Bulgaria has a high-dose flu vaccine for the first time this season. There are 50,000 doses, free under the national programme for people over 75, Bogdan Kirilov, executive director of the Bulgarian Drug Agency (BDA), told BNT. The doses are going out to GPs' surgeries, and jabs have already started.
The first batch under the national programmes, 150,000 doses for children and people over 65, arrived late last week. It has been shared out and sent to GPs and paediatricians, and vaccinations have begun. Another 50,000 doses of a different vaccine arrived at the end of the same week.
Where it began: 150,000 flu vaccine doses arrive in Bulgaria for children and people over 65
The high-dose vaccine has a higher concentration of antigen, the substance the body builds its defence against, and is suitable for people over 65.
Flu vaccine deliveries are late overall this autumn. More than 200,000 doses have been imported so far. Pharmacies will be short of 125,000 doses, because one maker warned it would not supply them. They are still waiting for about 30,000 injectable vaccines.
About 400,000 doses were delivered under the national programme last year. About 540,000 are planned for this year, around 140,000 more. More deliveries are due to reach the planned total.
Kirilov puts the delay down to production problems, the change in the vaccines' make-up, and makers' decisions on how to split doses between markets. The make-up changes every year, and "what is specific to this year is that all three strains were different from the year before", he told BNT.
The World Health Organization and the European Medicines Agency give their advice on the make-up between the end of March and May. Kirilov says makers link their problems to these late recommendations, which stop them delivering on time before national campaigns. The production delay affects a large share of EU countries.
The head of the BDA says the delay does not come from regulatory problems in Bulgaria. The agency has acted together with other countries, because marketing authorisations are international and checks are done at the same time.
The Ministry of Health and the National Health Insurance Fund (NHIF) run the national campaign, and the BDA does not set its terms. As regulator, the agency is responsible for approving vaccines for use. Supplying vaccines to pharmacies is the duty of makers and holders of marketing authorisations, and Kirilov says the two channels should be kept apart.
EU countries get different amounts and types of vaccine, depending on their markets. Kirilov gave Greece as an example, where there are traditionally far more flu vaccines. It imports 3 to 4 million doses a year, and this year, according to public data, more than 3.5 million. Bulgarian pharmacies have limited amounts.
Makers need to explain why they deliver first to certain countries, Kirilov says. Of Greece, he told BNT: "That is, makers give priority to bigger markets. There are also differences in prices."
Several vaccines from three makers have been on sale in Bulgaria for years.
Anyone looking for a vaccine outside the programme should know that the law does not allow online sales. Vaccines are issued on prescription and are sensitive to temperature, so they are stored at 2 to 8 degrees. They go from the maker to the wholesaler, and from there straight to GPs, so that this storage regime is not broken. Kirilov said this chain must be followed.