Q&A: Walgreens Flu Index Shows 130 Percent Higher Overall Dispensing, Signals Early Start to Flu Season

Australia also experienced their highest flu season in 5 years, which may foreshadow a bad flu season in the Northern Hemisphere.

To Anita Patel, PharmD, recently appointed Vice President of Pharmacy Services Development at Walgreens, the Walgreens Flu Index is giving us cause for concern about the upcoming 2022/2023 flu season. In this exclusive Q&A, Patel breaks down the latest information on how the Flu Index has changed over the past 9 years, why it is critically important to get vaccinated for COVID-19, Flu, and overcoming “vaccine fatigue.”

Q: During the 2022 and 2023 flu season, how much of an increase has there been in flu cases compared to 2021 2022?

Anita Patel, PharmD: There's a couple things that we're seeing with the Walgreens Flu Index.

It measures the rate of dispensing flu antivirals, which is great. It gives us an early indicator of what's happening with flu season itself… there's 2 interesting things that we're seeing within the index: the first is that we're seeing (compared to last year) 20-times higher antivirals being— that becomes the first indicator that this season is already started— and that we're well underway. These are numbers that we would normally see in the January through March time, because that's normally when we start seeing flu really begin to uptick.

The second really interesting thing that we're seeing in the index is a rapid increase over the last couple of weeks. So, if we look at the data from about two weeks ago, we're over 130% higher in terms of overall dispensing, which tells us two things: 1) we've got the season happening much sooner, and 2) we're in this steady uptick in terms of the rate and how quickly it's beginning to move across the country.

Q: Does it differ in different parts of the country or is it everywhere?

Anita Patel, PharmD: So what we see with flu, typically, is it beginning to start in the Southeast. And that's exactly what we're seeing this year. So if you look at our data from the last couple of weeks, we've seen week over week, it beginning to spread up towards the North. And that is pretty typical in terms of flu in general, starting in the southeast and then moving across to other areas of the country.

PT Staff: Oh wow, 130% is a rapid Increase!

Anita Patel, PharmD: We're really concerned this year. People are normally used to using the months of September, October, and November to get their flu shot. And flu shots are of course, the number one way for people to be able to protect themselves. This year with the season starting so much sooner, it's not a time to wait to get vaccinated. So more than ever, it's important that people go and get vaccinated now because it's not to protect you for flu that's going to come it's to protect you for flu that's already here.

Q: Is there a specific reason the season is starting so much earlier?

Anita Patel, PharmD: This is information that we've been watching very closely. We do know that with flu (and the patterns of flu), we glean a lot based on what's happening in the Southern hemisphere, and specifically Australia. We did see Australia have a more earlier flu season, so we anticipated that this was something that we'd be challenged with.

We did start having vaccinations for flu offered a little earlier this year as well, as early as August is when we started really encouraging people to get protected against flu. That early data from Australia also shows us that it was the highest season in the last 5 years that we've seen so far. So that's another really concerning data point for us. We don't know exactly how the season is going to pan out but learning from what happened in Australia. We are very much concerned and want to stay vigilant and make sure that people get protected and get vaccinated.

Q: Is this year’s uptick from a lack of masks? Less pandemic restrictions?

Anita Patel, PharmD: So that's a combination of things—it is the fact that we're seeing an early season, and Wwe also are seeing people doing things, really getting back to pre-pandemic measures. So, we're no longer wearing masks, we're no longer social distancing. Those are all having an impact and people are moving around. We also are more concerned with what's happening in terms of the timing for this. This is holiday season; I have 3 kids. And we're really excited to see my elderly grandparents, and they're going to be interacting. So when we think about flu and flu impacting those that tend to be very old (those that are at high risk, and kids) it's really important right now for everyone to be able to get vaccinated get protected, to make sure that as we move into this holiday season that we're safe.

Q: Are there certain ages or conditions where the vaccine is more prioritized?

Anita Patel, PharmD: It's critically important for everyone over six months of age to get vaccinated against flu. As we think about hospitals being overburdened with Respiratory Synctial Virus (RSV) and COVID-19 cases/hospitalizations, those that are very young, and those that are very old, tend to be the main callers.

But really everybody should be getting vaccinated this year. In addition, we're not just worried about flu, right? We've got COVID-19 and new strains in circulation and making sure that you've got your updated code booster is also critical component here.

Q: Do you see flu activity increasing beyond the 2022/2023 season? Where do you see activity in 5-year’s time?

Anita Patel, PharmD: in terms of flu, it's hard to be able to predict. And every flu season has been different. We know that it's going to peak, and we know that it will be severe for certain population groups. It just varies season to season. It's really hard to try to predict outward, over the next few years, what's going to happen because the viruses just continue to change. And this is where our vaccines also taped. So making sure that we've got vaccines that are a great match to the virus, and every year (seasonally, routinely) coming in to get a flu shot just helps to build that protection over time.

Q: Do you anticipate a vaccine that can combine both normal flu and COVID-19 protection?

Anita Patel, PharmD: I would love to see that happen. We are watching what's happening in terms of research and development for both flu and COVID-19 vaccines, and there's been a lot of talk over the last decade about having a universal vaccine, like that is that ideal blue-sky state, where you can get the same shot every year to have a level of protection that lasts over time.

And then with flu and COVID-19, there's already research underway to try to combine those two viruses into one shot making it easier for people to stay protected. But we're not there just yet. And this is where it gets really complicated. We recognize that there is a level of vaccine fatigue. We've talked a lot about hesitancy in this response, but really we're also combatting, right now, the idea and the feeling of “hey, I'm just tired. I don't want to get another shot.”

This is where the messaging and education [comes in], until people really absorb what's happening. We have this very strange season where we've got 3 viruses, we've got 2 vaccines that can be provided in 1 visit—where you can at least get protected for the viruses that you can keep yourself protected against—and there's also research that we're paying very close attention to [that is] for a vaccine that can help against RSV.

We have hospitals across the country filling up with kids who are being hospitalized with RSV. So having this vaccine also in our arsenal, to be able to help protect people in the future, is going to be another one for us to have.

Q: How does RSV specifically differ from COVID-19 or the normal flu? Can they be confused?

Anita Patel, PharmD:. It's sort of like a sniffle season, where you come in and you're not going to necessarily know which one of these viruses you have. And they all they all tend to have common symptoms, which makes it really hard to figure out which one you have (and how to care for yourself.) Getting the vaccines for COVID-19 that are right now available and getting a vaccine for flu (which is also available is really important) can give you protection against those 2 viruses. [But] in the future, the other virus we're worried about as RSV, and especially in kids. How do you ensure that you get protected? Well, if there's a vaccine for that, we can add that to what we have to help people stay healthy…

Q: How does the Flu Index work?

Anita Patel, PharmD: The Flu Index is really measuring how much we're dispensing in terms of antiviral drugs. So it's an interactive tool— it allows us to look right down to a county level, and to understand what's happening with flu based on those dispensing rates. We've had the Walgreens Flu Index up and going for about 9 years, so we have had a lot of experience and been able to learn about how to use the data to help inform what's happening and drive awareness—and also promote flu prevention within communities as flu emerges.

Q: How has the flu changed over those 9 years?

Anita Patel, PharmD: We've had a lot of progress in terms of how we're showcasing the data. And what we're learning, in terms of comparing the index to what CDC is reporting as well (to see how far off it is), is that it's actually been able to capture patient visits since these respiratory pathogens that are happening. And we're able to show slightly in advance where flu could potentially go.

It's actually matching CDC’s data. We've grown a lot in the index [and] in our ability to project and understand. We're able to use it as a surveillance tool to really help communities understand when flu is heading their way.

What's most important is what do you do with that information. So again, getting vaccinated, understanding that flu has started and understanding when it's coming to your community can be some of the information points you can use to ensure that you get vaccinated and right now, everyone should be getting vaccinated because of the weight spreading based on the data in the Flu Index.

Q: How would you recommend that pharmacists use this index for immunization purposes within community pharmacies like Walgreens, among others?

Anita Patel, PharmD: The Flu Index is an interactive tool, making it really easy to understand what's happening within your community. I think there's 2 major ways that the index can be used: 1) understanding when flu is heading your way, and 2) With that information, ensuring that we're really encouraging people and educating people on the importance of getting vaccinated so that they do get those important shots in arms.

In addition, once you do get sick and if you get sick, ensuring that you have the right medical countermeasures, the right pharmaceuticals, available to help so these are the antiviral drugs that have been around for a really long time—and they have been proven to be effective against flu [or] at least decreasing symptoms, and that those are available and can be dispensed as needed.

The other piece of this is really understanding where dispensing can happen in a way that if you test a patient and they have the flu, that pharmacists can write that prescription and make antivirals available. So with that test-to-treat concept, some states are allowing it to happen. And really making sure that we're ready to go and being able to help communities when flu emerges, both from protection as well as treatment is how we should be looking at it in terms of the field of pharmacy.

It's never too late to get a flu shot. The importance of getting the flu shot, getting protected, (also getting updated boosters and even catching up on routine immunizations) is more important now than ever to make sure that we stay healthy.