October 17th, 2015

Dear Flu Vaccine: Please Improve!

dog vaccineDear Flu Vaccine,

As the supply of you and your brethren have arrived in our clinics, on our hospital floors, and in pharmacies, I thought it would be a good time to reach out and tell you how to get better.

That’s right — here, free of charge, is  a to-do list for how you can improve.

Understand, I’m one of your top “boosters” (sorry for the pun), and of course I got mine this year — as I do every year. You’re better than nothing, after all.

But as a patient of mine refused his flu shot this past week — “it gives me the flu” he (wrongly) said — I became motivated to reach out and let you know exactly what you should start working on:

  • Become more effective. I’m sure you think that the less said about last year’s effectiveness the better, but really — 19% protection? That’s pretty lame, my friend! Your usual 60% protection seems kind of awesome by comparison, doesn’t it, and even that’s no great shakes. OK, ok, I realize it’s because the vaccine strains didn’t precisely match the circulating ones last year, but c’mon. You can do better than that. I know you can.
  • How about some durability? Let me list the number of vaccines we recommend to our patients every year.
    1) Flu.
    That’s it — you’re the only one. And you don’t want to be in this exclusive club. It’s no wonder that many people act like it’s tax day when you tell them that the flu vaccine is due. Again? Didn’t we do just do this, like, yesterday?
  • Give us fewer options. Must you come in so many different forms? It’s too complicated, like trying to choose a breakfast cereal in a big supermarket. Don’t you know that too much choice is paralyzing? Trivalent. Quadravalent. High dose. Regular dose. Attenuated intranasal mist. Recombinant egg-free. Free range and gluten- free. (I made that up.) Please, enough already. Even the vaccine experts at ACIP can’t (or won’t) make a firm recommendation. This is what they say: “For persons for whom more than one type of vaccine is appropriate and available, ACIP does not express a preference for use of any particular product over another.” Thanks, really helpful. Now what?
  • Be more reliably available. Supply is notoriously erratic. Sometimes the hospitals get flu vaccines first; sometimes the pharmacies; sometimes the community-based practices. Sometimes there are no vaccines for babies. There are shortages some years — then it’s like a new iPhone release, generating absurd lines — and too much supply the next, you can’t give the things away. This year it’s the nose spray vaccine — where is it? Next year it will be — who knows? Figure it out already!
  • Develop an easy, universal tracking system. People can get flu shots in so many different locations we have no idea whether our patients have received them. Doctors’ offices. Pharmacies. On the job. Pop-up “flu clinics” at the neighborhood mall, church-temple-mosque, community center. Toll booths and fast food drive-thrus (throughs?) will be next. While we like the widespread availability, it makes quality assurance programs all but impossible. Here’s an idea — how about a web site, igotmyflushot.org, where people can enter their name and date of birth, and electronically release the information to their doctors? Yes, I know it’s a great idea. You’re welcome.
  • Make it more understandable what you prevent. Email from non-MD friend:
    Friend: “Is there flu about? Wife has fever, nausea. Son too.”
    Me: “Yes there’s flu. But flu is mostly a respiratory illness — cough, sore throat, that kind of thing. Sounds like they have a stomach bug.”
    Friend: “Oh yeah. Both had questionable chicken tacos at State Fair yesterday.”
    Ok, maybe this misunderstanding isn’t really your fault. But somehow I believe that if you were more effective, the public would have a clearer understanding of what you prevent (on a good year) and what you don’t, and more confidence that they received something that works. Here’s what you prevent:  Influenza. Here’s what you don’t prevent:  Colds. Stomach bugs. Various other causes of fever. Is that so hard?

Remember, I offer the above suggestions even though I’m a strong advocate of getting the flu vaccine. It does work sometimes, influenza is a miserable illness, and frankly one could justify it solely on altruism — who wants to be the disease vector that triggered a hospitalization in a baby, a frail elderly person, or someone with a weakened immune system?

Still, there’s room for improvement. Ok, lots of room. And we can dream, can’t we? Just like the guy in the video below.


An Infectious Diseases Doctor with a Slightly Sore Left Arm (but it’s not too bad)

[youtube http://www.youtube.com/watch?v=gasAm4DIVsg&w=560&h=315]

3 Responses to “Dear Flu Vaccine: Please Improve!”

  1. Rod Gordon says:

    Great blog about the flu vaccine!! As far as tracking goes, in Alaska we now have program mandated by the State Dept of Epi called VacTrak, into which admin info must be entered by all who give vaccines within 14 days of the date of admin. Has worked great here! I like the idea of a universal way to do it too.. People move about so much, and Alaska is such a tourist destination. Would be great to know whether “visitors” have received their vaccinations too.

  2. Loretta S says:

    Agree with all you’ve said. I was one of the “lucky” ones who got my vaccine last year and still got the flu in January. Not an experience I want to repeat! But I’ve already gotten this year’s vaccine and I’m keeping my fingers crossed. I’m still a vaccine cheerleader. And nice touch, sneaking in a link to Louie’s adorable doggie face. Maybe Louie can convince all those doubters to get the not-always-very-effective flu vaccine: “Louie Sez: Get vaccinated and I’ll give you a big wet kiss!”.

  3. Sheldon Ball says:

    The influenza virus infects and replicates in ciliated columnar epithelial cells of the respiratory epithelium. [1] An effective vaccine thus should elicit IgA. Natural immunity to influenza results in IgA, IgG and IgM against the neuraminidase and hemagglutinin antigens of the virus. The current intramuscular vaccines elicit IgG and IgM. [2] They should effectively inhibit viremia, but not respiratory tract infection. But when there is money to be made, don’t let science get in the way of advertising.

    1. http://www.anvita.info/wiki/Influenza
    2. http://www.anvita.info/wiki/Influenza_Virus_Vaccine

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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