Effect Measure

Flu and the vaccine mismatch

The simultaneous news of widespread flu and the mismatch of two components of this year’s seasonal vaccine (see here and here) seem to have synergized. That’s not so good in the view of many flu experts, who believe (correctly) that it leads to a misunderstanding of how the vaccine works (or doesn’t):

Flu experts and public health officials don’t like it when the strains in the flu vaccine aren’t an optimal match to the circulating viruses. They know elevated rates of sickness and influenza-related deaths may result.

But they dislike the headlines almost as much, fearing the black-and-white nature of the reporting will undermine fragile public confidence in the value of flu shots.

“It is often portrayed as a kind of `on’ or `off’ kind of thing. There’s a match or there’s a mismatch. And in that kind of situation, it’s a very discomforting presentation for the public health community,” says Dr. Keiji Fukuda, co-ordinator of the World Health Organization’s Global Influenza Program.

“There is always concern we’re really setting up a situation where people would say: `Oh, why should I get something which is worthless?’ “(Helen Branwell, Canadian Press)

The issue is not just one of misinformation, however, it is one of credibility and trust. “Get your flu shot” has been the public health mantra, but there is a lot we don’t know about the efficacy of the vaccine. In this case it is possible, even likely, that even a mismatched vaccine will afford some protection. This, at least, is what advocates of getting the vaccine believe. Or is it hope? We should know after the flu season is over. Meanwhile I got both a flu vaccination and a pneumovax. I don’t know if it works but everything I know about it tells me it should work. So I had no hesitation in getting it. I would advise you to get it, too. I know from experience that many of you won’t. I think that’s foolish, but everyone makes their own decision about this.

Meanwhile, as Helen Branswells article points out, not everyone in the flu community likes the idea that we know about the mismatch:

Given the complexity of the situation, some public health officials would prefer not to talk about mismatches and sub-optimal vaccine efficacy at all.

Dr. Michael Osterholm is director of the Center for Infectious Diseases Research and Policy at the University of Minnesota. CIDRAP, as it is better known, runs an infectious diseases news operation; its writers were among the first to report on the vaccine mismatch this year.

“I actually received a fair number of negative e-mails from colleagues and public health officials for the articles that we first published in CIDRAP on the lack of protection from this year’s vaccine,” Osterholm acknowledges.

“All we did is just told the truth. We just said what was happening.”

I rarely disagree with Mike Osterholm and this time isn’t going to be an exception. I think he is exactly on target. Not telling the whole truth is a much greater threat to credibility than the occasional mismatched vaccine.

The most powerful arrow in the quiver of any public health official is credibility. If it is squandered people will die. It’s that simple.

Comments

  1. #1 Snowy Owl
    February 25, 2008

    Salutations Revere,

    Maybe it is the time to use what we have in our closet for the time being.

    Traditional & Alternative Treatments,
    Eastern Traditional Treatments,
    Alternative Medicines Library

    Snowy

  2. #2 M. Randolph Kruger
    February 25, 2008

    Revere-In your opinion do you think (BF notwithstanding) that they’ll get it right next year. Doesnt this mean our friends in the S. Hemisphere are going to have to deal with flu basically unprotected at all this “year” for the bugs that are heading south for our summer and the beginning of their winter?

    I mean jeez look at New Zealand last year. They were hauling kids off in body bags and it wasnt even bird flu. UHC and all things being equal I am sure they gave and got flu shots right? Was it that badly off the mark?

  3. #3 revere
    February 25, 2008

    Randy: Yes, I think they’ll get it right. They usually do. Bad flu seasons happen and while the peds deaths in Oz were dramatic they were not that numerous. And UHC still requires care seeking behavior. It means if you want to be vaccinated you can be.

  4. #4 miso
    February 25, 2008

    Well at least, by accident or design, the vaccine included coverage of the Tamiflu resistant strain. That will have helped in reducing the incidence of the H27Y mutation in the U.S., and makes the vaccine useful in bird flu hot spots.

  5. #5 miso
    February 25, 2008

    Should of course read “H274Y mutation”.

  6. #6 Immunologist
    February 28, 2008

    Snowy, I suppose I must concede the finite possibility that some naturally derived or traditional remedy may in fact prove efficacious (think quinine for malaria). That being said, I rather take my chances on the estimated 40% efficacy of a partially mismatched vaccine than on the vastly smaller probability that such things as you have in your closet will prove effective.