Pharmacy contractors should order flu vaccines from more than one manufacturer to ensure they have sufficient stock, the government has said.

This comes in the 2025/26 flu vaccination letter, published yesterday (13 February) by the Department of Health and Social Care, the UK Health Security Agency and NHS England (NHSE).

Community pharmacy team members will not be eligible for NHSE-funded flu vaccinations, unless they meet other eligibility criteria, but rather should be vaccinated through employer schemes as in previous years. 

It also confirmed that pharmacies will be able to begin vaccinating pregnant women against influenza from 1 September 2025.

And vaccination for other cohorts will begin from October 2025, with the exact starting date to be confirmed by NHS England 'in due course'.

This is based on Joint Committee on Vaccination and Immunisation (JCVI) advice, which also recommended the move from a quadrivalent to a trivalent formula, because one of the antigens in the vaccine 'is no longer warranted'.

But when ordering flu vaccines, pharmacy owners should order the JCVI advised first line vaccines irrespective of whether they are currently described as quadrivalent (Q) or trivalent (T) formulations in the below table set out in the letter:

For patients aged 18 to 64 years in clinical risk group (including pregnant women)

Offer in the following order of preference:

First line
• recombinant (TIVr/QIVr)
• or cell-culture (TIVc)
• or adjuvanted (aTIV) (in those from 50 years of age)
• or high dose (TIV-HD/QIV-HD) (in those from 60 years of age)

Second line
• egg-culture (TIVe/QIVe) only reimbursed as set out in the letter

For patients aged 65 years and over

Offer in the following order of preference:

First line
• recombinant (TIVr/QIVr)
• or adjuvanted (aTIV)
• or high dose (TIV-HD/QIV-HD)

Second line
• cell-culture (TIVc) only reimbursed as set out in the letter

 

Community Pharmacy England (CPE) noted the change to adult flu vaccines, in that the adjuvanted trivalent influenza vaccine (aTIV) is now licensed from age 50 years and over.

Clinics should be planned using the recommended first line vaccine, and providers will only be paid for NHS vaccinations given as above, the flu letter said. 

'Where a provider does not have a first line vaccine in stock, patients should be directed to an alternative provider who has stock of a first line vaccine or told to rebook when the new stock is available,' the letter added.

'Vaccination with a second line vaccine should only be considered on an exceptional basis where there is a valid reason why the patient may not return for a further appointment.

'Practices and community pharmacy should aim to minimise the need for this by procuring adequate stock before the campaign starts.'

And it said that 'due to manufacturing processes and commissioning arrangements, some vaccines may only be available in limited quantities, or batches of vaccine may be subject to delay'.

'Therefore, it is recommended that orders are placed with more than one manufacturer to ensure providers receive sufficient stock,' the government said.

David Onuoha, CPE service development manager, welcomed the earlier publication of the letter this year.

And he encouraged pharmacy owners to 'consider the reinforced advice regarding the timing of the service, the restriction on the use of second line vaccines and the advice to place orders with more than one manufacturer to ensure receipt of sufficient stock'.

This year, community pharmacy contractors told The Pharmacist that they were seeing increased demand for flu vaccinations later in the season, with some ordering 'top-up' stock throughout the winter in order to meet demand.