- Lindsay Broadbent, assistant professor in virology
Every year, as the weather turns colder, we can’t go far without hearing someone cough or sniffle. The “cold and flu” season is nothing new, but we need to do more to tackle winter illness.
The end of 2024 saw a “quademic,” with high incidence of influenza, respiratory syncytial virus (RSV), covid-19, and the winter vomiting bug (norovirus) all putting pressure on the NHS. The number of hospital admissions with influenza rose from 1190 to 5074—more than 300%—from the end of November to the end of December.1 This was triple the number of admissions recorded at the same point last year.
As hospitals throughout the UK declare critical incidents, we shouldn’t be surprised by the demand on healthcare services during winter. High rates of hospital admissions with flu aren’t unprecedented: we saw a similar peak in the 2022-23 winter season.2
But we should be doing more to tackle the winter viruses that in our ageing population can range from inconvenient to life threatening. Ramping up, or even rethinking, our approach to winter bugs could massively ease pressure on our health services and reduce the number of days missed at work or school.
Influenza is not a new respiratory virus. It was first isolated from patients with flu-like symptoms in 1933, but it had been causing illness for centuries.3 Decades of research have provided information on the virus’s molecular biology, epidemiology, and clinical presentation.456789 We have vaccines that are effective at reducing the risk of severe disease, as well as seasonal public health campaigns that encourage people to get vaccinated and to practise good respiratory health.10111213 This means that influenza, among the common seasonal viruses, is an appropriate target to tackle in a bid to reduce winter illness.
People over 65 are one of the highest risk groups for flu and make up the majority of patients admitted to hospital with severe disease. In 2024 the flu vaccine rollout was delayed in this group until October, to help avoid waning immunity before the peak of infections, owing to early vaccination. However, this resulted in slightly lower vaccine coverage of 70% in this group by mid-December, down from 73% in 2023.14
Availability
The flu vaccine is designed to target the most likely circulating strains each winter season, meaning that its effectiveness can vary depending on how well it matches the predominant strains. Studies suggest that flu vaccinations can reduce hospital admissions by 30-50% in vaccinated people.1516 If we were to achieve a population vaccination rate of 90% the reduction in hospital admissions could be substantial.
Letters and text messages prompting eligible people to attend a vaccine clinic is a good start, but vaccinations need to be made more easily and widely available. Currently in the UK, free flu vaccines are available to over 65s, pregnant women, people with certain health conditions, healthcare workers, and schoolchildren. This programme should be expanded to offer free flu vaccinations to the entire population, and barriers to vaccination must be tackled by improving trust and reducing the associated direct and indirect costs. This could help to achieve higher levels of vaccine coverage and reduce the incidence of flu and associated healthcare expenses.17
A population-wide flu vaccine programme would come at a cost. But this would be financially viable because it would help to reduce the healthcare costs related to treating flu, and seasonal flu infections are associated with a loss of £644m to the UK’s economy from time off work with illness.18 Fewer flu cases would result in fewer sick days, improving workplace productivity and school attendance. Modelling has indicated that increasing the vaccination rate of the working population by 10% could increase the UK’s economic output by over £250m a year.18
Widening the vaccination programme to include everyone is something that can’t happen in isolation. Trust in scientific advice and vaccination has suffered in recent years, and we continue to see the effects of disinformation. Vaccines have become a pawn in a game of political chess, and the greatest loser is the public’s health. We need to re-examine how we communicate science to the public, how we counter disinformation, and how we encourage people to act in the best interests of their own health and that of their communities.
Vaccine hesitancy is often underpinned by fear and a lack of access to accurate information. There’s an important debate to be had on how to counter online misinformation and disinformation. In the meantime, scientists and healthcare workers should approach people’s concerns with understanding and empathy. Improved messaging and greater trust in vaccines would have wider reaching benefits to other vaccination programmes, as well as general public health messaging around infectious disease control.
All of this would require a collaborative approach from policy makers, scientists, and the NHS. An extended vaccine rollout would need to be accompanied by a public health campaign, scientific communication and education, and willing politicians who understand the benefit to public health and the country’s finances.
Footnotes
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Competing interests: Lindsay Broadbent receives research funding from Merck Sharp & Dohme and has received honorariums from Sanofi for educational symposiums.
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Provenance: Commissioned; not externally peer reviewed.
