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LCQ14: Vaccination programmes

     Following is a question by the Dr Hon Lam Tai-fai and a written reply by the Acting Secretary for Food and Health, Professor Sophia Chan, in the Legislative Council today (February 25):


     Hong Kong is now in an influenza season, and influenza-associated deaths have occurred incessantly. It has been reported that Hong Kong people's influenza vaccination rate has all along been on the low side, ranging from 10% to 15% over the past decade and, even for healthcare personnel, the rate has been 10% or so only. An expert on infectious diseases is of the view that given the low public awareness of influenza prevention, the Government needs to step up publicity efforts. Besides, some members of the public are concerned that every time when an influenza season arrives, the public healthcare system is invariably subjected to immense pressure, including an acute shortage of healthcare manpower and hospital beds, etc. In this connection, will the Government inform this Council:

(1) whether it has compiled statistics on the respective numbers to date of healthcare personnel (including doctors, nurses and ambulancemen) and members of the public who received influenza vaccination for preventing infection in this influenza season; if it has, of the details; if not, the reasons for that;

(2) whether it has assessed why the vaccination rate is on the low side at present; if it has, of the details; if not, the reasons for that;

(3) as the authorities have indicated in a paper submitted to the Panel on Health Services of this Council this month that in order to encourage the public to receive influenza vaccination, senior government officials take the lead to receive vaccination as role models, whether it knows if the Directors of Bureaux other than the Secretary for Food and Health have received vaccination; if they have, which Directors of Bureaux have already received or are prepared to receive vaccination; if not, of the reasons for that;

(4) whether it has assessed the health risks arising from the side-effects after influenza vaccination faced by children under five, the elderly and chronic patients;

(5) of the total quantities of influenza vaccines purchased by the Department of Health (DH) and the Hospital Authority (HA) in each of the past five years; the existing stock of such vaccines and their expiry dates;

(6) of the procedures adopted by DH and HA for disposal of expired influenza vaccines, and the quantities and costs of influenza vaccines which expired and were written off in the past five years;

(7) whether it has assessed if the existing influenza vaccine stock kept by DH and HA is sufficient to meet the demand in this influenza season; if it has not assessed, of the reasons for that; if it has assessed, the details; if the assessment outcome is in the negative, why such a situation has emerged, and how it will cope with the demand;

(8) whether it will launch new publicity activities to step up publicity on the advantages of vaccination; if it will, of the details;

(9) of the number of pharmaceutical manufacturers whom the authorities have contacted to date for the provision of new vaccines targeting the prevailing influenza A (H3N2) virus; whether the authorities will step up efforts to promote research and development of influenza vaccines in Hong Kong; if they will, of the details; if not, the reasons for that;

(10) given the frequent contacts between Hong Kong residents and those of the Mainland and Macao, whether the authorities know the latest statistics on influenza infection and vaccination on the Mainland and in Macao;

(11) whether it has assessed if the present shortage of hospital beds in various public hospitals is more serious when compared with that in previous years;
(12) whether it knows the emergency services attendances at various public hospitals since the onset of this influenza season, and whether the utilisation rate has reached such a level that the hospitals are unable to cope with; how the rate compares with those in the past five years; and

(13) whether it knows the shortage of healthcare manpower in various public hospitals?



(1) 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.

     The figures on the number of healthcare workers and persons of the high-risk groups who have received influenza vaccination under these programmes are set out at Annex. As some eligible persons might not receive seasonal influenza vaccine (SIV) under these two programmes, the actual figures are expected to be higher.

(2) 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, detailed breakdown is as follows:

                             Rate of Seasonal
Target Groups            Influenza Vaccination (%)
-------------            -------------------------

Children aged six months                28.4
to five years old
Persons aged six to 49 years            11.0
Persons aged 50 to 64 years              8.5
Persons aged 65 years or above          39.1
Pregnant women                           2.0
Persons with chronic medical problems   28.2
Healthcare workers in public sector     28.6 - 44.9
Healthcare workers in residential       39.8
care homes  
Healthcare workers in private sector    32.6 - 35.4
Local population                        14

     The survey found that the main reasons for Hong Kong residents not receiving influenza vaccination include: "they are healthy and do not think that they will be infected with the influenza easily"; "consider vaccination to be ineffective for preventing influenza" and "they have no time". The survey results have been uploaded onto the CHP website.

(3) To encourage members of the public to receive seasonal influenza vaccination, the Secretary for Food and Health together with the Permanent Secretary (Health), Under Secretary for Food and Health, Director of Health, Controller, CHP, etc. took the lead in receiving vaccination on November 3, 2014. We do not have information on whether other Directors of Bureaux have received vaccination.  

(4) SIV is very safe and usually with no side effects apart from possible swelling at the injection site. Some recipients may experience fever, muscle and joint pains, and tiredness beginning six to 12 hours after vaccination and lasting up to two days.  The Department of Health (DH) has a surveillance system in place to monitor adverse events following usage of drugs (including influenza vaccines). Since commencement of the various seasonal influenza vaccination programmes in October 2014 up to now, no report on serious adverse events has been received.

(5), (6) and (7) The following figures are the quantities of SIVs that the government procured under GVP (including supply to the Hospital Authority (HA) and other relevant venues which provide vaccination service) in the recent five years:

Year      Number of Doses
----        ---------------
2010-11      300 000
2011-12      300 000
2012-13      285 000
2013-14      285 000
2014-15      268 000

     As at February 15, 2015, there are more than some 20 000 doses of vaccine in stock under the GVP. The supplier has to supply sufficient quantity of vaccines to the Government according to the contract terms and ensure that all the vaccines supplied would not be expired before the 2014/15 season. Also, the DH would regularly liaise with the HA and various departments that provide vaccination so as to monitor the demand for SIVs and the injection progress for the purposes of estimation and making flexible arrangement with pharmaceutical manufacturers. To meet the recent demand, the DH has already ordered an extra 10 000 doses of quadrivalent SIV.

     The Government will assess the number of doses administered in the previous season, expected increase of vaccination rate, damage of vaccine and current vaccination situation in deciding the quantity of SIVs to be ordered. It will also strive to reduce wastage of vaccines whilst ensuring sufficient vaccine provision by collaborating with different service units. SIVs can last for one year in general, and the DH and HA will dispose of the damaged or unused but expired vaccines by phases in accordance with established procedures and arrangement. The DH and HA disposed of 52 000, 54 000, 32 000, and 33 000 doses of SIVs in 2011, 2012, 2013 and 2014 respectively, and the cost involved in disposal of vaccines depends on the relevant contract price for the vaccine for that year.

(8) The Government has been closely monitoring the vaccination rate of SIVs, and promote the importance of SIVs to the public through various channels. It has arranged a series of publicity activities in the 2014/15 season to promote vaccination, in particular to the targeted high risk groups, as follows -

Early Appeal

     Though the 2014/15 VSS and the free GVP were launched in early October and early November 2014 respectively, the CHP had already 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, the 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 announcements in public interests for promulgation on the prevention of influenza through television, 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 non-governmental organisations 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).

(9) According to the record of the DH, currently there are four vaccine suppliers who have registered the Southern Hemisphere influenza vaccine. The DH has contacted the influenza vaccine suppliers, and actively procuring the vaccines containing the current predominant influenza strain A / Switzerland / 9715293/2013. Provided that there is supply, the vaccines are expected to arrive at Hong Kong in late April to May this year.  The quantity of vaccines to be supplied is still uncertain but the Government will try to request more.

     Hong Kong is at the forefront in medical research and development (R&D) (especially on epidemiology). The Food and Health Bureau is committed to assisting local R&D professionals through the Health and Medical Research Fund (the Fund).  Research projects relating to vaccination programmes (including development of new vaccines, acceptability of vaccination programmes, and measures to enhance vaccination of elderly, institutionalised or other at-risk populations) are in fact within the thematic priorities of the Fund and may have priority in funding application.    

(10) Regarding prevention and control of infectious diseases, Hong Kong has established a close reporting mechanism with the health authorities in the Mainland and Macao. Besides, Guangdong will also share the latest influenza surveillance data with Hong Kong. According to past experience, the peak of winter influenza season in Southern provinces in the Mainland usually occurred later than that in Hong Kong.

     According to the Chinese Center for Disease Control and Prevention, the national influenza vaccination coverage rate in the Mainland was around 2% as of January 2015. According to the Health Bureau of Macao, the overall free vaccination coverage rate was 14% as of February 5, 2015.

(11) and (12) The HA has already drawn up an overall response plan before the start of the surge in service demand during the winter influenza season. Availability of hospital beds is one of the key elements to respond to the challenge of upsurge in service demand. In this connection, the HA has opened 205 additional beds in 2014/15, and 250 additional beds in 2015/16.  To further increase the service capacity, the HA has opened a total of 282 additional beds on a time limited basis for six months during the influenza season. Since the demand for in-patient service has increased sharply since January 2015, various clusters will, with regard to the actual demand and manpower situation, further increase more than 200 extra beds to cope with the urgent need. The level of utilisation of beds at present is similar to that in past years.

     The number of Accident and Emergency (A&E) attendances increases during the influenza peak seasons every year. In January 2015, the average daily number of A&E first attendances exceeded 6 500, which is 12% higher than the normal number of 5 800 and is on par with the number during the same period in past years. To alleviate the demand for A&E services, the HA had increased the quota for general outpatient clinics (GOPC) by 560 during Christmas holidays in 2014 and by 1 486 in this year's Lunar New Year holidays. The above additional quota represents an increase of 14% and 30% of service capacity in the respective period. Given the current keen demand for healthcare services, the HA will further increase the GOPC quota by 1 216 in February, and by 2 760 in March.

(13) In view of the challenges due to increasing service demand, the HA has endeavoured to continue to recruit different grades of staff including doctors, nurses, allied health professionals and supporting staff through various means. For doctors, there are about 5 500 doctors in the HA at present, with a shortfall of around 340 doctors. The HA has employed a total of 311 specialist doctors through the central recruitment exercise in 2014/15 and will continue to recruit additional ones in 2015/16 to strengthen doctor manpower. As for nurses, the HA has a shortage of about 500 nurses in 2014/15. It plans to recruit about 1 680 nurses to alleviate the manpower shortage, maintain existing services and implement service improvement measures. Subject to the supply in the labour market, the HA will recruit 300 additional nurses to address the surge in demand during the winter influenza season.

Ends/Wednesday, February 25, 2015
Issued at HKT 18:12


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