My analysis was based on 206 studies (several million observations' worth of data) included in systematic reviews spanning some 40 years. The hypotheses by Mandl do not fit some of the evidence in the elderly population.1 He cannot explain how in years of good matching between vaccine antigenic content and circulating viruses the vaccines fail to prevent deaths from all respiratory diseases in elderly community dwellers (1.32, 95% confidence interval 1.25 to 1.39, 426 668 observations) while at the same time preventing 42% (25% to 55%, 404 759 observations) of deaths from all causes,2 …