Who can afford this year’s flu vaccine?

The high price of avoiding flu this winter

For many months now, we’ve been warned that the coming flu season could pack a punch. Yesterday, prime minister Jacinda Ardern said influenza is a greater risk for respiratory hospitalisation than Covid-19.

“We’re looking at everything we can to ease the pressure, but here I have an ask for the public: please get your flu vaccine and please wear your mask,” she said.

Though the severity of flu seasons are hard to predict, there were signs of what might come. Last year’s respiratory syncytial virus (RSV) outbreak followed the opening of the Australia-New Zealand travel bubble. RSV infections went from 20 sporadic RSV cases to 538 in a week.

The rate of hospitalisations due to severe acute respiratory infection (SARI) is the highest it has been all year. Calls to Healthline about flu-like illnesses exceeded historical rates for all DHBs with available data this month.

In Australia, Queensland premier Annastacia Palaszczuk made flu shots free in what she called a “pre-emptive strike”. Australia's Communicable Diseases Network reported that New South Wales, Victoria and Queensland had already had more cases this year than the entire country did last year. Other premiers quickly followed suit to shield a health system already overwhelmed by Covid-19.

In Aotearoa, yearly flu vaccinations are free for pregnant people, people aged 65 years and over, Māori and Pacific people aged 55 years and over, people who have a long-term medical condition like diabetes, asthma, or a heart condition, and children four years old or younger who have been in hospital with respiratory illness such as asthma.  

But annual flu vaccination is recommended for everyone over the age of six months.

Last week, minister of health Andrew Little cut a cake to celebrate one million flu vaccines delivered. Meanwhile, in messages and emails from parents, I heard from families trying to balance paying for vaccines and paying for petrol.

The Ministry of Health website states “if you’re not eligible for a free flu jab, and not covered by an employer-funded programme, it costs between $25 and $45 depending on the vaccine and provider”.

Photo by Stephen Andrews

Porirua mother Courtney told me: “We were charged $170 for two adults, a three year-old and a 14-month-old. We are about to take my 14-month-old back for a second dose and we are expecting to be charged for this also.”

Heather in Palmerston North was charged $37 for each dose of the vaccine, costing her family $114. For the second dose required for children being vaccinated the first time, she will have to pay a further $111, she said.

Maria in Auckland is a cancer survivor and her partner has asthma. She paid $80 to have her children vaccinated.

Amy in Wellington has $5 to last her until payday after paying $148 to get herself vaccinated with her children. She felt she needed to do it despite the huge cost. “I want to protect my tamariki and my community. I want to try to keep others from getting so sick that they need to go into hospital and that puts pressure on the hospital too.

“I kept reading how much worse the flu would be this year and knew we needed to do it. I have asthma and I assumed mine would be free, but they told me it wasn’t.”

Some said there was no way they could ever afford a flu vaccine. The vaccine is not covered by the community services card, making it a particular strain on low-income families. Others who got in touch offered to “pay it forward” to provide their fellow parents with money for a vaccine.

But just how much they’d have to donate is anyone’s guess. There is little transparency around the costs of delivering the vaccine by GPs, health professionals or chemists.

Lydia in Wellington usually gets the flu vaccine every year as her employer pays for it. But this year she’s on maternity leave with a baby.

“I’ve had some health issues this year and my immune system isn’t great. I also have close family who are immunocompromised and we have a three-year-old coming home from childcare with sickness every few weeks – including Covid-19.

“I would love to be able to protect myself, my kids and others from the flu but it’s not affordable for my whānau right now. It feels unfair that it isn’t accessible for many families at a time with Covid-19 around. It seems important for the flu vaccine to also be free,” she said.

While the Ministry of Health is responsible for the implementation and promotion of the annual flu vaccination promotion, and subsidises vaccines for people who meet certain clinical criteria, funding and distribution is managed by Crown drug agency Pharmac. It contracts with one supplier for the funded vaccines, but also oversees the private market, which is supplied by several different vaccine suppliers.

Pharmac sells influenza vaccines for $11 a pop – an increase this year of $2 after remaining unchanged since 2008 – to medical centres, health providers and pharmacies, who then set the cost to the person being vaccinated. The government sets no cap on how much can be charged. 

Pharmac’s director of operations Lisa Williams said: “For people who do not meet the criteria [for a free vaccine] but would like to purchase the flu vaccine for themselves privately, there is no restriction set by government on what a vaccinator can charge for both the vaccine itself and the service fees for administering the vaccine.”

Asked whether the government could set a cap or restriction on how much a GP or pharmacy could charge for a flu vaccine, Andrew Little’s office said: “Ministers don’t set the price of treatment that is not funded by the government”.

“The minister says he is aware that the cost for some who pay for a flu immunisation can be as low as $20.”

Meanwhile, the cost of groceries has risen once again, with a major spike for fresh produce, according to the latest Stats NZ figures.

This week the KidsCan charity used a letter from a school principal to illustrate the desperate need that is making itself felt within the community: "Whānau are at breaking point... no water for weeks, no power, no petrol to bring their children to school."

The Auckland City Mission has said it’s struggling to keep up with demand, with requests for food parcels almost tripling over the last three years. In the first three months of 2022, it distributed the highest number of food parcels ever for that time of year

Is it any wonder parents are not able to cover the cost of a flu vaccination when some medical centres are charging up to $40 per dose plus a $32 consultation fee?

Dr Bryan Betty, medical director of The Royal New Zealand College of General Practitioners, said the college doesn’t advise on the pricing for non-subsidised flu vaccination. 

“The government restricts access to subsidised flu vaccinations and outside of those that are subsidised, vaccines need to be bought and paid for by the practice and/or pharmacist. The cost of the vaccine and administration is passed onto the patient,” Betty says. 

“The college has been very active in supporting the extension of the subsidised flu vaccine programme this year and was involved in discussions with the ministry on extending eligibility. We will continue to advocate for subsidised vaccines for those who are most at risk.”

The Pharmacy Guild of New Zealand chief executive Andrew Gaudin said the guild does not advise pharmacies on how to charge for a flu vaccine, and does not have oversight of what individual member pharmacies charge for products or services.

“Pharmac sets the criteria for who is eligible for a funded flu vaccine. This currently includes children with certain underlying health conditions. The guild would, however, be supportive of increased access to funded flu vaccines for children from low-income families to deliver improved equity of health and wellbeing outcomes.”

In February, the government widened the eligibility for people to get vaccinated for free. But figures provided to RNZ by the Ministry of Health show just 18.1% of the population meet the new criteria – a total of 914,920 people. 

Mother of three Liv from Petone is currently battling the flu with her tamariki. She describes it as “worse than the Covid we had”.

“Our four-year-old had it first and was basically in bed, not eating, sleeping constantly for two weeks. It was so scary.”

She implores parents to immunise their children, but knows for many it’s just not possible to put food on the table and afford the cost of the vaccination.

As to whether the government will consider any changes to the flu vaccine rollout, Andrew Little said the ministry would continue to gauge the uptake of the flu vaccine and “just see what is needed at a later stage”.

Last week, Auckland GP Sandhya Ramanathan told RNZ that busy days at Surrey Medical Centre were like being in a "warzone". In the same week, Auckland’s Middlemore Hospital confirmed a patient died after leaving an overloaded ED.

Counties Manukau District Health Board told RNZ patient presentations are up 17% (an extra 400 patients) on pre-Covid levels and rising.

Surely, the “later stage” is already here.

Edit: The following line “This year's flu vaccine tally is just halfway to last year’s 2.1 million doses.” has been removed and replaced with numbers provided by the Ministry of Health.