15 September 2014
The influenza uptake rate in Hong Kong is consistently low. Only 14% of the population were vaccinated last year, which fell short of the ideal herd immunity threshold and lagged behind other developed countries and areas. In August, the Government announced that quadrivalent influenza vaccines (QIVs) would be adopted in the Government Vaccination Programme in the upcoming season. Despite the aim of adopting QIVs is to enhance the protection coverage of the public, there is a lack of co-ordination by the Government with pharmaceutical companies for securing an adequate supply vaccines in both the public and private sectors. The vaccination subsidy is also obviously insufficient. The Hong Kong Medical Association (HKMA) urges the Government to fix all these flaws before the overall influenza vaccination uptake rate drops as a consequence.
The HKMA President Dr. SHIH Tai Cho, Louis, JP, appeals to the public today, "Although QIVs provide additional protection against Group B influenza virus, trivalent influenza vaccines (TIVs) are indeed good enough to protect against the major influenza viruses. If there is insufficient supply of QIVs, people should still consider taking TIVs without delay to get well prepared for the winter flu season."
Last year, 40% of the Americans were vaccinated for influenza vaccines. The vaccination uptake rate in South Korea was over 30%. In Taiwan, 40% of children and 80% of elderly aged over 65 took the flu vaccine and the number of deaths related to influenza decreased from 3,000 to 200. However, in Hong Kong, only 14% of the population were vaccinated.
Dr. CHAN Yee Shing, Alvin, the HKMA Vice-President cum Chairman of the HKMA Task Force on Vaccination Public-Private-Initiative stresses that with an aim to safeguard the health of the people, the HKMA advocates on public education and the provision of incentives by the Government to raise the uptake rate of flu vaccine. The risk of influenza epidemic outbreak can be greatly reduced by enhancing the overall immunity of the community. By investing on immunisation, public health expenditure can be significantly reduced (see appendix). Unfortunately, it is disappointed to learn about the recent announcement on the new season's "Government Vaccination Programme" and "Influenza Vaccination Subsidy Schemes".
Firstly, HKMA is an early advocate of QIVs by the Government. We hope that the Government can co-ordinate with pharmaceutical companies to ensure sufficient supply of QIVs in both public and private markets. However, it turns out that the Government only bulk-purchased QIVs for its "Government Vaccination Programme" and left the number of QIVs in the private market very minimal. There are private doctors complaining to the HKMA by quoting the pharmaceutical companies that vaccine supply is tense and there is shortage in the short run.
And although the Scientific Committee on Vaccine Preventable Diseases recommends various priority groups for influenza vaccination, the Government remains its policy in the new season by only offering free vaccinations to certain populations within the recommended high-risk groups. E.g. pregnant women and people aged 50 or above, only those receiving Comprehensive Social Security Assistance or holding valid Certificates for Waiver of Medical Charges can be offered free vaccinations.
Even though the Centre for Health Protection (CHP) of the Department of Health realised that the prime cost of QIV is doubled than that of TIV (please refer to the announcement of Dr. LEUNG Ting Hung, JP, Controller of CHP on 21 August 2014), the proposed subsidy amount does not reflect the increased prime cost ratio in reality. Previously the subsidy amount was HK$130 per dose (prime cost: $80; injection fee: $50). The new subsidy amount is HK$160 but such cost is barely enough only for vaccine purchasing, which means the Government has revoked the subsidy on patients' injection fee.
Even if the Government explained that within the $160 subsidy, $110 is the prime cost and $50 is the injection fee, such "prime cost" is self-contradictory with the increased cost as mentioned by CHP. Furthermore, the $50 injection fee has not been adjusted in the past 5 years along with the raise of market cost in reality.
The Hong Kong Medical Association would like to appeal for the following:
(1) If there is shortage of QIVs
in the market, people should still protect themselves against influenza infection
by vaccinated for TIVs. This is in line with the recommendation of the Centers
for Disease Control and Prevention.
(2) The Government provide influenza vaccination subsidy to ALL in the high-risk groups.
(3) The Government should increase the subsidy of QIVs of "Influenza Vaccination Subsidy Schemes" to HK$220.
(4) The Government should try its best to secure enough flu vaccines by importation in order to prevent the flu epidemic and increase the overall influenza vaccination uptake rate in Hong Kong.
Vaccination is the most effective way to protect one from influenza infection and its complications. The Hong Kong Medical Association strongly advice all people, especially those fall into the high-risk groups, to take flu vaccine before the winter flu season and maintain good personal hygiene as a protection of oneself, one's family and the community against influenza.
Invest on Epidemic Prevention,
to reduce the Public Expenditure
In 2012, there were 233 fatal cases due to influenza infection. 329 adults were admitted to Intensive Care Unit (ICU). During 3 January to 7 February 2014, there were 112 cases of influenza associated ICU admission, in which 39 of them were fatal.
According to Notices of the Hospital Authority:
Charges of ICU bed
$14,600 (per day per patient) x 329 patients = $4,803,400
Stay for 10 days: $4,803,400 x 10 = $48,034,000
Charges of in-patient
There were about 800 hospitalized influenza-associated cases in January 2014 daily.
Assuming there are 10,000 cases per year:
$3,760 (per day per patient) x 10,000 = $37,600,000 (daily)
Stay for 5 days: $37,600,000 x 5 = $188,000,000
If there were 500,000 influenza
cases per year
Total Expenditure: $1,086,034,000
Estimated budget by increasing subsidy of influenza vaccinations for high-risk groups
|High-risk Groups||Estimated Population|
|Nurses in private sector||20,000|
|Obese individuals (BMI > or = 30)||238,000|
|Adults aged between 50 and 65||750,000|
Based on the subsidy amount of $220 of influenza vaccination for the abovementioned high-risk groups = $234,190,000
|If offer subsidy to 30% of the HK population for influenza vaccination: 7,000,000 x 30% x $220 = $462,000,000|
Notes to editors:
The Hong Kong Medical Association, founded in 1920, aims to bring together Hong Kong's government, institutional, university and private medical practitioners for an effective exchange of views and co-ordination of efforts. The foremost objective of the Association is to safeguard and promote public health. The Association speaks collectively for its members and aims to keep its members abreast of medical ethics, issues and advances around the world. In fulfilling these goals, the association hopes to better serve the people of Hong Kong.