LCQ19: Seasonal influenza vaccination
Following is a question by the Hon Nixie Lam and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (November 15):
Question:
The winter influenza peak season this year is the first influenza peak season after the lifting of the mask mandate, and it is learnt that quite a number of members of the public have made early arrangements to receive seasonal influenza vaccines (SIVs). Some private doctors participating in the Vaccination Subsidy Scheme (VSS) of the Department of Health have indicated that there is already a shortage of SIVs. In this connection, will the Government inform this Council:
(1) of the respective current numbers of residential care homes for the elderly, residential care homes for persons with disabilities, primary schools, as well as kindergartens and child care centres which have participated in the seasonal influenza vaccination programmes of the current year, and the respective numbers of persons who have received vaccination to date;
(2) of the amount of the Government's expenditure on the procurement of SIVs, and the total amount of subsidies for seasonal influenza vaccination it provided to private doctors participating in VSS, in each of the past three years;
(3) of the measures put in place to ensure that there are sufficient SIVs to meet the demand of members of the public; and
(4) whether it has projected the overall virus activity in the winter influenza peak season of the current year, and of the respective levels which seasonal influenza vaccination uptake rates among the elderly and children need to reach before they will suffice to build an immunity barrier; if so, of the details; if not, the reasons for that?
Reply:
President,
As announced in early November, the summer influenza season in Hong Kong which started in late August this year ended. However, a high chance for seasonal influenza surge in the coming months and possible co-circulation of COVID-19 and influenza is expected against the backdrop of Hong Kong's first winter after the lifting of mandatory mask-wearing requirement. During the summer influenza season this year, the Centre for Health Protection (CHP) recorded a total of 308 adult cases of intensive care unit (ICU) admission or death with laboratory confirmation of influenza, in which 203 of them were fatal. About 60 per cent of severe cases did not receive influenza vaccine. For children, a total of 15 severe cases, including one fatal case, were recorded. Among these 15 children, 11 did not receive influenza vaccine.
Seasonal Influenza vaccination (SIV) is one of the most effective means to prevent seasonal influenza and its complications. It also reduces influenza-related hospitalisation and death. Given that influenza vaccines are safe and effective, all persons aged six months or above, except those with known contraindications, are recommended to receive influenza vaccination for personal protection against influenza and its complication, and to reduce the risks of related hospitalisation and death. To boost our citizens' immunity, the Department of Health (DH) has been administering various vaccination programmes/schemes to provide free or subsidised SIV to eligible persons. Channels for vaccinations include public and private clinics, residential care homes and school outreach vaccination service.
The reply, in consultation with the DH, to the questions raised by the Hon Nixie Lam is as follows:
(1) The Seasonal Influenza Vaccination Subsidy Scheme (VSS) 2023/24 was launched on September 28, 2023 whereas the Government Vaccination Programme (GVP), the Seasonal Influenza Vaccination School Outreach (Free of Charge) Programme (SIVSOP) and the Residential Care Home Vaccination Programme (RVP) commenced on October 5.
As at November 5, a total of 816 Residential Care Homes for the Elderly (RCHE) and 326 Residential Care Homes for Persons with Disabilities (RCHD) have participated in the RVP, with a total of about 9 500 residents received influenza vaccines (representing a 24 per cent increase when compared with the same period of last year), including about 8 000 RCHE residents and about 1 500 RCHD residents.
Besides, a total of about 340 secondary schools, 570 primary schools and 870 kindergartens, kindergarten-cum-child care centres and child care centres participated in the SIVSOP or the VSS School Outreach (Extra Charge Allowed) this year. As at November 5, about 249 100 children aged 6 months to under 18 years old have received influenza vaccines under various vaccination programmes (representing a 41.6 per cent increase when compared with the same period of last year).
Since the launch of various influenza vaccination programmes, about 1 054 400 doses of vaccine have been administered as at November 5 (representing a 25.7 per cent increase when compared with same period of last year). The number of persons in target groups vaccinated under the GVP, VSS and SIVSOP in the past three years are as follows:
| Target group | Number of vaccine recipients (Percentage of the persons in the target group)　(Note 1) |
||
| 2021/22 | 2022/23 | 2023/24 (As at November 5, 2023) |
|
| Children of age 6 months to under 6 years | 107 400 (37.6%) | 92 700 (37.7%) | 74 400 (31.7%) |
| Children of age 6 to under 12 years | 234 500 (65.8%) | 209 700 (60.2%) | 129 500 (37.4%) |
| Children of age 12 to under 18 years (Note 2) | N/A | 62 600 (19.3%) | 45 200 (13.0%) |
| Persons of age 50 to 64 years | 198 700 (11.2%) | 320 200 (17.8%) | 219 200 (12.0%) |
| Persons of age 65 years or above | 578 700 (40.4%) |
734 200 (48.3%) | 510 300 (31.2%) |
| Others (Note 3) | 97 300 | 112 600 | 74 600 |
| Total number of vaccine recipients (Note 4) | 1 216 600 | 1 532 000 | 1 053 200 |
Note 1: Only where accurate population statistics are available for the group.
Note 2: In 2022/23, eligible groups of SIV programmes were expanded to include Hong Kong residents less than 18 years or secondary school students.
Note 3: Eligible pregnant women, persons with chronic medical problems, healthcare workers, poultry workers, pig farmers or pig-slaughtering industry personnel.
Note 4: As children under 9 year old who have never received SIV should receive two doses, the total number of vaccine recipients would be slightly lower than the total number of doses vaccinated.
(2) The total number of doses and contract amount of influenza vaccines procured for the GVP, SIVSOP and RVP in the past three years are as follows:
| Year | Number of doses | Procurement amount ($ million) |
| 2021/22 (Actual) |
880 900 | 79.3 |
| 2022/23 (Actual) |
1 268 000 | 79.5 |
| 2023/24 (Estimate) | 929 000 | 47.9 |
Note: The Government procures the vaccines by means of open tender. Owing to the COVID-19 epidemic, the price per dose of SIV increased substantially in 2021/22 and the price level decreased gradually in the subsequent years of 2022/23 and 2023/24.
The total amount of subsidies provided to private doctors participating in the VSS in the past three years are as follows:
| Year | Number of doses | Subsidy amount ($ million) |
| 2021/22 (Actual) |
483 800 | 116.1 |
| 2022/23 (Actual) |
674 500 | 175.4 |
| 2023/24 (As at November 5, 2023) |
558 400 | 145.2 |
Note: The subsidy was $240 per dose in 2021/22 and $260 per dose for 2022/23 and 2023/24.
(3) The Government has all along been encouraging the public to receive vaccination early. Eligible persons, especially the elderly and children, should receive free or subsidised SIV early in public healthcare system or by private doctors and clinics under the VSS through various government programmes.
The DH will endeavour to ensure a stable supply of influenza vaccines for various vaccination programmes. The DH has procured a total of about 929 000 doses of influenza vaccines for the 2023/24 vaccination programmes, comprising about 592 000 doses of inactivated influenza vaccine under the GVP; about 316 000 doses of inactivated influenza vaccine and about 21 000 doses of nasal spray live attenuated influenza vaccine under the SIVSOP for eligible high-risk groups to receive vaccination free-of-charge in phases. The Government makes an estimate based on the number of persons covered by the eligible groups in that year with reference to the past vaccination rates before ordering the influenza vaccines every year. The Government has included flexible clauses in the tender documents for the procurement of influenza vaccines to ensure that the order amount can be appropriately adjusted in response to demand. Relevant vaccine suppliers have also undertaken to ensure a steady supply of vaccines procured by the Government. Eligible groups may continue to receive free or subsidised vaccination through various Government programmes.
Besides, it is the usual arrangement for participating doctors to purchase influenza vaccines themselves under the VSS and VSS School Outreach (Extra Charge Allowed). Private doctors will order influenza vaccines from vaccine suppliers for the upcoming season from April to June every year. Vaccine suppliers are now supplying influenza vaccines in phases to private doctors who have placed pre-orders. In view of recent demand for influenza vaccines by members of the public, the vaccine suppliers have arranged the allocation of additional doses for private doctors who have not ordered influenza vaccines in advance or the order quantity is insufficient. Those influenza vaccines have been gradually supplied to Hong Kong starting from early November. According to past experience and depending on the situation, while ensuring the sufficient supply for the Government's vaccination programmes, the Government would co-ordinate vaccine suppliers to reallocate some of the vaccines reserved for the Government to the private market.
(4) The CHP has been conducting systematic surveillance of the local influenza situation and regularly publishes data on relevant surveillance indicators and the latest assessment of local influenza activity in the weekly publication "COVID-19 & Flu Express". Since the lifting of the mandatory mask-wearing requirement, there have been two influenza surge in Hong Kong, from April to May and from August to October this year respectively. Based on historical data, seasonal influenza surge usually arrives in winter (around late this year to early next year).
In 2022/23, a total of 1.56 million doses of vaccines were given under all SIV programmes. This represented an increase by 25 per cent as compared with 2021/22. This was attributable to concerted efforts of citizens, the DH, the Hospital Authority and private doctors engaged through the private-public partnership programme. The vaccination rate among residents of RCHEs stood at 78 per cent through efforts of visiting medical officers, while that of community elders increased by 8 per cent to 48 per cent. The vaccination rate among school students below 12 however dropped slightly by 3 per cent to 50 per cent.
While there is no specific vaccination rate of SIV as recommended by the experts in the relevant Scientific Committee, a higher vaccination rate among high risk group can offer better protection against severe cases of influenza. As aforementioned, the vaccination rate of various influenza vaccination programmes increased as compared to the same period of previous year, the Government would continue to promote influenza vaccination. Receiving influenza vaccine early could safeguard the health of individuals and their families. The Government recommends all persons aged six months or above except those with known contraindications to receive influenza vaccine. Moreover, getting infected with influenza and COVID-19 at the same time will be more likely to result in serious condition or even death. Citizens may consult healthcare personnel when receiving influenza vaccine and arrange for COVID-19 vaccination in due course for better self-protection.