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SHANGHAI – For years, Yu has been one of the few Chinese to get a flu shot when the weather turns colder. It has always been a routine procedure. But this year, fears about how the upcoming flu season will exacerbate the current COVID-19 pandemic appear to have dramatically increased the demand for vaccines.
With this in mind, Yu left home early Tuesday to visit his local clinic. From a distance, the 65-year-old could see a line snaking through the front door of the clinic.
When Yu called ahead, they told him that only the first 100 people to show up would get appointments for a flu shot. Grabbing his bag, he hurried to join the line, accepting a small slip of paper from a clinic employee. In black and handwritten ink was the number “97”.
“I was so relieved when I saw the note,” he tells Sixth Tone Yu, who only gave his last name because he wanted to keep his medical information private.
Public health experts around the world are also concerned about a “doubledemic,” a situation in which the coronavirus and influenza virus are circulating among the population. Simultaneous outbreaks could push already overwhelmed healthcare systems to the limit.
Although it is much less lethal than COVID-19, the flu can spread widely, causing symptoms that require hospitalization and even death in a small proportion of cases. In China, flu and its complications are estimated to kill more than 88,000 people each year. National infection figures are not available, but a study of Beijing residents showed that 10% of them contracted the flu in the 2017-18 season.
A woman wearing a face mask takes photos on the deck of a tourist boat on the Huangpu River in Shanghai on September 1, 2020. Kevin Frayer / People Visual
The COVID-19 outbreak in China is currently well controlled, but without a safe and effective vaccine, healthcare professionals anticipate a resurgence of the coronavirus in the coming months. Respiratory viruses such as those that cause COVID-19 and influenza are more easily transmitted in winter and spring due to a variety of natural and human factors.
“Cluster infections (COVID-19) from imported sources like the ones we saw in Beijing and Jilin are inevitable,” says Lu Hongzhou, a lead virologist at the Shanghai Public Health Clinical Center, referring to two places that experienced outbreaks months later. that the disease was brought under control in China. He tells Sixth Tone that, in the future, he does not expect another situation as serious as in Wuhan, the city in central China that was closed for 76 days to contain the disease.
Fundamentally, both viral infections produce very similar symptoms: fever, sore throat, headache, and fatigue. Thus, a flu outbreak would make it extremely difficult to control and prevent COVID-19, Zhang Xiaoqin, a respiratory disease expert at Zhejiang Provincial People’s Hospital in eastern China, told Sixth Tone. Studies have also suggested that co-infections, relatively rare so far, make diagnosis difficult and increase the likelihood of severe symptoms and death.
“It is not yet conclusive whether the flu makes COVID-19 worse,” says Zhang. “But if more people can get the flu vaccine, preventing the coronavirus would be much easier.”
National health authorities agree. The Chinese Center for Disease Control and Prevention (CDC) released this year’s flu vaccination guide on September 12, about a month earlier than last year. “The COVID-19 pandemic is expected to continue to circulate critically around the world,” says the guide. “The flu vaccine is the most effective way to prevent flu. (It can) reduce the damage caused by flu and related illnesses while freeing up medical resources. “
With the expectation of a pickup in demand, the central government has given the green light for more than 58 million shots to enter the market, more than double the number last year, to meet the potential increase. But this year’s interest is hard to predict, Feng Luzhao, a flu vaccine expert at the CDC China and co-author of its flu vaccination guide, tells Sixth Tone.
Demand can vary regionally, creating supply imbalances across the country. Xia Wen, a press officer for the Shanghai CDC, tells Sixth Tone that the city expects a shortage of flu vaccines.
At Yu’s clinic in Shanghai, the Ruijin 2nd Street Community Health Center, staff say they have limited the number of appointments because they have no idea when or how many vaccines will arrive. “The number of people who showed up this year is unprecedented,” an employee surnamed Chen told Sixth Tone. “I think it’s from COVID-19. People are afraid of getting sick. “
It has always been difficult to properly match the supply of flu vaccines with the public demand. Because the dominant influenza strain changes every year, pharmaceutical companies are afraid of producing too many vaccines, as they will likely be useless next year. Manufacturing vaccines, which generally involves growing viruses in large quantities from chicken eggs, also takes several months. As a result, it is almost impossible to compensate for the sudden shortage, says Feng.
A baby receives a routine vaccination in Handan, Hebei province, on April 25, 2020. Hao Qunying / People Visual
But Feng and other experts welcome the surge in demand for flu vaccines, noting that in previous years, very few people were vaccinated – just 2% to 3% of the population. At 4%, the expected vaccination rate for this year remains low, they say. By comparison, about 50% of the US population receives a flu vaccine each year.
China’s flu vaccination rates are low for a variety of reasons. People lack knowledge about the disease and its dangers, says Feng, and there are no statistics that show the true scale of the annual outbreaks. “Many deaths that are the result of influenza are not diagnosed as such, because it is not the direct cause of death,” he says.
Vaccines are also unpopular because many people in China will only seek treatment after falling ill, rather than taking preventive measures, says Zhang from the Zhejiang Provincial People’s Hospital. “Many patients don’t even know some of the basic information about flu shots, like when and where to get them.”
Another obstacle to higher vaccination rates is that vaccines are not covered by insurance provided by the Chinese government, which is the only health care coverage that most people have. China’s social security policies state that vaccination is the responsibility of the public health system and not the medical system, and therefore vaccines are outside the scope of insurance.
China offers a total of 11 free vaccines that are mandatory for children, including those against hepatitis B and MMR (measles, mumps, rubella). For all other vaccines, including those against HPV and influenza, people generally have to pay out of pocket. In Shanghai, a flu vaccine costs between 53 and 136 yuan (between 7 and 20 dollars).
Providing free flu vaccines would be prohibitively expensive for the government, says Meng Qingyue, a health economist at Peking University. “When you only have a limited amount of money, it makes sense to allocate the funds to prevent the most damaging diseases,” he tells Sixth Tone. “But the current vaccine policy of (offering) completely free or fully loaded vaccines is not optimal either.”
Furthermore, the separation of China’s public health and medical care systems means that many health care facilities, such as local clinics, belong to one or the other and as such cannot offer a full range of services. “The separation of the two systems makes vaccination much more difficult,” Fang Hai, an expert in vaccine policy at Peking University, tells Sixth Tone. Unlike countries where both systems are integrated, the Chinese may not be able to receive vaccines in their regular health care facility, discouraging them from receiving vaccines.
Fang hopes that the government will begin providing more financial support for flu vaccines. “It would become a positive feedback loop,” he says. The subsidized prices would give pharmaceutical companies the confidence to increase production, which in turn would lower costs and incentivize more people to get vaccinated.
The experience of the southern hemisphere, where the flu season is coming to an end, offers a silver lining. Precautions against COVID-19, such as the use of face masks and social distancing, have helped keep flu cases in southern places to record lows, offering a glimmer of hope for people on the opposite side of the planet. .
Publisher: Kevin Schoenmakers.
(Header image: a man flu vaccine is injected in Zouping, Shandong province, on September 23, 2020. Guo Haitao / People Visual)
