Dr Donna Cosgrove MPSI on the importance of winter vaccines and the increasingly pivotal role of the pharmacist
Winter is associated with increased circulation of respiratory viruses, placing pressure on individuals and the healthcare system. Influenza, Covid-19 and other respiratory viruses circulate following various seasonal patterns in Ireland, with influenza particularly prevalent in winter.
Several factors contribute to the increased transmission of respiratory infections during winter. People spend more time indoors due to colder weather, where close contact and reduced ventilation can facilitate the spread of respiratory viruses. Furthermore, colder weather may also contribute to increased transmission of some respiratory viruses. In addition, the return to school and increased social interaction can increase transmission.
Vaccination is an important part of preventing serious respiratory disease. Vaccines work by exposing the immune system to an antigen from a pathogen, allowing the body to develop an immune response. If the individual subsequently encounters the pathogen, the immune system can respond more rapidly and effectively. The level and duration of protection may vary according to the disease, vaccine and individual; however, vaccination can reduce the risk of serious illness and death.
Winter vaccination programmes provide an opportunity for pharmacists to identify individuals who may benefit from vaccination, provide evidence-based advice, and ensure that eligible patients are protected. This article will look at the 2026/27 vaccination programmes against influenza and Covid-19, as well as providing information on pneumococcal vaccination and the role of the pharmacist.
Influenza vaccination
Influenza is one of the most important winter respiratory infections. In the northern hemisphere, seasonal influenza epidemics typically occur between September and April each year, affecting people of all ages. Although influenza is often self-limiting, it can cause significant morbidity and mortality, particularly among older adults, young children, pregnant women and those with underlying health conditions.
Annual vaccination is recommended in eligible populations because immunity wanes over time and circulating influenza viruses undergo continual antigenic change. The composition of seasonal influenza vaccines is reviewed and updated to provide protection against the influenza viruses expected to circulate. Influenza vaccination is therefore a key aspect of the annual winter vaccination programme.
For the 2026/27 season, the HSE influenza vaccination programme commences in autumn 2026. Under the 2026/27 programme, annual influenza vaccination is recommended for people aged 60 years and older, those aged six months and older who are at increased risk of influenza-related complications, all children aged two-to-17 years, pregnant women, and healthcare workers. Influenza vaccination is also recommended for those living in residential care facilities, carers, and household contacts of individuals at increased risk, and people with close contact with pigs, poultry or waterfowl.
Vaccine effectiveness can vary from year-to-year; however, influenza vaccination reduces the risk of influenza infection and can reduce the risk of serious complications, hospitalisation and death. Vaccination should ideally be administered when vaccines become available, before influenza activity increases substantially in the community. However, patients should not necessarily be discouraged from vaccination later in the season, as influenza can continue to circulate during the late winter and into spring. Following vaccination, it takes approximately two weeks for a full immune response to develop, making early vaccination important.
Live attenuated influenza vaccine (LAIV)
The live attenuated influenza vaccine (LAIV), brand name Fluenz, is used for eligible children aged two-to-17 years. It is administered using a nasal spray applicator, allowing a divided dose to be administered in each nostril. LAIV contains live attenuated viruses representing two influenza A strains and one influenza B strain, mimicking natural infection and inducing an immune response.
Post-marketing effectiveness studies have demonstrated that a second dose of LAIV is of little added benefit in healthy children. For this reason and for logistical purposes, healthy children should receive a single dose of LAIV. Children aged from two years to less than nine years in a clinically at-risk group should receive two doses of LAIV, at least four weeks apart, if they are receiving the vaccine for the first time or if their vaccination history is unknown.
Contraindications to LAIV include, among others, severe immunocompromise due to disease or treatment, living with a severely immunocompromised person requiring isolation, pregnancy, breastfeeding and acute asthma exacerbation. Those who cannot receive LAIV because of a contraindication or other relevant precaution may receive the IIV. Common adverse effects include nasal congestion, malaise, headache, myalgia, and fever.
Inactivated influenza vaccine (IIV)
Inactivated influenza vaccines (IIV) are administered by intramuscular injection and contain influenza antigens that stimulate an immune response without containing live virus. The 2026/27 programme uses both adjuvanted and non-adjuvanted IIV.
The 2026/27 programme uses both adjuvanted and non-adjuvanted IIV
An adjuvanted IIV (aIIV), brand name Fluad, is recommended for all adults aged 65 years and older. The adjuvant enhances the immune response and may be particularly beneficial in older adults, who can have a reduced response to vaccination. Non-adjuvanted IIV may be used if aIIV is unavailable.
Non-adjuvanted IIV is used for other eligible groups, including adults aged 60-to-64 years, adults aged 18-to-59 years who are clinically at risk, children aged six months to under two years, and children aged two-to-17 years who have a contraindication to LAIV. The brand names for the IIV are Vaxigrip and Influvac. Two doses may be required in certain circumstances, including following transplantation and during certain chemotherapy regimens, depending on age and vaccination history. Common adverse effects include injection site pain, fatigue, headache, myalgia, arthralgia and fever.
Covid-19 vaccination
Covid-19 vaccination is an important part of the winter vaccination programme, although the approach to vaccination has become more targeted since the initial pandemic vaccination campaign. This reflects the changing epidemiology of Covid-19, increasing population immunity from previous infection and vaccination, and the greater risk of severe outcomes in particular populations.
The aim of the programme is to provide year-round protection against severe disease in people at increased risk of hospitalisation, intensive care admission and death from Covid-19. To achieve this objective, vaccination once per year is recommended for most at-risk individuals. Individuals at particularly high risk, including those with significant immunocompromise, may require vaccination twice yearly.
The groups at higher risk if they contract Covid-19 and therefore recommended for vaccination include all adults aged 60 years and older, adults aged 18 years and older living in long-term care facilities, people aged six months and older with immunocompromise associated with a suboptimal response to vaccination, and people aged six months and older with a medical condition that places them at increased risk.
Examples of these medical conditions include cancer, chronic heart disease, chronic kidney disease, chronic liver disease, chronic neurological disease, chronic respiratory disease, diabetes, and certain immunocompromising conditions. The full eligibility criteria should be checked against current HSE guidance. Healthcare workers are also eligible to receive Covid-19 vaccination, while pregnant women with immunocompromise or a medical condition that puts them at increased risk of severe Covid-19 are recommended to receive vaccination. Individuals aged 18 years and older, including pregnant women, who do not have a medical condition that places them at increased risk may receive a Covid-19 vaccine if they choose to, following discussion with a healthcare provider.
Covid-19 vaccination may be administered at the same time as the influenza vaccine, helping to maximise uptake and improving convenience for patients. Co-administered vaccines should be administered in different arms if possible. However, if this is not possible, administration in the same arm, separated by at least 2.5 centimetres, is appropriate. There are no specific safety concerns associated with co-administration; however, there may be a slight increase in short-term mild adverse effects.
The Covid-19 vaccine being used this season is the Comirnaty XFG, manufactured by Pfizer. For those aged 12 years and older, Comirnaty XFG 30 micrograms is administered by intramuscular injection into the deltoid. A minimum interval of three months is recommended after the last Covid-19 vaccine or Covid-19 infection before receiving vaccination. Common adverse effects include injection-site pain, fatigue, myalgia, and fever.
Pneumococcal vaccination
Pneumococcal vaccination is not a seasonal vaccine, but the winter vaccination programme provides an opportunity for pharmacists to identify patients who may be eligible for protection against pneumococcal disease.
Streptococcus pneumoniae can cause a range of infections, including pneumonia and meningitis. Older adults and patients with certain underlying conditions are at increased risk. Pneumococcal vaccination is recommended for adults aged 65 years and older, as well as patients aged two years and older with medical conditions that increase their risk of pneumococcal disease.
Adults aged 65 years and older typically require a single dose, while eligible patients under 65 years may require two doses at least five years apart, depending on their risk factors and previous vaccination history. Patients should have their vaccination history checked before vaccination, particularly where previous vaccination may have been administered in another healthcare setting.
Pneumococcal vaccination is particularly relevant in community pharmacy. Since May 2026, community pharmacists have been funded to administer the pneumococcal polysaccharide vaccine (PPV23) to healthy adults aged 65 years and older with GMS/GPVC/HAA eligibility as part of the national immunisation programme. This provides an opportunity for pharmacists to identify eligible patients during the winter vaccination programme and ensure that they receive appropriate protection against pneumococcal disease. PPV23 can also be co-administered with influenza or Covid-19 vaccines.
Pneumococcal vaccination is particularly relevant in community pharmacy
The pharmacist’s role
Community pharmacists are ideally placed to improve uptake of winter vaccinations due to their accessibility and frequent contact with patients. They can assess patients to determine eligibility for influenza, Covid-19 and pneumococcal vaccination, review previous vaccination history, and identify opportunities for co-administration.
Pharmacists can also explain the benefits of vaccination and address concerns regarding adverse effects or effectiveness. Correct vaccine storage, vaccine administration and documentation are important aspects of the pharmacist’s role.
The 2026/27 winter vaccination programme provides community pharmacists with an important opportunity to protect patients against serious respiratory illness. Pharmacists can improve vaccine uptake and help ensure that patients receive appropriate protection through assessment, patient education, and administration of vaccines.
References upon request
