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LCQ11: Seasonal influenza vaccines
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     Following is a question by the Dr Hon Kwok Ka-ki and a written reply by the Acting Secretary for Food and Health, Professor Sophia Chan, in the Legislative Council today (February 25):

Question:

     The Department of Health currently implements the Seasonal Influenza Vaccination Programme and the Pneumococcal Vaccination Programme, but it has not implemented a similar programme for cervical cancers.  The first aforesaid Programme includes the Childhood Influenza Vaccination Subsidy Scheme (CIVSS), the Elderly Vaccination Subsidy Scheme (EVSS), the Childhood Vaccination Subsidy Scheme (PCV13 booster) (PCV13SS) and the Residential Care Home Vaccination Programme (RVP).  Members of the public may receive influenza vaccination from private doctors who have enrolled in CIVSS and EVSS and be entitled to a subsidy of $160 per dose of such vaccine.  Under the RVP, the authorities will provide free vaccines and reimburse registered medical doctors a $50 injection fee per dose of vaccine.  However, residential care homes (RCHs) need to make arrangements on their own for registered medical doctors enrolled in the programme to provide vaccination to residents, boarders and staff at their respective RCHs.  In this connection, will the Government inform this Council:

(1) of the details of the publicity efforts made by the authorities since the onset of the current influenza season through the mass media to arouse public awareness of the prevention of the influenza epidemic and the aforesaid vaccination programmes, including (i) the publicity channels, (ii) the publicity frequency, (iii) the expenditure involved, and (iv) the percentage of the air time for the broadcast of television announcements in the public interest (TV APIs) on influenza prevention in the total air time for the broadcast of government TV APIs during the period;

(2) whether it knows the respective vaccine costs and injection costs per dose of trivalent and quadrivalent influenza vaccines;

(3) of the respective number of people who received trivalent and quadrivalent influenza vaccines in the past five years under (i) CIVSS, (ii) EVSS and (iii) RVP and the expenditure involved; the respective numbers of private medical doctors/clinics enrolled in such programmes since their introduction; whether the authorities will step up publicity efforts to attract more private medical doctors to enrol in such programmes; whether the authorities will increase the amount of subsidy per dose of vaccine and simplify the application procedures to attract more members of the public/RCHs to participate in such programmes (and set out the information by programme);

(4) of the number of children who received vaccination under PCV13SS since the implementation of the scheme and the expenditure involved; the number of doses of 13-valent pneumococcal conjugated vaccine provided by the Government which are still unused at present; whether the authorities will step up publicity efforts to attract more parents to arrange for their children to participate in the scheme, and whether they will extend the implementation period of the scheme;

(5) given that the influenza epidemic in the current influenza season is more severe than that in previous years and there were already more than 200 influenza-associated deaths, whether the authorities will expeditiously allocate additional resources to the various aforesaid vaccination programmes for stepping up publicity efforts, procurement of additional doses of vaccines, and requesting the Hospital Authority to provide vaccination services in various public hospitals; if they will, of the details;

(6) whether it knows the respective percentages of children aged under six, elderly people (i.e. those aged 65 or above) and elderly people suffering from chronic illnesses who received vaccination in the past five years; whether the authorities have made reference to the relevant percentages in the neighbouring regions such as Taiwan, Japan and the Mainland and, in response to the severity of the recent influenza epidemic, introduce more subsidised vaccination programmes to enhance protection of public health;

(7) of the number of people who received vaccination under the Pneumococcal Vaccination Programme in the past five years and the expenditure involved, as well as the current percentage of the Hong Kong population who has received vaccination; and

(8) whether it has plans to introduce new programmes to provide free or subsidised cervical cancer vaccination service for the public; if it does, of the details; if not, how the authorities protect the public from the threat of cervical cancer?

Reply:

President,

     The Scientific Committee on Vaccine Preventable Diseases (SCVPD) of the Centre for Health Protection (CHP) recommended nine priority groups for seasonal influenza vaccination in the 2014/15 season.  People in these priority groups are generally at increased risk of severe complications or even death caused by influenza or transmitting influenza to those at high risk.  Hence, the Government provides free or subsidised seasonal influenza vaccination to some people in these high risk groups through the Government Vaccination Programme (GVP) and the Vaccination Subsidy Scheme (VSS).  The Administration also recommends those people who are not covered by the above schemes to consult their family doctors and consider receiving seasonal influenza vaccination for personal protection.  The Government will consider the recommendations of the SCVPD and review the implementation of the GVP and VSS, including their coverage, etc.

     Regarding the different parts of the question, my replies are as follows:

(1) The CHP has produced a variety of health education materials on prevention of influenza including a thematic web page, television (TV) and radio announcements in public interests (APIs), guidelines, pamphlets, posters, booklets, frequently asked questions and exhibition boards.  Various publicity and health education channels e.g. websites, TV and radio stations, health education hotline, newspapers and media interviews have been deployed for promulgation of health advice.  The CHP also launched a dedicated Facebook Page and a YouTube Channel in February 2015, with a view to further disseminating information on health promotion as well as disease prevention and control to members of the public, especially the younger generation.

     In addition, the CHP has also widely distributed health education materials in public and private housing estates, healthcare settings, schools and non-governmental organisations (NGOs), etc.  The CHP also keeps the stakeholders including government bureaux and departments, hotel and guesthouse associations, property management associations, Hong Kong Housing Society, District Councils, Healthy Cities Projects, NGOs and ethnic minority groups updated of the latest influenza activity and preventive measures to solicit their co-ordination and support to strengthen the publicity of related health messages.

     From November 1, 2014 to February 22, 2015, a total of 25 media interviews were conducted by CHP.  Nine APIs related to the prevention of influenza, avian influenza, vaccination schemes and general health advice were broadcast with a total of 4,399.5 minutes of TV air time or 8,799 slots allocated.  The APIs have been aired on a total of 40 channels operated by five TV stations.  The air time used represents 5.96% of all TV API free air time during that period.  Corresponding API versions were also aired on radio.  To enhance publicity, selected APIs are also being broadcast on public transport.

     The Government has arranged a series of publicity activities in the 2014/15 season to promote vaccination, in particular to the targeted high risk groups.  Four press conferences were held in August, September, October and November 2014 respectively to encourage Hong Kong residents to receive seasonal influenza vaccination.  As local surveys found that professional advice was effective in promoting vaccination, relevant experts were engaged in various publicity activities to promote vaccination to different target groups.  Experts from the SCVPD, Hong Kong Academy of Medicine and five specialist colleges also came together to announce a Consensus Statement regarding the importance of seasonal influenza vaccines (SIV).  Besides, specialists attended media interviews to explain the benefits and the necessity of receiving seasonal influenza vaccination.  Moreover, publicity was done through APIs in mass media; advertisements on the MTR, public buses, newspapers, magazines and on-line apps; promotion on websites; and collaboration with community partners, District Councils and NGOs to encourage vaccination.

     The expenditure on the publicity and public education on the prevention of influenza cannot be separately identified as it is absorbed as part of the overall expenditure for health promotion under the Department of Health (DH).

(2) The amount of subsidy for each dose of SIV under the VSS has been increased from $130 to $160 in the 2014/15 season, covering the vaccine cost and injection cost.  The DH has made reference to the market prices of SIV supplied to the private sectors to determine the amount of subsidy.  As services offered by different private doctors may vary, the Government will not set restrictions on or mandate a fixed fee.  Participating doctors are however requested to set out the additional service charge on the price poster and on the CHP website so that the public may make an informed choice.

(3) There are more than 1,600 private doctors, involving over 2,200 clinics, enrolled under the Childhood Influenza Vaccination Subsidy Scheme (CIVSS) and the Elderly Vaccination Subsidy Scheme (EVSS) in 2014/15.  Before the launch of these subsidy schemes every season, the DH would issue letters to all registered private doctors in Hong Kong inviting them to enrol in these two subsidy schemes and organise briefing sessions for them.  For the Residential Care Home Vaccination Programme (RVP), the DH would also issue letters to all registered Residential Care Homes (RCHs) for the Elderly and RCHs for Persons with Disabilities inviting them to enrol in the RVP.  More than 90% of the RCHs enrol in the RVP every year.

     The enrolment application procedures for these programmes have all along been very simple and convenient.  Relevant information and application details have been uploaded onto the CHP website.  Interested doctors can enroll in these programmes anytime.

CIVSS and EVSS

     The subsidised vaccine in these two subsidy schemes up till the 2013/14 season was trivalent SIV; and quadrivalent SIV is also included as the subsidised vaccine in these schemes in the 2014/15 season.  Among the some 2,200 clinics enrolled under the VSS, around 1,400 of them provide quadrivalent SIV.

     The number of persons receiving vaccination and the expenditure in the past five seasons are as follows:

CIVSS

         No of Persons      Expenditure
                            (in million dollars)
2010/11     49,000          4.63
2011/12     44,000          4.24
2012/13     60,000          10.53
2013/14     62,000          10.66
2014/15#    53,000          10.29
(#as at February 15, 2015)

EVSS

         No of Persons      Expenditure
                            (in million dollars)
2010/11    111,000          14.37
2011/12    121,000          15.73
2012/13    142,000          18.46
2013/14    160,000          20.80
2014/15#   174,000          27.84
(#as at February 15, 2015)

RVP

     Trivalent SIV was used in the programme up till 2013/14 season.  In the 2014/15 season, all vaccines used under the programme are quadrivalent SIV instead.  The number of administered doses and the expenditure in the past five seasons are as follows:

        No of Administered Doses  Expenditure*
                                  (in million dollars)
2010/11      65,000               3.3
2011/12      70,700               3.5
2012/13      72,000               3.6
2013/14      72,600               3.6
2014/15#     72,100               3.6
(#as at February 15, 2015)
*Figures include the subsidies for injection cost only.

(4) Since the launch of Childhood 13-valent Pneumococcal Conjugate Vaccine (PCV13) Booster Vaccination Programme, more than 23,200 eligible children have received booster doses of PCV13.  Among them, 21,600 eligible children received subsidised booster doses of PCV13 under the Childhood Vaccination Subsidy Scheme (PCV13 booster) (CVSS(PCV13 booster)) involving subsidies amounting to around $1 million dollars. Though the CVSS(PCV13 booster) ended on June 30, 2014, for better utilisation of the remaining vaccines, enrolled doctors who have not yet used up the PCV13 supplied by the Government may continue to provide subsidised vaccination to eligible children until the PCV13 expire.  As at February 8, 2015, enrolled doctors still have around 3,400 government-supplied PCV13 in hand.

     Besides, in order to optimise vaccine utilisation, the Government announced a one-off measure in February 2015 to allow enrolled doctors, with effect from March 2,  2015, to provide the remaining doses of government-supplied PCV13 under the CVSS(PCV13 booster) to eligible elders who have never received Government subsidised pneumococcal vaccination.

(5) Under the GVP, hospitals of the Hospital Authority (HA) would provide free influenza vaccination to eligible persons including hospitalised persons (include hospitalised children) with chronic medical problems, residents of RCHs, psychiatric elderly patients and long-stay residents of psychiatric institutions and institutions for the disabled.

     In response to the recent demand, the Government has already procure 10,000 additional doses of quadrivalent SIV.  The Government has also arranged a series of publicity activities to promote vaccination, in particular to the targeted high risk groups, such as:

Early Appeal

     Though the 2014/15 VSS and the free GVP were launched in early October and early November 2014 respectively, the CHP had kick-started the publicity activities as early as in August 2014 and arranged press conferences to encourage Hong Kong residents to receive influenza vaccination from time to time.

Collaboration with Medical Experts; Intensive Promotion Drive

     As local surveys found that professional advice was effective in promoting vaccination, relevant experts were engaged in various publicity activities to promote vaccination to different target groups.  Experts from the SCVPD, Hong Kong Academy of Medicine and five specialist colleges also came together to announce a Consensus Statement regarding the importance of SIV.  Besides, specialists attended media interviews to explain the benefits and the necessity of receiving seasonal influenza vaccination.

     As for healthcare personnel, the DH, HA and the Hong Kong Private Hospitals Association jointly conducted a press conference to promote vaccination for healthcare workers in public and private sectors.  Government officials have also taken the lead to receive vaccination as role models.  Moreover, the CHP has organised briefing sessions for healthcare workers to explain the safety and the necessity of vaccination.

Multi-channel and Continuous Promotion

     The Government has produced a variety of APIs for promulgation on the prevention of influenza through TV, radio channels, the webpage of Information Services Department and YouTube channel; placed advertisements in the MTR, public buses, newspapers, magazines and online apps; arranged promotions on websites and collaborated with community partners, District Councils and NGOs to encourage vaccination.  Looking ahead, the Government would solicit the help of voluntary welfare organisations to publicise vaccination education for the targeted population (such as the elders).

(6) As shown in the survey results on the coverage of seasonal influenza vaccination conducted by the CHP in the 2012/13 season, 14% of the local population has received seasonal influenza vaccination, among which the coverage for children aged six months to five years and elders aged 65 years or above were 28.4% and 39.1% respectively.  The survey results have been uploaded onto the CHP website.

     At present, most needy people of the high risk groups have been covered under the GVP and the VSS, receiving free or subsidised seasonal influenza vaccination.  To decide whether to further extend the coverage of the influenza vaccination schemes, the Government has to consider many factors including scientific evidence, risk factors, resource allocation, etc.  The Government will make reference to the recommendations of the SCVPD and review the free and subsidised vaccination programmes.

(7) The GVP and the EVSS launched by the Government provide pneumococcal vaccination to eligible elders aged 65 years or above.  The numbers of eligible elders receiving pneumococcal vaccination under these programmes, provided in the tables below, account for over 30% of the concerned age group.  As some eligible elders might have received pneumococcal vaccination from other sources rather than under these programmes, the actual figures are expected to be higher than those below.

     The number of persons receiving vaccination and the expenditure in the past five seasons are as follows:

Pneumococcal vaccination provided under the EVSS

            No of Persons      Expenditure
                               (in million dollars)
2010/11        14,000          2.68
2011/12        14,000          2.65
2012/13        18,000          3.41
2013/14        23,000          4.33
2014/15#       21,000          4.07
(#as at February 15, 2015)

Pneumococcal Vaccination provided under the GVP

            No of Persons      Expenditure
                               (in million dollars)
2010/11        16,000          2.37
2011/12¡@¡@    14,000          2.16
2012/13        13,000          1.94
2013/14        14,000          2.04
2014/15#       13,000          1.66
(#as at February 15, 2015)

(8) Regarding Human Papillomavirus (HPV) vaccination, according to the recommendations jointly issued by the SCVPD and the Scientific Committee on AIDS and Sexually Transmitted Infections, the Government should consider the local context and the development of scientific evidence, as well as conduct health economic evaluation of vaccination programme.  The SCVPD has also recommended strengthening the implementation of the Cervical Screening Progamme in Hong Kong, raising public awareness and enhancing the public's understanding of the HPV vaccine through health education and publicity.  The Administration will closely keep in view the latest developments on this subject.

Ends/Wednesday, February 25, 2015
Issued at HKT 18:28

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