The national influenza immunisation programme 2026 to 2027 (WHC/2026/010)

Issue Date: 

1 July 2026

Status: 

Compliance / Action

Category: 

Public Health

Title: 

The National Influenza Immunisation Programme 2026 to 2027

Date of Expiry / Review: 

N/A

Required by: 

N/A

Action by:    

• Chief Executives, Health Boards and Trusts
• Immunisation Leads, Health Boards and Trusts 
• Immunisation Coordinators, Health Boards
• Vaccination Operational Leads, Health Boards and Trusts
• Occupational Health Leads, Health Boards and Trusts
• Medical Directors, Health Boards and Trusts
• Directors of Primary Care, Health Boards and Trusts
• Nurse Executive Directors, Health Boards and Trusts
• Directors of Therapies and Health Sciences, Health Boards and Trusts
• Chief Pharmacists, Health Boards and Trusts
• Directors of Public Health, Health Boards and Trusts
• Directors of Maternity Services, Health Boards
• Directors of Workforce and Organisational Development, Health Boards and 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 Vaccination 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 provides detailed guidance for the influenza (flu) vaccination programme for the coming autumn and winter (the National Influenza Immunisation Programme 2026 to 2027).

In 2025 to 2026 we introduced a new model of flu delivery which included the move to central procurement of flu vaccines and the universal use of the Welsh Immunisation System. This change was introduced to support greater flexibility in vaccine supply, improve reporting and generate increased vaccine uptake so that more people benefited from protection against flu. We recognise the challenges that significant change can bring. We thank you all for your hard work last year in making the change an overall success and for the valuable feedback you provided on where things could be improved.

In response to lessons learned and your feedback from last season, we have made some changes to this year’s programme, which are reflected in this Welsh Health Circular. 

There are several important considerations for this year’s flu programme:

1. The main period of activity for delivery of the flu programme for the 2026 to 2027 season will be shorter than in previous years and will run from 1 September 2026 to 28 February 2027. The aim is to maximise vaccine uptake early in the programme to protect those most at risk from flu before infections peak in winter. 
2. Opportunities for co-administration of flu and COVID-19 vaccines should be maximised. This is a patient-centred approach. Providers commissioned to deliver both flu and COVID-19 vaccinations should opportunistically offer both to eligible people presenting for either vaccination. Specific details of the autumn 2026 COVID-19 vaccination programme are in a separate Welsh Health Circular. 
3. The trivalent cell culture influenza vaccine (TIVc) will be the only adult influenza vaccine in use as part of the national programme and should be used to vaccinate all eligible adults during the 2026 to 2027 season. This aligns with advice from the Joint Committee on Vaccination and Immunisation. This change should reduce complexity and improve logistical efficiency in delivery, provide more flexibility in stock management for Primary Care Providers (GMS contractors and community pharmacies), greater opportunity for increased uptake and reduced wastage.  
4. In all settings, providers must use WIS to digitally record flu vaccinations administered to eligible children, young people and adults. In practice this should be recorded during or immediately after vaccination, wherever possible, and by no later than the end of the day on which a vaccination is administered.   
5. Accurate vaccine stock check balances must be recorded in WIS by the end of each working day in which vaccinations are administered.

The detailed guidance on the flu vaccination programme follows.

The eligible cohorts for 2026-2027 are:

• children aged two and three years on 31 August 2026 (with a date of birth on or after 1 September 2022 and on or before 31 August 2024)
• school aged children from reception to year 11 (inclusive)
• people aged 6 months to 64 years in a clinical risk group as defined in the Green Book, Influenza Chapter
• people aged 65 years and older (age on 31 March 2027)
• 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
• health and social care workers and NHS Trust staff
• people experiencing homelessness
• household contacts of the immunocompromised (defined as immunosuppressed in table 19.4 in chapter 19 of the Green Book, Influenza Chapter)
• poultry workers and livestock (cattle and swine) workers who are at higher risk of exposure to zoonotic influenza

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.

The inactivated influenza vaccine (IIV) necessary to deliver the 2026 to 2027 immunisation programme is centrally procured and will be supplied directly to those providing vaccinations. The vaccines for use with eligible cohorts in Wales in the 2026 to 2027 season are as follows: 

Trivalent cell culture influenza vaccine (TIVc) 

• those aged 65 years and older
• those aged 18 to 64 years (including pregnant women) in a clinical risk group as defined in the Green Book, Influenza Chapter
• those aged 18 years and older in other risk groups: pregnant women, residents in Welsh prisons, carers, people experiencing homelessness, household contacts of the immunocompromised, health and social care workers and NHS Trust staff, poultry and livestock workers at higher risk
• children aged 2 to 17 Years who are contraindicated for, or otherwise decline, LAIV including those opting for an alternative, gelatine-free vaccine
• children aged 6 months to under 2 years in risk groups

Live attenuated influenza vaccine (LAIV)

• Children and young persons aged 2 to 17 years

Please note: Unless receiving as an occupational vaccine, including eligible poultry and livestock workers, health and social care workers and NHS Trust staff aged 16 to 17 years TIVc can be offered if LAIV is not available or if LAIV is contraindicated or otherwise declined. 

The main period of activity for delivering the flu programme is from as soon as vaccine becomes available in September 2026 to 28 February 2027. The ambition is to maximise uptake while ensuring an equitable vaccination offer to all eligible people. Local systems must develop robust delivery plans to achieve high levels of coverage, as early as possible in the programme, from September 2026 to 30 November 2026. Progress must be monitored closely and early remedial action taken where trajectories are not being achieved. This will maximise protection in those at risk from flu before infections peak in winter. 

From 1 December 2026 Health Boards are expected to immediately commence ‘mop-up’ activities alongside ongoing primary care contractor activity. Where expectations on vaccine uptake, as outlined below, are not being achieved, Health Boards should act immediately to ensure that all eligible individuals receive a vaccination. Offering support to primary care contractors and commencing ‘mop-up’ activity early as needed.

It is essential this year that Health Boards make every effort to work closely with primary care contractors to increase uptake. This collaboration should also seek to promote equity and ensure that the current variation in uptake, between the most and least deprived areas, is minimised.  This collaboration should start at the planning stage of the campaign.

During the 2026 to 2027 season Health Boards must include proposals for incrementally increasing uptake in their communities as part of their winter planning activity. 

The overall target remains 75% uptake for each cohort. Every practicable step must be taken by Health Boards to ensure a trajectory towards achieving at least a two-percentage points improvement in uptake towards this overall target in each of the eligible cohorts described below, compared to the end of the 2025 to 2026 season.

September start: 2 and 3 year olds, school aged children and young people and pregnant women

2 and 3 year olds

Two and three year olds should be vaccinated as quickly as possible at the beginning of the season with vaccinations starting as soon as LAIV becomes available in September 2026. There should be a concerted drive towards increased LAIV administration from September 2026 to 30 November 2026. Health Boards are expected to monitor uptake closely from the start of the season and to intervene early (and before 30 November 2026 if needed) in areas where uptake is not as expected.

Maximising uptake of flu vaccination in 2 and 3 year olds is essential, commissioned providers should ensure every contact counts by co‑administering the flu vaccine with pre‑school booster appointments where possible. In some areas of Wales local agreements are in place to take the vaccine to children aged 3 years, such as to nursery settings, via the school nursing and health visiting service.

School aged children and young people

School aged children and young people should be vaccinated as quickly as possible at the beginning of the season when LAIV becomes available. Planning for the flu season should be prioritised by school nursing teams, working alongside schools, so vaccinations can start as early as possible in September. There should be a concerted drive towards increased LAIV administration from September 2026 to 30 November 2026.

LAIV remains the recommended vaccine for children, however, Health Boards are expected to ensure an equitable offer and suitable alternative to LAIV is available. This must be clearly communicated in consent information. The aim should be to offer vaccination concurrently with other children. The TIVc should be available in any school setting where LAIV is declined in favour of a gelatine-free alternative as recorded in consent forms.

A suitable adult, responsible for any child in primary school who has declined LAIV in favour of a gelatine-free alternative, should be supported to attend vaccination with the child so that they can receive TIVc.

If the above arrangements are unsuccessful a timely alternative appointment for vaccination with their GP or Local Health Board vaccination facility must be offered. This must be communicated to all providers and parents.

Pregnant women

In line with previous years, the Joint Committee on Vaccination and Immunisation have advised inviting pregnant women for vaccination as soon as vaccines are available in September 2026.

October start: older adults, care home residents, clinical risk groups and other at-risk groups

In accordance with advice from the Joint Committee on Vaccination and Immunisation, based on the best clinical evidence of vaccine efficacy and waning, the flu programme for older adults and at-risk groups (as outlined above in ‘Eligible Cohorts’) will commence on 1 October 2026.

Health Boards should ensure that delivery to care home residents is completed by no later than 31 October 2026.

Mop-up activity in Health Boards should start from 1 December 2026. Planning for any additional Health Board activity to augment primary care delivery should be directed at achieving high levels of vaccine uptake by the end of December. This is to ensure that the greatest proportion of the population is vaccinated ahead of periods of high prevalence of flu.

Older adults

In line with targets from the World Health Organisation and the NHS Wales Performance Framework, the Welsh Government uptake target for adults aged 65 years and older is 75%. Uptake in this group last season was increased compared to the 2024 to 2025 season. We want to continue this improvement with a trajectory towards achieving 75% uptake. Each Health Board must ensure that at least two thirds of eligible older adults have been vaccinated by 30 November 2026.

Clinical risk groups

For people aged under 65 in a clinical risk group eligible for flu vaccination the ambition is to show clear progress towards achieving 75.0% uptake by the end of the programme. Last season, overall uptake across Wales for this cohort increased significantly compared to the 2024 to 2025 season. We want to build upon the positive trajectory from last season.

Each Health Board must ensure that at least 38% of eligible under 65 years of age in a clinical risk group have been vaccinated by 30 November 2026.

Health and Social Care workers and NHS Trust Staff

Flu vaccination rates amongst health and social care workers and NHS Trust staff showed significant improvement during the 2025 to 2026 season thanks to the concerted effort across the system. We want to build upon that success during the 2026 to 2027 season to protect patients and clients, reduce the transmission of flu and avoid staff absences due to flu that disrupt NHS services over winter.

Health Boards have operational flexibility to vaccinate eligible staff who are under the age of 65 and not in a wider clinical risk group, and therefore not at heightened risk from waning of vaccine efficacy, as soon as vaccine is available in September. Eligible staff who are over the age of 65 and who fall in a clinical risk group eligible for flu vaccination should not be vaccinated until 1 October 2026. This will offer the best protection against flu over winter for these staff based on the best clinical evidence of vaccine efficacy and waning. 

Health Boards and NHS Trusts should make every effort to encourage eligible 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. Uptake of vaccination is a professional standard for all medical staff and all dental professionals. It is implicitly included in the professional code for nursing staff and similarly implicitly included in the requirements of Allied Health Professionals registered with the Health and Care Professions Council under a generic requirement to “Establish and maintain a safe practice environment”. Profession leaders have a role in promoting vaccination as a matter of maintaining these professional standards.

Ensuring equity

Alongside maximising vaccine uptake, providers are expected to retain their focus on reaching the most vulnerable. Disparities persist in uptake between the most deprived communities compared to the least deprived communities across all eligible cohorts.  

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

Interventions to remove all possible barriers to vaccination should be explored and acted upon. Taking up a vaccination should be as accessible as possible, and providers should be ambitious in undertaking activity that minimises patient burden (including travel burden). Providers must ensure access to vaccination at a convenient time and place.  Health Boards and providers contracted to deliver flu vaccinations should consider personalised invitation letters and phone calls to encourage eligible people to attend for vaccination.

The Vaccine Equity Toolkit includes guidance and resources to support equitable delivery. The toolkit can be accessed via the NHS Wales intranet.

The Primary Care (Contracted Services: Immunisations) (Influenza) Directions (the PCCS:I) sets out the legal requirements on Health Boards for the 2026 to 2027 flu 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 flu vaccination services. In respect of community pharmacies, the specification relates to the provision of IIV, not LAIV, to eligible persons aged 17 years and over only. The IIV may only be administered by community pharmacies to 17-year-olds if they are contraindicated for, or otherwise decline, LAIV.

There are additional expectations important to local planning and contracting arrangements for delivery of the flu vaccination programme:
GP Practices are expected to issue an invite to 100% of eligible patients.  Practices must share clinic plans with Health Boards and provide assurance that all eligible patients are offered vaccination including, for example, through demonstrating their approach to engaging with eligible patients. 

• GP Practices are expected to adopt a proactive approach to offering flu vaccinations by using robust call, recall and reminder systems to contact all eligible patients.  This may include direct contact by phone call, email, personalised letter, text or otherwise (determined at a practice level). Practices should follow-up with a minimum of three reminders/recalls for all those patients 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 flu vaccination to any patient they identify as being eligible should the patient present in the pharmacy for any reason. Community pharmacies that supply medicines to care homes may wish to arrange with those homes to offer flu vaccination to staff on the premises.
• For individuals in a clinical risk group eligible for flu vaccination, collaborative working between GP practices and community pharmacies is encouraged. This is particularly important to maximise uptake in eligible groups and to protect more individuals.
• As part of their arrangements with primary care providers, Health Boards should complete any necessary planning and agree a date from which they will commence activity to assist in the delivery of the programme. The purpose of this activity should be to maximise uptake across all adult groups but particularly those in a clinical risk group. 
• Health Boards and primary care providers delivering the programme should maximise opportunities for co-administration of flu and COVID-19 vaccines in all settings. Where the flu and COVID-19 vaccines are delivered by the same provider they can be co-administered to patients who are eligible for both. 
• Vaccinators should also consider opportunities to review the vaccination record of eligible individuals presenting for flu vaccination and identify any opportunities to signpost to relevant providers to deliver outstanding vaccinations (including, for instance, shingles or pneumococcal).

Engaged providers must comply with their contractual obligations under the specifications and any locally agreed requirements. Health Boards should proactively monitor engaged provider compliance with their contractual obligations. Appropriate action should be taken in the event of non-compliance as set out in the PCCS:I and local agreements. 

A separate National Supplementary Service Specification will be issued before 31 August 2026, for use by GPs delivering aspects of the childhood seasonal flu vaccination programme, including the vaccination of children aged 2 and 3 years. 

Digitally Recording Vaccinations 

All flu vaccinations administered (including to health and social care and NHS Trust staff), in all settings under the national programme, must be digitally recorded in WIS. Where possible this should be during or immediately after vaccination but by no later than the end of the day, on the day which a vaccination is administered.   

All flu vaccinations recorded in WIS will be automatically written back to update GP systems by the next working day following recording. Providers must ensure consistent recording of vaccinations in WIS, including clinical risk group (priority group) coding, to ensure accurate data capture and compliance with relevant information governance legislation.

Health Boards should ensure that any planning, including any staff training and additional resource or equipment needed to enable this, is in place prior to the September start of the programme. Digital Health and Care Wales and Health Boards will offer voluntary training on using WIS in school settings, for those providers that require it, prior to the start of the programme and at a date and time to be confirmed.

A template Patient Group Direction (PGD), for IIV use with eligible children aged 6 months to less than 2 years of age, will be available before the start of the flu season. The PGD should be reviewed, ratified and authorised locally by the Health Board and Trust for local use.

A ratified Vaccine Group Direction (VGD), for LAIV and IIV use with eligible children and adults aged 2 years and older, will also be available prior to the flu season starting. This must be authorised by the Health Board and Trust for local use. 

Please see the relevant pages of the Welsh Medicines Advice Service website for more information on PGDs and VGDs.

Training slides and eLearning resources to support the flu programme will be updated prior to the commencement of the season and will be available at: 

     Immunisation training resources and events - Public Health Wales

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

Brechlyn Ffliw - Iechyd Cyhoeddus Cymru

Flu Vaccination - Public Health Wales

Public Health Wales leads the surveillance and monitoring of influenza and the influenza immunisation programme in Wales. When data on the programme becomes available, weekly surveillance reports will be published to support delivery of the programme. These will include reports on coverage at practice, 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 any additional data needed to allow monitoring of coverage. 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.

To ensure accurate and timely reporting of performance across cohorts in the 2026 to 2027 season, Health Boards must ensure they have an accurate denominator for all children’s cohorts against which to measure performance ahead of the start of the programme. This includes ensuring that necessary coding in CYPrIS reflecting school age cohorts is up-to-date and accurate. 

Health Boards must also ensure they have an accurate denominator for all NHS staff cohorts. Guidance to support this process will be provided to Health Boards in due course. 

Detailed surveillance reports from national to GP practice level are published for NHS stakeholders on:

• Surveillance (sharepoint.com)

Weekly surveillance summaries at national and Health Board level will be available for public access on:

• Weekly influenza and acute respiratory infection report

The 2025-2026 annual epidemiological summary of influenza activity and influenza immunisation uptake will be published shortly by Public Health Wales: 

• Annual influenza surveillance and influenza vaccination uptake reports - Public Health Wales

A weekly surveillance summary of influenza and other acute respiratory infection activity is published throughout the year.

The Green Book chapter “Immunisation against infectious disease” provides guidance to healthcare practitioners on all aspects of immunisation. It is regularly updated and the specific influenza chapter. 

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

Yours sincerely,

Dr Keith Reid

Deputy Chief Medical Officer (Public Health)