The national influenza immunisation programme 2025 to 2026 (WHC/2025/020)

Issue date:

5 June 2025.

Status:

Compliance/action.

Category:

Public health.

Title:

The national influenza immunisation programme 2025 to 2026.

Date of expiry / review:

Non-applicable.

Required by:

Non-applicable.

Action by: 

• Chief executives, health boards / trusts.
• Immunisation leads, health boards / trusts.
• Immunisation coordinators, health boards.
• Vaccination operational leads, health boards / trusts.
• Occupational health 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 Vaccine Delivery, Vaccination Programme Wales.
• General practitioners.
• Community pharmacists.
• 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.

Sender:

Dr Keith Reid, Deputy Chief Medical Officer (Public Health).

Welsh Government contacts:

Vaccination Division,
Welsh Government,
Cathays Park,
Cardiff.
CF10 3NQ.
Email: wg.vaccinationsprogrammeteam@gov.wales

Enclosures:

None.

Dear Colleagues,

This Welsh health circular is being published to provide detailed guidance for the influenza (flu) vaccination programme for the coming autumn and winter (National Influenza Immunisation Programme 2025 to 2026).

There are a number of important changes from the way the programme operated in 2024 to 2025.

1. The flu and COVID-19 Immunisation Programmes will no longer be treated as a single Winter Respiratory Vaccination Programme. Although opportunities for co-administration of these vaccines should continue to be maximised, they will be run as two programmes. Details of the autumn 2025 to 2026 COVID-19 vaccination programme will follow at a later date.
2. The Inactivated Influenza Vaccine (IIV) necessary to deliver the 2025 to 2026 vaccination programme has been procured centrally by NHS Wales Shared Services Partnership on behalf of Welsh Government and will be supplied directly to those providing vaccinations. This is a significant departure from previous programmes, where primary care providers have procured their own supply of IIV for use with eligible patients.
3. Primary Care Providers (GMS contractors and community pharmacies) will be commissioned by health boards to provide flu vaccination services under a Primary Care (Contracted Services): Immunisation Specification (for eligible groups aged 16 and over). This specification replaces the previous separate arrangements made for engaging GMS contractors and community pharmacies. In respect of community pharmacies, the specification relates to the provision of inactivated influenza vaccine, not live attenuated influenza vaccine, to eligible persons aged 17 and over.
4. All providers operating under the national programme will be required to use the newly improved Welsh Immunisation System (WIS) to record digitally flu vaccinations given to adults.

The detailed guidance on the flu vaccination programme is as follows:

Programme ambitions: maximising uptake and ensuring equity

We expect local systems to develop robust delivery plans, to achieve high levels of coverage as early as possible in the programme and to monitor progress closely, taking early remedial action where trajectories are not being achieved.

September start: school-aged children / young people

Starting as soon as Live Attenuated Influenza Vaccine (LAIV) becomes available in September, 2- and 3-year-olds and school-aged children / young people should be vaccinated as quickly as possible. Our ambition is to achieve 75% uptake amongst these groups during the 2025 to 2026 season. Health boards must take every practicable step to set a trajectory towards achieving this ambition. There should be a concerted drive towards increased LAIV administration particularly during the main vaccination window for these cohorts from September to October half-term.

For children where the LAIV vaccine is not appropriate, for example, due to the porcine gelatine content, health boards are expected to ensure a suitable alternative pathway for vaccination is in place, ideally offering concurrent vaccination with other children. This must be communicated to all providers and parents.

October start: older adults and at-risk groups

In accordance with the Joint Committee on Vaccination and Immunisation (JCVI) advice, based on the best clinical evidence for vaccine efficacy and waning, the adult flu programme will again commence on 1 October. We expect health boards to support contractors to achieve high levels of coverage early in the programme. Planning for any additional health board activity to augment primary care delivery should be directed at achieving high levels of coverage by mid-December and should be seen as an integral part of the programme. Health board activity must look to address inequity in coverage in year, with particular attention paid to provision of vaccination to those in groups with increased risk of adverse outcomes from influenza.

The Welsh Government uptake target for adults aged 65 years and older remains at 75%. This accords with the World Health Organisation’s uptake target and the NHS Wales performance framework target for this cohort. In 2023 to 2024 and again in 2024 to 2025, the uptake for the over 65 years cohort fell. At the end of last season, it stood at 70% across Wales. This trend must be reversed and a trajectory set towards achieving 75% uptake. In 2025 to 2026 our expectations are that each health board ensures that at least 65% of older adults have been vaccinated by 1 December and that 75% are vaccinated by the end of the programme.

For people aged under 65 in a clinical risk group eligible for flu vaccination the uptake ambition also remains at 75%. For this cohort, overall uptake across Wales has fallen each season over the last three years, standing at 37% at the end of the 2024 to 2025 season. This downward trend must also be reversed if we are to realise the ambition of 75% uptake. Our expectation is that at least 37% of people in clinical risk groups have been vaccinated by 1 December with a trajectory towards 75% by the end of the programme.

In areas where expectations on vaccine uptake by 1 December have not been achieved, health boards will be expected to commence ‘mop-up’ activities immediately, alongside continued primary care contractor activity.

Health and social care workers

Flu vaccination rates have also fallen amongst health and social care workers. Health boards should make every effort to encourage health and social care staff to come forward for a flu vaccine by ensuring easy access and effectively communicating the benefits of vaccination. We expect health board clinical professional leaders to advocate for vaccination within the workforce in support of professional standards. Where there is sufficient vaccine supply vaccination of health and social care staff who are under the age of 65, can commence before October or as soon as vaccine is available and should continue following the start of the older adults and at-risk groups programme. The earlier start of health and social care staff vaccinations does not apply to the older adults and at-risk groups, which should commence in October as set out above.

Ensuring equity

Those living in our most deprived communities, people from ethnic minority backgrounds, and all other underserved communities such as those with disabilities and people who are experiencing homelessness, must be given fair and equitable opportunity to fully benefit from flu vaccination. Where inequities exist, there is an expectation that there will be an incremental improvement in uptake each season as part of a planned approach to removing barriers to vaccination.

Central procurement and collaboration with primary care

The move to central procurement will ensure the sufficiency of vaccine supply and the universal use of the WIS will ensure more accurate and timely reporting of uptake data. Building on these improvements, and having regard to the expectations set out above, health boards must make every effort to work closely with primary care contractors to increase uptake. This collaboration should also seek to ensure that the current variation, between GMS (General Medical Services) contractors and between the most and least deprived areas, is minimised.

Flu vaccine supply

The vaccines for use in Wales in the 2025 to 2026 season for the different age cohorts are as follows:

• Those aged 65 years and over – aTIV (adjuvanted Trivalent Influenza Vaccine)
• Those aged 18 to 64 years (including pregnant women) – TIVc (Trivalent cell culture Influenza Vaccine)
• Children aged 2 to 17 years – LAIV (Live Attenuated Influenza Vaccine)
• Children aged 2 to 17 Years who are contraindicated for or decline LAIV – TIVc
• Children aged 6 months – 2 years in risk groups - TIVc

Note:
aTIV is licensed for use in those aged 50 to 64 years. Where TIVc is not immediately available pending delivery of additional TIVc vaccine, or where TIVc is not available to order, aTIV can offered as an alternative to 50 to 64 year olds.

Eligible cohorts for 2025 to 2026

The eligible cohorts for 2025 to 2026 are:

• children aged two and three years on 31 August 2025
• 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 2026)
• 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 social care workers
• people experiencing homelessness
• household contacts of the immunocompromised
• poultry workers

Further detail on these cohorts can be found on the eligible groups page for this flu programme.

Specific guidance in relation to the children’s programme and health and social care workers can be found on the eligible groups page for this flu programme.

Service specifications and expectations

The Primary Care (Contracted Services: Immunisation) (Influenza) Directions set out the legal requirements on health boards for the 2025 to 2026 influenza programme for adults aged 16 and over. The directions provide a template specification to be used with primary care providers (currently GMS contractors and community pharmacies) when engaging those providers to provide of flu vaccination services.

There are a number of additional expectations important to local planning and contracting arrangements for delivery of the flu vaccination programme.

GPs are expected to adopt a proactive approach to offering flu vaccinations by using robust call, recall and reminder systems to contact all eligible patients, for example, through direct contact by phone call, email, text or otherwise (determined at a practice level). Practices are expected to follow-up eligible patients and remind/recall those who do not receive their flu vaccination. This expectation does not apply to those covered under the school nursing service programme.

Community pharmacies engaged to provide flu vaccination services should proactively offer influenza vaccination to any patient they identify as being eligible to receive it should the patient present in the pharmacy for any reason. Community pharmacies that supply medicines to care homes may wish to make arrangements with those homes to offer flu vaccination to staff on the premises.

For individuals in a clinical risk group, collaborative working between GP practices and community pharmacies is encouraged and is particularly important in helping to maximise uptake in eligible groups and to help protect more individuals.

As part of their arrangements with primary care providers, health boards should agree a date and any necessary planning from which they will commence activity to assist in the delivery of the programme as needed. The purpose of this activity should be to maximise uptake across all adult groups, but particularly those in a clinical risk group. Residual ‘mop up’ activity should not normally commence before 1 December.

Engaged providers must comply with their contractual obligations under the specifications and any locally agreed requirements. They should take all necessary steps to meet the expectations set out above. Health boards should be proactive in monitoring engaged provider compliance with their contractual obligations and take appropriate action in the event of non-compliance.

A separate National Supplementary Service (NSS) specification for use where GPs are delivering aspects of the childhood seasonal influenza vaccination programme, including the vaccination of children aged two and three years on 31 August 2025, will be issued in due course. The Welsh Government is currently considering whether to include a requirement that vaccinations given under this specification are also recorded in the WIS. A decision on that will be taken in the coming weeks and set out in the specification.

Patient Group Directions (PGDs)

Template PGDs and supporting content will be available prior to the commencement of the season, and should be reviewed, authorised and signed off locally by the health board/trust according to local policies and governance procedures. Where PGDs are used by GMS contractors they must be signed by the doctor working at the practice who is authorising the administration of flu vaccine by a registered healthcare professional to eligible people covered by the PGD.

It is currently intended that national protocols will be available before the start of the season to support mixed workforce and flexible delivery models. Please see the relevant pages of the Welsh Medicines Advice Service website for more information.

Communications

Public Health Wales will lead the national flu immunisation programme communications and marketing campaign. Information will be available at:

Brechlyn Ffliw - Iechyd Cyhoeddus Cymru (gig.cymru)
Flu Vaccination - Public Health Wales (nhs.wales)

Surveillance and reporting

Public Health Wales leads the surveillance and monitoring of influenza and the influenza immunisation programme in Wales. Providing data is available, weekly surveillance reports will be published to support delivery of the programme. These will include reports on coverage at practice, pharmacy, cluster, local authority and health board level. Public Health Wales will work closely with Digital Health and Care Wales to access data from WIS and other appropriate national data systems, scoping potential for centrally reconciling uptake data where appropriate.

Health boards and NHS trusts will be required to provide Public Health Wales Vaccine Preventable Disease Programme Surveillance Team with data to allow monitoring of coverage in NHS staff on a monthly basis using a standard data template. Data to enable surveillance of uptake of LAIV in school-aged children will be requested by Public Health Wales from health boards monthly. Public Health Wales will work with other UK nations on surveillance of influenza vaccine effectiveness and will scope development of surveillance of influenza vaccine equity where robust and complete data on vaccine delivery is available.

Detailed surveillance reports, from national to GP practice and community pharmacy level are published for NHS stakeholders on NHS Wales' Sharepoint page 'Surveillance'.

Weekly surveillance summaries at national and health board level will be available for public access on Public Health Wales' website.

The 2024/25 annual epidemiological summary of influenza activity and influenza immunisation uptake will be published shortly by Public Health Wales on their surveillance Sharepoint page or Public Health Wales' guidance, reports and planning Sharepoint page.

A weekly surveillance summary of influenza and other acute respiratory infection activity is published throughout the year on Public Health Wales' website.

The Green Book

The Green Book, “Immunisation against infectious disease” provides guidance to healthcare practitioners on all aspects of immunisation. It is regularly updated and the Green Book's specific influenza chapter can be found on Gov.UK.

I know that you recognise influenza vaccination as an important public health intervention, and I wish to thank you for your continuing support for this seasonal campaign.

Yours sincerely,

Dr Keith Reid
Deputy Chief Medical Officer (Public Health)