Flu vac: use of second line vaccine

Pharmacy owners have reported strong patient demand for flu vaccination in the first month of the full seasonal vaccination programme and we have also been asked questions about use of second-line vaccine, such as IIVe (egg-cultured inactivated influenza vaccine).

The recommended flu vaccines are set out in the Annual Flu Letter and the UKHSA’s Flu vaccines for the 2026 to 2027 season poster provides a useful summary of them.

The Seasonal Vaccination Services Specification includes requirements on use of second-line flu vaccines in paragraph 6.13:

Where the pharmacy contractor does not have a recommended vaccine in stock, patients should be directed to an alternative provider who has stock of a recommended vaccine or told to rebook when the stock is available.

Reports from some pharmacy owners have indicated stock levels of IIVc (cell-cultured inactivated influenza vaccine) are under particular pressure, with some reporting they have used all of their stock. Based on reports on the availability of the other first-line vaccine this season, IIVc will have been the main first-line vaccine used in the 18-49 years cohort of patients.

Where a pharmacy is out of stock of first-line vaccines for this or other cohorts, the service specification requirement is that patients are directed to another pharmacy or their general practice, if stock of first-line vaccine is available at those alternative locations.

This will require local communication between pharmacies and general practices to identify whether first-line stock is available. Your LPC may be able to support that local communication.

The aim is that wherever possible, all patients are offered a first-line vaccine.

If no local pharmacies or general practices have stock of the first-line vaccine available, the service specification then states:

Administration of alternative vaccines must only be considered where the recommended vaccine is not available to order from any manufacturer or the pharmacy’s regular wholesaler, or on an exceptional basis where there is a valid reason why the patient may not return for a further appointment.

We have been informed that no IIVc stock is now available to order from the manufacturer or wholesalers.

Where no first-line stock is available locally, pharmacy owners can then offer patients administration of a second-line vaccine. In the case of the 18 to 49 years patient cohort, that would be IIVe.

If pharmacy owners are considering use of a second-line flu vaccine, they should keep a record of actions taken to ascertain the local availability of first-line vaccine prior to offering patients second-line vaccines.

Read more about the Seasonal Vaccination Services on our service webpage