Correspondence

National flu immunisation programme 2026 to 2027 letter

Published 26 February 2026

26 February 2026

Dear colleagues,

This letter is aimed at those responsible for commissioning and operationally delivering the NHS seasonal flu vaccination programme in England and provides national guidance for the 2026 to 2027 flu vaccination programme.

To help protect the most vulnerable and keep health and care services running during winter when respiratory viruses reach their peak, it is vitally important that we continue to increase the numbers vaccinated in all of the eligible cohorts. This will require continued collaboration across the vaccination system and NHS England (NHSE) will set out further detail on ambition and expectations ahead of the 2026 to 2027 flu vaccination programme.

Eligibility

There are no changes to eligible cohorts for the 2026 to 2027 programme. The following cohorts, based on the advice from the Joint Committee on Vaccination and Immunisation (JCVI), are announced and authorised to be eligible to receive a flu vaccination:

From 1 September 2026:

• pregnant women
• all children aged 2 or 3 years on 31 August 2026
• primary school and secondary school-aged children (from reception to year 11)
  • (individuals 17 years and over attending a special education needs (SEN) school and who are in a clinical risk group may also be vaccinated alongside their peers)
• all children in clinical risk groups aged from 6 months to less than 18 years (as defined by the Green Book, Influenza Chapter)

From 1 October 2026:

• those aged 65 years and over
• those aged 18 years to under 65 years in clinical risk groups (as defined by the Green Book, Influenza Chapter)
• those in long-stay residential care homes
• carers in receipt of carer’s allowance, or those who are the main carer of an elderly or disabled person
• close contacts of immunocompromised individuals
• frontline workers in a social care setting without an employer-led occupational health scheme, including those working for a registered residential care or nursing home, registered domiciliary care providers, voluntary managed hospice providers and those that are employed by those who receive direct payments (personal budgets), or Personal Health budgets, such as personal assistants

All frontline health care workers, including both clinical and non-clinical staff who have contact with patients, should be offered flu vaccine from 1 October as a vital part of the organisation’s policy for the prevention of the transmission of flu. Employers should make the vaccine accessible for all frontline staff, encourage staff to get vaccinated, and monitor the delivery of their programmes. Further communications from NHS England will describe operational considerations.

Social care workers directly working with people clinically vulnerable to flu should also have the flu vaccine provided by their employer. There are circumstances where frontline staff, employed by specific social care providers without access to employer-led occupational health schemes (see frontline workers eligibility above), can access the vaccine through the NHS free of charge.

Providers are expected to deliver a 100% offer to eligible groups. They should ensure they make firm plans to enable delivery of more vaccinations in the 2026 to 2027 season than they did in the 2025 to 2026 season. Providers should also ensure they have robust plans in place to identify and address health inequalities for all underserved groups, and we would like to see progress on reducing unwarranted variation and improving uptake.

Primary care providers are asked to prioritise the vaccination of 2 and 3 year olds as soon as the vaccine is available as this will help reduce transmission and protect those most vulnerable. To help support improvements in access and uptake, as for last season, some school-age immunisation providers will plan to deliver vaccines in nursery settings attached to primary schools for 2 to 3 year olds or deliver to this cohort in catch-up community clinics when appropriate. Guidance regarding the provision of vaccinations for 2 to 3 year olds in community pharmacies will be issued following the evaluation of the 2025 to 2026 season. See Annexe B for more about the eligibility of 2 and 3 year olds.

Timing

In line with the advice from JCVI, the start of the adult programme for 2026 to 2027 will continue to be 1 October. This start date is based on evidence of the waning of flu vaccine’s effectiveness in adults which means that it is preferable to vaccinate individuals closer to the time when the flu virus is likely to circulate. As flu typically peaks in December or January, this will provide optimal protection during the highest risk period, even in early seasons such as we saw in 2025 to 2026 season.

There are some exceptions to the October start date:

a) Vaccination of pregnant women should continue to be offered from 1 September.

b) Following clinical assessment, there may be a small number of other adults who would benefit from vaccination from 1 September. For example, for those who are due to commence immunosuppressive treatment (such as chemotherapy), having a flu vaccine before they start treatment would allow them to make a better response to their vaccination.

c) As flu circulation in children normally precedes that in adults, the children’s programme should continue to start from 1 September, or as soon as availability of vaccine supply allows. Protection from the vaccine also lasts much longer in children so the priority is to start vaccinating all children (including those in clinical risk groups), both to provide early protection to children and to reduce transmission to the wider population. Achieving early high uptake in the childhood flu vaccination programme has the potential to push down rates of flu in older adults through indirect protection. As the public health benefit of vaccination is greater in younger school children, where possible school-aged immunisation providers are encouraged to schedule vaccination in primary schools early in the season.

For adults and children eligible for the national vaccination programme, and all frontline health and social care workers, the majority of vaccinations should be completed by the end of November. This is to ensure that as many as possible are protected ahead of the winter months. Vaccination should still be offered after the end of November, as there is often flu activity in late winter. Vaccination after November is also important for those who have just become eligible for the national programme, such as those who have become pregnant or been diagnosed in an eligible clinical risk group. Vaccinations can be given up until 31 March.

All schools should have a first visit by the end of November with second visits completed by 11 December 2026. Catch-up opportunities should also be provided via a range of well publicised community clinics, accessible throughout the season. Additional school visits and community clinics may be considered beyond 11 December 2026 to improve vaccination uptake.

It is important that by the end of November, all those resident in long-stay residential care homes should have been offered a vaccination.

Employers should ensure all frontline health care workers are offered a vaccine by the end of November.

Recommended adult vaccines for reimbursement

Every year JCVI reviews the latest evidence on flu vaccines and advises on the type of vaccine to be offered to different age groups, see Table 1.

All preferred vaccines available for the 2026 to 2027 season are trivalent. The acronym IIVx denotes all inactivated influenza vaccines (IIV), regardless of how many virus strain antigens are included in the vaccine.

Flu vaccines are updated for each season to give protection against the strains of flu that are most likely to be circulating. The viruses in the vaccines for the 2026 to 2027 season will be updated as per the World Health Organization (WHO) recommendations for the Northern hemisphere ^{[footnote 1]}.

There have been 2 changes to the JCVI advice for adult flu vaccines for 2026 to 2027:

• in those aged 65 years and older, IIVc (cell-cultured) should be considered equivalent to allV (adjuvanted), llV-HD (high-dose) and IIVr (recombinant)
• in those aged 50 years to 59 years in clinical risk groups, IIV-HD can be used off-label

Table 1. Preferred adult influenza vaccines that will be reimbursed

Aged 18 to 49 years in clinical risk group (including pregnant women)	Aged 50 to 64 years (in a clinical risk group)	Aged 65 years and over
All vaccines are listed alphabetically. Order any of these vaccines: • cell-cultured (IIVc) • or recombinant (IIVr)	All vaccines are listed alphabetically. Order any of these vaccines: • adjuvanted (aIIV) • or cell-cultured (IIVc) • or high dose (IIV-HD) (licensed from 60 years of age but can be given off label to those aged 50 to 59 years) • or recombinant (IIVr)	All vaccines are listed alphabetically. Order any of these vaccines: • adjuvanted (aIIV) • or cell-cultured (IIVc) • or high dose (IIV-HD) • or recombinant (IIVr)

The egg-cultured influenza vaccine (IIVe) should only be offered to those aged between 18 and 65 as part of the national programme in circumstances where preferred influenza vaccines Table 1 are not available to order. IIVe will only be reimbursed as set out in section on reimbursement below.

In those aged 65 years and over, IIVe is not advised by JCVI and will not be reimbursed for use.

For those aged under 65, ahead of the flu season the JCVI preferred vaccines set out in Table 1 should always be ordered, and clinics should be planned using the JCVI preferred vaccines. Once the vaccination campaign has started, if providers need additional stock for those aged under 65, IIVe should only be ordered if the JCVI preferred vaccines are not available.

A list of all influenza vaccines marketed in the UK is available on GOV.UK.

Contractual requirements for all commissioned NHS flu vaccination providers states that to receive payment for flu vaccination and reimbursement of flu vaccine, they will need to use the JCVI preferred vaccines outlined in Table 1 for the appropriate cohort and administer vaccines in line with the announced and authorised cohorts. In addition, vaccines need to be offered and (ideally) administered at the correct time for each cohort. Please note that commissioners will actively recover any payments made if the incorrect vaccine is administered or if the correct vaccine is administered too early.

With the exception of frontline workers in certain social care settings (see eligibility section above, the vaccination of all other frontline health care staff (for example, those working in NHS trusts, primary care organisations or private sector health care organisations) will not qualify for payment or reimbursement. Frontline health and social care workers should be offered vaccines according to the age groups set out in Table 1 and in the Recommended adult vaccines for reimbursement section.

Recommended children’s vaccines

No changes were recommended by JCVI for children’s flu vaccines for 2026 to 2027 and all vaccines available are trivalent.

Table 2. Recommended flu vaccines for children

Children aged 6 months to less than 2 years in clinical risk groups	Children aged 2 to less than 18 years in eligible groups (including clinical risk groups)
Offer in the following order of preference: 1. IIVc 2. IIVe	Offer in the following order of preference: 1. LAIV (live attenuated inactivated influenza vaccine) 2. IIVc is recommended where LAIV is contraindicated or otherwise unsuitable (for example, parents object to LAIV on the grounds of its porcine gelatine content) 3. IIVe

The UK Health Security Agency (UKHSA) supplies all flu vaccines for the children’s programme and these will be available to order through ImmForm and are therefore not reimbursable. The latest information on ordering controls and other ordering advice for UKHSA-supplied flu vaccines will be featured on the ImmForm news page, both prior to and during the flu vaccination period. All parties involved in the provision of flu vaccines to children should ensure they remain up to date with this information at all times.

Further information

The influenza chapter in ‘Immunisation against infectious disease’ (the ‘Green Book’), gives detailed descriptions of the clinical risk groups and guidance for health professionals on administering the influenza vaccine.

See Annexe A for links to resources that will become available to support the 2026 to 2027 programme.

See Annexe C for information on vaccine uptake data collections.

NHSE will share operational considerations and further system guidance in due course.

Conclusion

Thank you all for your hard work in delivering the programme. The annual flu programme saves thousands of lives every year and reduces GP consultations, hospital admissions and pressure on A&E.

Yours sincerely,

Dr Thomas Waite, Deputy Chief Medical Officer for England

Dr Mary Ramsay, Director of Public Health Programmes, UK Health Security Agency

Caroline Temmink, Director of Vaccination, NHS England

Any enquiries regarding this publication should be sent to: immunisation@ukhsa.gov.uk and england.vaccination@nhs.net

For operational immunisation queries, providers should contact their regional NHS England Public Health Commissioner.

1. WHO Recommendations for influenza vaccine composition. Recommendations for Northern Hemisphere 2026 to 2027 are expected to be published late February 2026. ↩