Belief not science is behind flu jab promotion, new report says

BMJ 2012; 345 doi: (Published 19 November 2012) Cite this as: BMJ 2012;345:e7856

Re: Belief not science is behind flu jab promotion, new report says

I was disappointed to see this news item, which misrepresents the CIDRAP report.

The author has fallen for the "Nirvana" or "Perfect solution" fallacy: the idea that if a solution isn't perfect, it should not be implemented.

The CIDRAP report does say that the currently available flu vaccines are not so good that we should be complacent enough to not fund better vaccines. But the report acknowledges that the vaccine does have a useful role in preventing serious disease.

The vaccine is "good enough" to be worth using as it is in the UK. It is not so good enough for us not to be looking for a better vaccine.

Problems with the current vaccine are well described in the report:

- There is inadequate evidence that it is effective in old people (which may or may not mean that immunosenescence means it is ineffective. We do know that it is much more effective in younger people - part of the reason for the proposal to vaccinate children against flu (though not before autumn 2014) is that children act as very effective vectors for flu and other respiratory infections: they are more infectious than adults when ill, and they remain infectious for longer.

- Because of the constant mutation of the parts of the virus targeted by current vaccines a new vaccine is required every year or so; so an annual vaccination programme is necessary.

- Even in younger age groups the vaccine is not as effective as we'd like it to be (which is NOT the same thing as saying that it is not effective enough to be worth using - that's the Perfect Solution Fallacy).

- An ideal vaccine could not only be given only once (or at worst, with a priming course and then no or only very occasional boosters); but it would also be given without requiring the injection that seems to put people off. It goes without saying that it should - like the current vaccines - also be extremely safe.

So there is, as the CIDRAP report says, good reason to be working on better vaccines.

The BMJ piece picks up on concerns about mandatory flu vaccination. This seems to fail to recognise that the report relates to the situation in the USA where in some states or hospitals mandatory vaccination of staff is required.

There is no proposal that flu vaccination should be mandatory for health care staff in the UK, so concerns about this are misplaced.

Readers may be interested in my - rather hastily written, but referenced - blog on this "Dont rubbish flu vaccine just because it's not perfect", and in the much better piece on the NHS Choices web site .

Competing interests: I have received honoraria for attending vaccine "boards" (which gather experts to discuss vaccine policy), and expenses to attend professional conferences. I am editor of Vaccines in Practice magazine, which is supported by Wyeth Pharmaceuticals.

23 November 2012
Peter M B English
Public Health Doctor
Chessington, Surrey