Flu season is just around the corner and that means it’s time for everyone to get a flu shot. That’s a simple, easy-to-understand message. Yet, public-health officials in Canada seem to struggle with saying so in a straightforward manner.
Instead, we get muddled messaging, irrational funding policies and, unsurprisingly, poor uptake.
About 9.9 million Canadians got a flu shot last year – fewer than half of adults and a quarter of children. Officially, Canada’s stated goal is to vaccinate 80 per cent of two target populations against the flu – people over the age of 65, and everyone with chronic health conditions.
We do relatively well with seniors, with about 69-per-cent coverage, but poorly among those with chronic health conditions, 37 per cent. The flu shot is free for everyone in Canada, except in British Columbia, Quebec and New Brunswick. In our decentralized health-care system, there’s always an exception – or three. Why is vaccination universal in some provinces but not in others?
Quebec takes the prize for head-scratching public policy. It used to have universal flu-vaccine coverage, but this year decided to target high-risk groups only – seniors over the age of 75, children aged six-to-23 months, pregnant women and those with chronic conditions.
It even launched an ad campaign with the tag line: “When it comes to the flu, we’re not all the same.” This is a ridiculous approach.
There is no question that some people are at much higher risk of illness and death if they contract influenza. But who in the hell do we think they get the flu from?
Infections spread via family and friends, caregivers and strangers. So why would we discourage anyone from getting a flu shot, from becoming potentially infectious? One of the main reasons to promote universal vaccination – whether it’s for measles or the flu – is to achieve herd immunity, to have so many people vaccinated that a pathogen can’t get a foothold and spread.
This is important because, paradoxically, the flu vaccine is less effective for people in high-risk groups.
Presumably, targeted campaigns are implemented to save money. But there is no evidence they do so. Nor is there any evidence that provinces with targeted campaigns have a higher rate of uptake in high-risk groups. In short, these policies are a failure.
There are plenty of myths and misunderstandings about vaccination already; provincial health departments don’t need to add to the confusion with poorly thought-out campaigns.
No one is suggesting the flu shot is perfect. Its effectiveness varies from about 40 per cent to 60 per cent.
But that’s nothing to sneeze at when you consider that, annually, the flu causes an estimated 3,500 deaths, 12,200 hospitalizations and millions of workdays lost to illness.
Unlike other vaccines, you need to get a flu shot every year, because the virus mutates. This year’s vaccine protects against A/H1N1/Michigan, A/H3N2/Singapore and B/Colorado strains. We don’t know yet how good a match it will be.
Ideally, we need a universal flu vaccine, one that protects against all strains over the long term, as traditional childhood vaccines do. We’re not there yet, but there have been improvements.
For example, there are now high-dose versions of the flu vaccine that create a more robust immune response; these are particularly useful for seniors. There is also a quadrivalent vaccine (that is, targeting four different viruses) that protects against an additional strain, B/Phuket. It is generally given in long-term care facilities, as seniors are hit harder by B strains.
In addition to better product, we are stepping up our game on delivery of vaccines. We pay a lot more attention to minimizing the unpleasantness of the needle, thanks to initiatives such as the social-media campaign #itdoesnthavetohurt. (There is also a nasal spray version of the flu vaccine, used principally in children, but there is debate about its effectiveness, so it has fallen out of favour.)
The flu shot is also widely available in pharmacies, community health centres and workplace clinics, in addition to physicians’ offices. Unfortunately, there are dizzying sets of rules on what is available where. For example, in some provinces, pharmacists cannot administer high-dose flu vaccine, and in others it is given only in institutions.
Again, if we want to limit the ravages of the flu, we have to make the message simple, and access even simpler – we have to give it our best shot.