On Flu Vaccine and the Elderly

Marc Siegel, MD
Marc Siegel, MD

I have written before about the flu vaccine and why I believe in it wholeheartedly yet do not believe it should be mandatory for health care workers. It is difficult for those in the media to grasp this grey area of medicine—useful, even essential, yet not mandatory. How can that be?

The answer is that the vaccine is effective, though not to the point of other vaccines such as measles, or hepatitis, or whooping cough, which are and should be mandatory in certain populations.

But the media is famous for not understanding the nuances of public health care. In fact, the latest news from the Centers for Disease Control, that this year's vaccine appears to be less than 60 percent effective at preventing severe flu symptoms, and only 9 percent with the elderly, has stirred the pot in the direction of denigrating what is still a useful vaccine.

For one thing, we know that the elderly have a diminished immune response, and especially in a year where a particularly nasty strain of the flu (which the vaccine covers) has hospitalized an almost unprecedented number of elderly patients, it makes sense to give those over 65 a second shot rather than no shot at all.

For another thing, if this flu vaccine is less effective in the elderly that's all the more reason for everyone around an older person to get vaccinated, creating a ring of immunity and decreasing the risk that flu will enter the house in the first place.

To be sure, we need to cut through the fear of flu vaccines, acknowledge their usefulness, and create newer, better ones. First, we need to widely adapt the cell culture flu vaccines that are catching on in Europe, to replace the antiquated hen-egg variety that still predominates here. Second, we need to plow ahead on research for a universal flu vaccine, targeting the M2 protein common to all flu. This vaccine, once successful, is likely to be one you can take once every ten years.

In the meantime, we need to promote compliance with the vaccine we do have; not over-touting it, but certainly not trashing it.