some adults with a learning disability, the use of LAIV may be considered a reasonable adjustment (see here for more details). LAIV is supplied centrally and will be available to order through ImmForm.
Changes to the start of the 2024 to 2025 vaccination programme
JCVI has recently advised that the evidence on vaccination effectiveness supports the case for moving the start of the adult flu vaccination programme to early October. The committee has recommended there should be no change to the start of the children’s programme as evidence shows early vaccination of children provides the best protection against transmission.
It has also recommended pregnant women should continue to be vaccinated in September, if delaying until October would mean they risk missing out on vaccination.
In the light of the committee’s advice, we will adopt a phased approach to the commencement of the flu vaccination programme in 2024 as follows:
- During September, general practices and health boards should concentrate their efforts on maximising uptake in the children’s programme, both amongst school-age children and 2-and 3-year-olds.
- The main adult vaccination programme should begin at the start of October and be delivered at pace with an expectation that all eligible patients should be offered a vaccination by early December.
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 for vaccination to begin in September, rather than risk failing to complete the programme in a timely way.
The flu vaccination programme is a vital element of our winter planning and resilience arrangements. I have been disappointed to see lower than expected uptake in the 2023/24 programme and I hope the details set out above will support colleagues to develop effective plans to ensure the 2024/25 programme is a successful one.
Finally, I would like to offer my sincere thanks for all the hard work that goes into delivering our vaccination programmes, which offer vital protection to eligible citizens and to our health service through the winter months.
Sir Frank Atherton
Chief Medical Officer / Medical Director NHS Wales
 JVCI has also recommended QIV-HD – high dose quadrivalent inactivated influenza vaccine – for the vaccination of those aged 65 years and over. This product would also be eligible for reimbursement but is not currently marketed in the UK.
 aQIV may be offered ‘off-label’ to those who become 65 years of age before 31 March 2025.
 Whether a vaccine is ‘available’ should be a balance of clinical and operational judgement. The potential delay in sourcing the preferred vaccine (due to a temporary or localised shortage or a national batch failure) should be weighed against the protection afforded by the alternative vaccine. Whether the flu virus is circulating or is imminent at the time would be a factor in making this judgement.