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Bring science back into the discussion of influenza vaccination.
That is the essential message of a controversial report on flu vaccination by the Center for Infectious Disease Research & Policy (CIDRAP) at the University of Minnesota in Minneapolis. While supporting flu vaccination as providing “moderate” protection from disease, CIDRAP says U.S. public health authorities have focused too much on expanding the uptake of the existing vaccine and not enough on promoting the development of a better vaccine.
CIDRAP lobbed its biggest indictment at the Centers for Disease Control and Prevention and its Advisory Committee on Immunization Practices (ACIP) for overstating the effectiveness of the vaccine and relying on expert opinion while failing to acknowledge the weak scientific basis for many recommendations.
“There was such an emphasis placed on getting more people vaccinated that they lost sight of the [question] of ‘How well do these vaccines work?’” says Michael Osterholm, PhD, MPH, director of CIDRAP, former Minnesota state epidemiologist and lead author of the study.
CIDRAP calls on the U.S. government to declare that development of a new influenza vaccine is a “national priority” and to provide financial resources to make that a reality.
“It’s going to take at least a billion dollars, if not more, to get a new influenza vaccine that will work more effectively than the current one. There is no financial source even close to supporting the vaccine at that level,” he says.
From 2005 to 2011, the United States spent about $2 billion to develop manufacturing capacity for the influenza vaccine – but none of it on a novel, “game-changing” version, he says.
Overstatement of the effectiveness of the current vaccine essentially creates a barrier to moving forward, he says. “We have basically frozen in time real progress toward a game-changing vaccine,” he says.
Other issues raised in the report include:
* The impact of health care worker vaccination on influenza transmission. ACIP asserted that the recommendation for HCW vaccination had the highest quality evidence (category 1A), but CIDRAP found that two of four studies cited did not provide support with statistically significant results and two provided “some support.”
* The use of the nasal vaccine (live attenuated influenza virus or LAIV) in adults. A CIDRAP meta-analysis of randomized controlled trials found that the efficacy of the nasal vaccine was 83% for children ages 6 months to 7 years, but there was no evidence of efficacy in those 8 years to 59 years of age.
“The single most important currency that public health owns is trust,” says Osterholm. “We owe it to the public to tell them exactly what we know and we don’t know.”
For the full story on this important issue see the January 2013 issue of Hospital Employee Health