Doctors, paediatricians and parents want the government to provide free flu vaccinations for all New Zealanders, particularly young children, as the country heads into the depths of winter.
They argue free influenza shots are a cost-effective way of easing the strain on hospitals in cities like Christchurch, where hundreds of people are turning up to the emergency department every day.
Pharmac was advised that children under the age of five would benefit from funded flu vaccines this season, but the drug-buying agency said there was not enough supply to widen access this year.
Hard-up Christchurch families who cannot afford to pay at least $20 per dose warn they will just have to hope for the best when winter bites.
"I feel a bit guilty not getting my kids flu shots, but at the same time, it's that or they eat. We basically live week to week. I think it's the same for a lot of young families," a mother-of-two told RNZ.
"It would be better if they were free."
An estimated 1.8 million people - just over a third of the population - are entitled to a free flu vaccine this year under Pharmac's widened eligibility criteria.
Pregnant women, Māori and Pacific people over 55, over 65s, people with long-term medical conditions like asthma and children aged four and under who have been hospitalised with a respiratory illness are covered.
Everyone else must pay for their own flu shot unless the fee is covered by an employer.
Papakura Marae Health Clinic GP Dr Matire Harwood said the vaccine was unaffordable for many families.
"Cost is a major barrier for people to get the flu vaccination. People struggling already post-Covid and lockdowns with poverty, loss of work, income issues, can't afford $25. That's petrol for a week for them to get to work," she said.
"I'd love to see the government expand our current flu vaccination programme."
Many Australian states have made flu jabs free for everyone over the age of six months in a June vaccination blitz.
Pharmac operations director Lisa Williams said clinical advisers told the agency children under the age of five would benefit from free flu vaccines.
"Unfortunately, the quantities of flu vaccine to be brought to New Zealand had already been set for 2022, and there was not enough of the flu vaccine specifically for use in children under three years of age to support widening funded access for them this year," she said.
Williams said Pharmac's immunisation advisory committee considered options for wider access to the vaccine at its May meeting.
"Options for widening funded access to the influenza vaccine will be assessed and ranked against all other medicines or vaccines also being considered for funding," she said.
Starship Hospital paediatrician Professor Cameron Grant warned the flu could leave children in intensive care or even kill them, but vaccination at least halved the risk of hospital admission.
"I think this coming winter is a time of great concern for anyone working in child health in New Zealand," he said.
"We're very worried about the potential for measles and whooping cough and influenza. It could be a really, really difficult time. The hospitals are already very stretched."
He said New Zealand had higher hospital admission rates for childhood respiratory infections than Australia, England and the United States, yet did not routinely immunise children against influenza.
Professor Grant is also in favour of free flu shots for all New Zealanders and wants the vaccine permanently added to the childhood immunisation schedule.
"I can only imagine that it's a matter of cost. I don't think there's any scientific justification for it not being on our schedule," he said.
At the very least, the Immunisation Advisory Centre's Dr Emma Best said, the flu vaccine should be free for all children under the age of five.
"More than half of children hospitalised with influenza haven't actually got an underlying condition, they were previously healthy," she said.
"Having a vaccine that costs money is a barrier to families when they're trying to work out their budgets and prioritise. It should be free."
Best said high vaccination rates among children helped to protect other members of their whanau and the wider community.
Ministry of Health data shows 807,585 people have so far been vaccinated against the flu, or 16 percent of the population.
Influenza all but disappeared in New Zealand over the last two years because of border closures and other Covid-19 restrictions, but cases are now on the rise.
More than 700 people turned up to Christchurch's Hospital's emergency department last weekend and doctors have seen a further 380 in the days since.
Around 30 percent of people were admitted, leaving the hospital at 112 per cent occupancy with more patients than staffed beds and forcing surgery deferrals.
Canterbury District Health Board said an average of 200 staff had been off sick with Covid-19 every day for weeks, in addition to high levels of sick leave taken by employees for other illnesses and to care for dependants.
Influenza hospitalises thousands of people and around 500 die in a typical year, according to the ministry.
Symptoms include fevers, chills, muscle aches, a runny nose, cough and stomach upsets.