Dr. Rachel Herlihy is a preventive medicine physician and the deputy director for the Division of Disease Control and Environmental Epidemiology at Colorado Department of Public Health & Environment (CDPHE). In her current role, Dr. Herlihy oversees the Department’s Programs on Communicable Disease Epidemiology, Tuberculosis, Refugee Health, and Immunizations. Dr. Herlihy is the mother of a healthy, happy, fully vaccinated toddler.
We need a better influenza vaccine. Period. Many smarter and more well-positioned people than me have said this. Even the Centers for Disease Control and Prevention states the limitations of the vaccine: Efficacy varies from season to season and depends on the person being vaccinated. They have very good reasons to want a better vaccine, but I have my own:
I am a tired flu vaccine promoter and defender.
I support our nation’s universal influenza vaccination recommendation that nearly all individuals over 6 months should receive an annual influenza immunization, but it isn’t always easy.
I serve as the medical advisor to Colorado’s immunization program. In this role I frequently respond to inquiries from the media, clinicians, and general public about vaccines and vaccine preventable diseases. I’ve just started receiving the first calls of the season. These inquiries come in 2 flavors:
1. “Which vaccine should I get? There are so many choices.”
2. “Why should I get this vaccine? I’ve heard it barely works.”
Question 1 is increasingly difficult to answer. Add quadrivalent versus trivalent and egg based versus cell based to last year’s intramuscular versus intradermal versus nasal spray, standard dose versus high dose, and mercury-free or not. It is dizzying. For this question, I have the embraced the standard public health flu vaccine choice SOCO (single overriding communication objective), pronounced “sock-o”: “Just get one.”
But question 2 is the one that really tires me. I have my talking points, the same ones shared by many flu vaccine defenders. My first point: The reported 60% effectiveness of flu vaccines at preventing influenza illness is actually pretty good compared to other preventive medicine interventions. We would be jumping up and down if we could achieve such levels of effectiveness with obesity prevention, smoking cessation, and cardiovascular disease prevention. We’ve set the bar very high for vaccines. Are we expecting too much from influenza vaccines? I’m not sure, but I do know that I don’t have to make this argument for the measles vaccine, with effectiveness estimates of 95–99%. A better flu vaccine to promote would be much appreciated.
My second point relates to the endpoint we typically discuss with flu vaccines: Illness prevented. I frequently hear people say that the influenza vaccine is worthless for the elderly, given effectiveness estimates for illness prevention in that population. Not true. The flu vaccine does much more than prevent illness. It prevents influenza-associated hospitalization and deaths, especially among the elderly. For example, in February of this year, Talbot et al. at Vanderbilt published a study that reported that influenza vaccination reduced the risk of flu-related hospitalization by 71.4% among adults of all ages and by 76.8% in study participants 50 years of age and older during the 2011–2012 flu season. Based on Talbot et al. estimates, increasing flu immunization rates could prevent 100,000 hospitalizations a year. That’s a lot of saved morbidity, mortality, and medical expense.
As we head into another influenza season, I’m poised with my flu vaccine talking points, but it would make my life much easier if someone could finally make the holy grail, long lasting, universal flu vaccine a reality.