“Does the Vaccine Matter?”

Mike just blogged about this article in the Atlantic, which questions conventional wisdom about the effectiveness of influenza vaccination. I agree that the article is not to be dismissed as an anti-vaccine screed, as it balances discussions with both skeptics and high profile advocates of influenza vaccine (including Nancy Cox and Tony Fauci).

The title of the article (“Does the Vaccine Matter?”) grossly oversimplifies the question. I agree that estimates of vaccine effectiveness in the elderly are inaccurate, as they rely on imprecise outcome measures (death rates) and are confounded by variables associated both with receipt of vaccine and risk of death from all causes (see here and here for the references cited in the article).

But, as the article concedes, flu vaccine appears to effectively prevent symptomatic infection in the young and healthy. While these individuals are very unlikely to die from influenza, they are critical in sustaining influenza spread during epidemics. Blunting an epidemic by vaccinating as much of this population as possible will thereby reduce infections among the elderly and among other groups at higher risk for complications and death.

This begs the question—what is the best way to utilize a limited vaccine supply? Is it better to flood those population groups who are most likely to generate protective immunity and are most important in community transmission? Or should we concentrate on those most vulnerable to death from influenza complications, even if the effectiveness of the vaccine in that population is lower?


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