Updated guidance for 2026-27 flu season

The loss of some two million doses of one of the recommended vaccines mean general practice nurses face a potentially more stressful start to the main seasonal flu vaccination campaign (1 October 2026).

Sanofi’s trivalent recombinant influenza vaccine (TIIVr) has been hit by a combination of late identification of the B-strain influenza candidate and a manufacturing ‘challenge’ resulting in severe supply constraints.

As a result, GPNs have been advised to use IIV-HD off license for people aged 50 to 59 years in clinical risk groups, where TIIVr is not available.

In a statement to Practice Nurse, Sanofi said: ‘Sanofi regrets to inform that we are facing supply challenges with Supemtek TIVr influenza vaccines for the 2026/2027 flu season in England.

‘We fully recognise the impact this will have on healthcare providers and the patients they serve, and we sincerely apologise for the disruption this supply challenge causes.

‘This season has been particularly challenging for the influenza vaccine manufacturing industry. Two significant external factors have affected influenza vaccine manufacture: three strain changes compared with last year's vaccine composition, and the late identification of the B strain candidate, which delayed the shipment of the reference strain to manufacturers globally.

‘In addition, the manufacturing of biological products is inherently complex. Sanofi has experienced a separate manufacturing challenge with Supemtek TIVr influenza vaccines for the 2026/2027 season, which has resulted in supply constraints.

‘We communicated the situation to the UKHSA, NHS England and other relevant stakeholders as soon as we were able to. We are focused on actively working with them to mitigate the impact and Sanofi remains committed to supporting national immunisation programmes and the patients and healthcare providers who rely upon it.’

For the 2026-27 season, the Joint Committee on Vaccination and Immunisation (JCVI) recommends:

• In those aged 65 and older, IIVc (cell-cultured) which should be considered equivalent to aIIV (adjuvanted), IIV-HD (high-dose) and IIVr (recombinant).
• In those aged 50 to 59 years in clinical risk groups, IIV-HD can be used off-license
• Those aged 18 – 49 in a clinical risk group, including pregnant women, offer either IIV-c or IIVr (if available)
• Children aged 2 – less than 18 years in eligible groups, including clinical risk groups, offer in the following order:
  • LAIV (live attenuated inactivated influenza vaccine)
  • IIVc where LAIV is contraindicated or unsuitable (e.g., parents object to its porcine content)
  • IIVe (egg-cultured inactivated influenza vaccine) NB. Egg allergy is no longer a contraindication to any influenza vaccine used in the UK, and there is no need to ask about egg allergy before administering the vaccine.
• Children aged 6 months to 2 years in a clinical risk group, offer in the following order of preference:
  • IIVc
  • IIVe

Prioritisation of adult IIV vaccines

Manufacturing Northern Hemisphere vaccines for the 2026 to 2027 season has been very challenging. This means that some inactivated vaccines will not be available, or will only be available in limited quantities, or will be delivered significantly later than originally anticipated.

Although IIVc and IIVr are JCVI preferred vaccines for use in adults of all ages, for this season, these vaccines should be preferentially used in younger adults (below 50 years), with those vaccines licensed in older adults (aIIV and IIV-HD) preferentially used in those over 50 years. This will help ensure that supply of suitable vaccines is sufficient for each age group.

In instances where aIIV or IIV-HD are not available for those aged over 50 years, it is better to vaccinate someone eligible for the national programme with any JCVI preferred vaccine for that age group, than risk them not being vaccinated at all.

The egg-cultured influenza vaccine (IIVe) should only be offered to those aged between 18 and 65 as part of the national programme in circumstances where preferred influenza vaccines are not available. The JCVI does not recommend IIVe in people aged 65 and over.

Eligibility – a reminder

The clinical risk groups

• Chronic respiratory disease (including asthma, COPD)
• Chronic heart disease and vascular disease
• Chronic kidney disease
• Chronic liver disease
• Chronic neurological disease (including stroke, transient ischaemic attack, severe multiple learning disabilities)
• Diabetes
• Immunosuppression
• Asplenia
• Morbid obesity
• Pregnant women
• Household contacts of people with immunosuppression
• Carers
• NEW - People experiencing homelessness

Vaccination of some groups got underway from 1 September:

• Pregnant women
• All children aged 2 or 3 years on 31 August 2026
• Primary and secondary school-aged children
• All children in a clinical risk group aged from 6 months to less than 18 years

From 1 October, the following groups are eligible:

• Those aged 65 years and over
• Those aged 18 to under 65 in clinical risk groups
• Those in long-stay residential care homes
• Carers (receiving carer’s allowance or those who are the main carer of an elderly or disabled person)
• Close contacts of immunocompromised patients
• Frontline workers in social care
• All frontline healthcare workers, including non-clinical staff, who have contact with patients

For the first time, people experiencing homelessness (rough sleepers and people using homeless hostels or night shelters) should be offered flu vaccination. This was first recommended by the JCVI in 2024, but it wasn’t until March 2026 that the policy decision was made to include them in the national flu programme.

Timing

The staggered start – as occurred in 2025-26 – is because flu circulation in children normally precedes that in adults, but flu vaccine efficacy wanes over time in adults. So children (and pregnant women) should be offered vaccinated from 1 September, but delaying vaccination for adults until 1 October, closer to the peak of the flu season, offers optimal protection during the highest risk period. All vaccinations should be completed by the end of November.

Uptake

Everyone who is eligible for the flu vaccine should be offered it. Practices should make ‘firm plans’ to deliver more vaccinations in the 2026-27 season than they did in 2025-26.

While uptake among the 65 and older group was close to the 75% target, only 40.6% of those under 65 in clinical risk groups were vaccinated. In real terms, the number of patients aged 65 and older vaccinated by the end of the last season was 8.7 million, 131,000 more than the previous year because of the ageing population. This year, the number should increase by over 240,000.

While the ambition of ‘equivalent or higher’ than the previous achievement was achieved for patients in clinical risk groups, around 5.7 million of those aged 6 months to under 65 years remained unvaccinated. In children aged 6 months to 2 years, only 2,260 (11.6%) out of a possible 17,795 were vaccinated. 

Highest uptake by individual risk group was in patients with a severe learning disability (55.9%), diabetes (49.4%), or chronic kidney disease (48.1%). Among the groups with the lowest uptake were patients with chronic liver disease (33.4%) and morbid obesity – BMI >40kg/m².

Resources

The Green Book: Influenza; updated 27 August 2026. https://www.gov.uk/government/publications/influenza-the-green-book-chapter

UKHSA. Flu vaccination programme 2026 to 2027: information for healthcare practitioners; updated 27 August 2026. https://www.gov.uk/government/publications/flu-vaccination-programme-information-for-healthcare-practitioners/flu-vaccination-programme-2023-to-2024-information-for-healthcare-practitioners#influenza-vaccination-programme-2026-to-2027

UKHSA. Seasonal influenza vaccine uptake in GP patients in England: winter season 2025 to 2026. https://www.gov.uk/government/statistics/seasonal-influenza-vaccine-uptake-in-gp-patients-winter-season-2025-to-2026/seasonal-influenza-vaccine-uptake-in-gp-patients-in-england-winter-season-2025-to-2026#gp-practice-response-rate