11 June 2021

The Guardian: “The endless hunt for the perfect flu vaccine”

One way to better protect older people is to vaccinate an entirely different demographic: schoolchildren. This notion was elegantly demonstrated in a natural experiment in Japan. From 1962 to 1987 most Japanese schoolchildren were vaccinated against influenza; at one point the vaccine was mandatory for a solid decade. The vaccination rate grew to around 85%, but the mandatory vaccination programme was discontinued in 1994. Over the next several years, there was an increase in the number of deaths in elderly people during the flu seasons. In the US, where there had been no change in the vaccination policy, deaths of elderly people over the same flu seasons remained unchanged. Vaccinating one part of the population, in other words, benefits another.

Jeremy Brown

This topic has lost much of its urgency with a far deadlier virus causing worldwide havoc, but some of the findings can prove insightful for dealing with this pandemic. The debate around school closures was fierce in many countries. Many claimed that young children do not spread the virus, based on the fact that they rarely develop symptoms; some countries even failed to test children to obscure results that would contradict those assumptions. This has been disproven whenever actual studies were performed, and a parallel with influenza further reinforces this often neglected point: protecting children from infection indirectly protects their families and social contacts, including old relatives who are most vulnerable to both influenza and COVID-19.

In fact, widespread measures against the coronavirus, such as mask wearing and social distancing, have almost eliminated the winter flu season. And the mRNA vaccine technology employed successfully against the coronavirus may lead to the development of the long-sought universal flu vaccine.

Flu virus collage
Composite: Ersoy Ermin/Alamy

The article makes another great observation about the state of the US heath care system and an American mentality that has contributed to its poor pandemic response: the belief in a single, hi-tech miracle cure (vaccines), while neglecting other low-tech measures that would have significantly reduced spread before vaccines became available (quarantines, travel restrictions, universal mask wearing, frequent testing and contact tracing).

This is the overriding approach to healthcare in the US. They are always ready to do more, to try the latest medications or surgical procedures, because, well, why take a chance? Compared with other western countries, the US does more invasive studies of the heart for patients with chest pain, without actually improving their outcomes. We in the US put more of our patients into the intensive care unit, even though they are, on average, less sick than their counterparts abroad. We give more chemotherapy to cancer patients near the ends of their disease, even though it improves neither the quality nor the length of their lives. We do these things because we can, because to do otherwise would be considered giving up – even if doing less would be an extremely sensible and kind decision.

Influenza is not cancer, and it is not heart disease. But the US approach to it is emblematic of the way it treats most diseases: doing more is better. If there is an unexhausted option, exhaust it. And because many vaccines have had spectacular success in preventing and eradicating some ghastly infectious diseases, the expectation is that the influenza vaccine will do the same. It’s another hi-tech solution. To most people, the word “vaccine” is tantamount to a guarantee that a disease will leave you alone.

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