There are three things that frustrate the public about the flu shot:
1) You need to get it every year;
2) It tends to offers only partial protection;
3) It's delivered with a needle – and people don't like needles.
So, ideally, what we need is a flu shot that is universal, long-lasting and that isn't a shot.
The good news is that scientists (and, yes, even big bad pharma) are on it.
The bad news is that it's going to take time because influenza viruses are wily and the human immune system is complicated.
Yet, we shouldn't let the quest for the holy grail of a painless, flawless vaccine distract us from the fact that scientific knowledge and vaccination technology have both been getting steadily better since the first flu vaccine was developed in the early 1930s.
Until the virus was isolated in 1933, it was widely believed that the flu was caused by bacterial infection. The discovery that there were different strains of influenza viruses did not come until 1940.
Over the years, the vaccine evolved from a shot with a single strain that didn't change from year to year to one that protects against up to four strains, bolstered by a monitoring system to try to match the vaccine strains to those that will be circulating in the population six months hence.
It's a complex cat-and-mouse game with a virus that mutates routinely and does so in an environment where mutations are getting easier and more frequent.
Human influenza strains tend to emerge from poultry and swine and, in many parts of the world, these animals are raised in proximity to humans and large population centres. Not to mention that a new flu strain that emerges in China can now be carried around the world in a matter of hours.
We should also bear in mind that the vaccine itself is safer than it's ever been. Vaccines are now produced in highly sterile conditions. Bacterial contamination was once commonplace, so it was not unusual for vaccination to make people sick – with a totally unrelated pathogen. For decades, it was also common practice to reuse needles, so infections were inadvertently passed on from person to person. Someone getting a flu vaccine, for example, could end up with hepatitis B.
It is ironic that one of the most common fears of the flu vaccine is that it contains thimerosal, a mercury-based preservative, when, in fact, the additive has made the shot safer. And, to be clear, the preservative is used only in multidose packaging, to prevent contamination, not in individually packaged flu shots – which is another innovation that is gaining in popularity.
Because needle-phobia is such a predominant concern, especially among parents of young children, it should be noted, too, that needles today are increasingly thin and less painful, and there are numerous pain attenuation measures that are now promoted in highly successful social media campaigns such as #itdoesnthavetohurt.
There is also a constant search for needle-less alternatives such as nasal spray vaccines – though there are currently mixed reviews about the effectiveness of a popular product for children called FluMist – and products that use pressurized air to "inject" powdered vaccine without breaking the skin. All of these developments remind us that there has been steady scientific progress over the years which, hopefully, will get us to a painless universal flu vaccine.
The bottom line is that the flu vaccine is only about 50-per-cent to 70-per-cent effective, even when there is a good match with the circulating strain and, most frustratingly, works the least well in people who most need the protection, such as the frail elderly and people with chronic conditions like COPD.
But some protection is better than no protection – it reduces the severity of illness and the likelihood of transmission. Which is precisely why the healthy should get flu shots – "to protect your granny," to state it in vernacular terms.
No, the flu vaccine is not perfect – far from it. But we shouldn't let the quest for perfect prevent us from embracing good.
Nor should we get so hung up about the vaccine's makeup and its delivery system that it blinds us to the grim reality that the biggest impediment to reducing the carnage inflicted by the flu is not technology but human foibles.
Stated bluntly: No matter how good a vaccine is, it's not worth much if people don't actually get vaccinated.