National flu immunisation programme 2025 to 2026 letter

Question 1

Eligibility

Accepted Answer

Eligible cohorts for flu vaccination are based on the advice of the Joint Committee on Vaccination and Immunisation (JCVI). The programme aims to provide direct protection to those who are at higher risk of flu associated morbidity and mortality and to reduce transmission to all age groups through the vaccination of children.

The following cohorts are announced and authorised to be eligible to receive a flu vaccination:

From 1 September 2025:

pregnant women
all children aged 2 or 3 years on 31 August 2025
primary school aged children (from Reception to Year 6)
secondary school aged children (from Year 7 to Year 11)
all children in clinical risk groups aged from 6 months to less than 18 years

From October 2025, exact start date to be confirmed by NHS England in due course:

those aged 65 years and over
those aged 18 years to under 65 years in clinical risk groups (as defined by the Green Book, Influenza chapter 19 )
those in long-stay residential care homes
carers in receipt of carer’s allowance, or those who are the main carer of an elderly or disabled person
close contacts of immunocompromised individuals
frontline workers in a social care setting without an employer led occupational health scheme including those working for a registered residential care or nursing home, registered domiciliary care providers, voluntary managed hospice providers and those that are employed by those who receive direct payments (personal budgets) or Personal Health budgets, such as Personal Assistants

All frontline health care workers, including both clinical and non-clinical staff who have contact with patients, should be offered flu vaccine from the start of October (exact date to be confirmed) as a vital part of the organisation’s policy for the prevention of the transmission of flu. Employers should make the vaccine accessible for all frontline staff, encourage staff to get vaccinated, and monitor the delivery of their programmes. Further communications from NHS England will describe operational considerations.

Social care workers directly working with people clinically vulnerable to flu should also have the flu vaccine provided by their employer. There are circumstances where frontline staff, employed by specific social care providers without access to employer led occupational health schemes (see cohort eligibility above), can access the vaccine through the NHS free of charge.

Providers are expected to deliver a 100% offer to eligible groups. They should ensure they make firm plans to equal or improve uptake rates in 2025 to 2026, particularly in those cohorts where uptake has been lower (health and social care workers, clinical risk groups, children aged 2 and 3 years old, and pregnant women). Providers should also ensure they have robust plans in place to identify and address health inequalities for all underserved groups, and it is expected progress will be made on reducing unwarranted variation and improving uptake.

Question 2

Timing

Accepted Answer

The start of the adult programme for 2025 to 2026 will again be from the beginning of October (exact date to be confirmed) with the majority of the vaccinations to be completed by the end of November. This later start date is based on the advice from JCVI concerning the waning of flu vaccine’s effectiveness in adults which means that it is preferable to vaccinate individuals closer to the time when the flu virus is likely to circulate (which typically peaks in December or January), as this will provide optimal protection during the highest risk period.

There are some exceptions to this later start date. Vaccination of pregnant women should continue to be offered from 1 September. One of the benefits of the flu vaccine is the protection it offers to the child in the first few months of life, when they are particularly vulnerable to flu. It is important to ensure that as many newborn babies are protected during the flu season by not delaying vaccination for pregnant women. Therefore, no change in the timing of the offer for the maternal programme was advised by JCVI. They are not expected to lose protection as rapidly as the elderly population; starting vaccination earlier (particularly in those women who are in the later stages of pregnancy), will still offer protection to women themselves in the peak season.

As flu circulation in children normally precedes that in adults, the children’s programme should continue to start from 1 September or as soon as delivery and supply of vaccine allows. Protection from the vaccine also lasts much longer in children so the priority is to start vaccinating all children (including those in clinical risk groups), both to provide early protection to children and to reduce transmission to the wider population. Therefore, getting the childhood flu vaccination programme to start in early September with rapid uptake could push down rates of flu in older adults through indirect protection. As the public health benefit of vaccination is greater in younger children, where possible, school-aged immunisation providers are encouraged to schedule vaccination of primary school children early in the season. For school-aged cohorts, vaccination in schools should be completed by the second Friday in December (12 December 2025), with further catch-up opportunities provided via community clinics or additional school visits as appropriate.

Following clinical assessment there may be a small number of other adults who would benefit from vaccination from 1 September. For example, for those who are due to commence immunosuppressive treatment (such as chemotherapy), having a flu vaccine before they start treatment would allow them to make a better response to their vaccination. GPs should use clinical judgement to bring forward vaccination only in these exceptional circumstances otherwise payment will not be made for adults vaccinated before October, in line with contractual arrangements.

Question 3

Recommended vaccines

Accepted Answer

Every year JCVI reviews the latest evidence on flu vaccines and advises the type of vaccine to be offered to different age groups. Their advice for 2025 to 2026 noted that the World Health Organization (WHO) has concluded that B/Yamagata lineages are no longer circulating and are unlikely to cause future epidemics, and that inclusion of a B/Yamagata antigen as a component of flu vaccines is no longer warranted. WHO has stated that every effort should be made to exclude this as soon as possible, across all vaccine types.

At the time of publication, all flu vaccine manufacturers have either already received, or applied for, the Medicines and Healthcare products Regulatory Agency (MHRA) approval to produce a trivalent formulation for the 2025 to 2026 season. When ordering vaccine providers should order the JCVI advised first line vaccines irrespective of whether they are currently described as quadrivalent (Q) or trivalent (T) formulations in table 1 below.

Adult vaccines eligible for reimbursement

There has been one change to the advice for adult flu vaccines for 2025 to 2026 recommended by JCVI as the adjuvanted influenza vaccine (aTIV) is now licensed from age 50 years and over.

For those aged 18 years to less than 65 years

JCVI advises that the first line vaccines should be either the cell-culture influenza vaccine (TIVc) or the recombinant influenza vaccine (TIVr/QIVr). In addition, first line vaccines include the adjuvanted influenza vaccine (aTIV) for those aged 50 years and over, and the high-dose influenza vaccine (TIV-HD/QIV-HD) for those aged 60 years and over, in line with their licenses.

The egg-culture influenza vaccine (TIVe/QIVe) should only be offered in circumstances where the preferred first line influenza vaccines are not available to order.

For those aged 65 years and over

First line vaccines for this age group include the adjuvanted influenza vaccine (aTIV), the high-dose influenza vaccine (TIV-HD/QIV-HD) and the recombinant influenza vaccine (TIVr/QIVr).

There is strengthening evidence of additional benefit of the recombinant influenza vaccine (TIVr/QIVr) relative to other products. Therefore, JCVI would also like to see more use of the recombinant influenza vaccine (TIVr/QIVr) in the programme to improve estimates of vaccine effectiveness and have data over multiple seasons on the performance of this vaccine, especially in older adults.

Cell-culture influenza vaccine (TIVc) should only be offered in circumstances where the preferred first line influenza vaccines are not available.

Table 1: Recommended adult influenza vaccines that will be reimbursed

Vaccines that are currently listed here as quadrivalent (Q) formulations are likely to be supplied as trivalent (T) ones (and therefore both formulations are listed in the tables).

Aged 18 to 64 years in clinical risk group (including pregnant women)	Aged 65 years and over
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 section on ordering below	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 section on ordering below

aTIV: adjuvanted trivalent influenza vaccine
TIVc: cell-culture trivalent influenza vaccine
TIVe: egg-culture trivalent influenza vaccine
QIVe: egg-culture quadrivalent influenza vaccine
TIV-HD: high-dose trivalent influenza vaccine
QIV-HD: high-dose quadrivalent influenza vaccine
TIVr: recombinant trivalent influenza vaccine
QIVr: recombinant quadrivalent influenza vaccine

The GP and Community Pharmacy service specifications will be updated and published in due course following engagement with relevant representative bodies.

Contractual requirements for all commissioned NHS flu vaccination providers will state that to receive payment for flu vaccination and reimbursement of flu vaccine they will need to use the specific flu vaccines outlined above for the appropriate cohort and administer vaccines in line with the announced and authorised cohorts. Please note that commissioners will actively recover any payments made for the incorrect vaccine administered.

Ahead of the flu season first line vaccines should always be ordered for a given cohort. Once the vaccination campaign has started, if providers need additional stock, second line vaccines should only be ordered if first line options are not available to order. Clinics should be planned using the recommended first line vaccine. 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. 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.

With the exception of frontline workers in certain social care settings (see cohort eligibility above), the vaccination of all other frontline health care staff (for example, those working in NHS Trusts, Primary Care organisations, and private sector health care organisations) will not qualify for payment or reimbursement.

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. A list of all influenza vaccines marketed in the UK is available on GOV.UK. Providers should remain flexible when scheduling vaccination sessions and be prepared to reschedule if necessary.

Children’s vaccines

No changes were recommended by JCVI for children’s flu vaccines for 2025 to 2026.

For those in clinical risk groups aged 6 months to less than 2 years

The first line vaccine is the cell-culture influenza vaccine (TIVc). Where this is not available, egg-culture influenza vaccine (TIVe/QIVe) can be offered as a second line choice.

For those aged 2 years and above in eligible and clinical risk groups

The first line choice is the live attenuated influenza vaccine (LAIV). TIVc is recommended where LAIV is contraindicated or otherwise unsuitable (for example, parents object to LAIV on the grounds of its porcine gelatine content). Where TIVc is not available, TIVe/QIVe can be offered but this is the least preferred option.

Table 2: Recommended flu vaccines for children

Children aged 6 months to less than 2 years in clinical risk groups	Children aged 2 to less than 18 years in eligible groups (including clinical risk groups)
Offer in the following order of preference: First line • TIVc Second line • TIVe/QIVe	Offer in the following order of preference: First line • LAIV Second line • TIVc is recommended where LAIV is contraindicated or otherwise unsuitable (for example, parents object to LAIV on the grounds of its porcine gelatine content) Third line • TIVe/QIVe

TIVc: cell-culture trivalent influenza vaccine
TIVe : egg-culture trivalent influenza vaccine
QIVe: egg-culture quadrivalent influenza vaccine
LAIV: live attenuated influenza vaccine

The UK Health Security Agency (UKHSA) supplies all flu vaccines for the children’s programme and these will be available to order through ImmForm and are not reimbursable. As in previous seasons, ordering controls will be in place in 2025 to 2026 to enable UKHSA to balance vaccine availability and demand appropriately across the programme. The latest information on ordering controls and other ordering advice for UKHSA supplied flu vaccines will be featured on the ImmForm news page, both prior to and during the flu vaccination period. Information will also be featured in Vaccine Update and disseminated via the National Immunisation Network as appropriate. It is strongly advised that all parties involved in the provision of flu vaccines to children ensure they remain up to date with this information at all times.

Question 4

Co-administration

Accepted Answer

Further guidance will follow on how the flu programme should be aligned to any autumn COVID-19 vaccination programme. Providers are encouraged to offer flu vaccination with other commissioned vaccination programmes for which the patient may be eligible (for instance shingles or pneumococcal vaccines, and for pregnant women pertussis and RSV) where it is clinically acceptable, operationally feasible, and where the patient is content. Where co-administration may not be feasible providers must make every effort to encourage individuals to take up the offer of every vaccine they are eligible for.

The RSV vaccine should not routinely be scheduled to be given to an older adult at the same appointment as a flu vaccine as some data indicates that this may reduce the immune response to the flu and RSV vaccines. No specific interval is required between administering the vaccines. If it is thought that the individual is unlikely to return for a second appointment or immediate protection is necessary, then the RSV can be administered at the same time as flu.

Question 5

Data collection

Accepted Answer

UKHSA is responsible for monitoring vaccine coverage and for publishing vaccine uptake for frontline healthcare workers (HCWs), school aged children and eligible GP registered patients. These national Official Statistics collections are managed through the ImmForm website, reported to the World Health Organization and used in public notices. Providers should ensure they complete these data returns through ImmForm during the appropriate time windows throughout the season.

During the 2025 to 2026 flu immunisation programme monthly data collections for frontline HCWs and eligible GP registered patients will take place over 5 months (November to March publications), and for school aged children over 4 months (November to February publications).

The NHS England automated data collection to monitor uptake and inform payment of flu vaccinations to frontline eligible HCWs who don’t have access to occupational health offer will continue in 2025 to 2026, as commissioned under the NHS Standard Contract.

NHS Trusts delivering vaccinations must use an NHS-endorsed Point of Care (PoC) system for vaccination event data capture. This will feed back to relevant systems, such as the service user’s GP record, and national and local reporting tools. Primary care providers must use their relevant systems for vaccination event data capture.

Question 6

Further information

Accepted Answer

The influenza chapter in ‘Immunisation against infectious disease’ (the ‘Green Book’), gives detailed descriptions of the clinical risk groups and guidance for health professionals on administering the influenza vaccine.

See Annexe A for links to resources that will become available to support the 2025 to 2026 programme.

Question 7

Conclusion

Accepted Answer

Thank you all for your hard work in delivering the programme. The annual flu programme saves thousands of lives every year, and reduces GP consultations, hospital admissions and pressure on A&E.