Flu vaccine: high take-up is essential

Europe is bracing itself for a challenging flu season. The scale of what lies ahead for health services was encapsulated by Prof Sir Malcolm Grant, chairman of the National Health Service in England, who noted that health chiefs were "more scared than they have ever been".

The reason for alarm is a particularly difficult flu season experienced by Australia’s health system during its southern hemisphere winter. People were hit by two separate types of influenza: A (H3N2) and B. By the end of September more than 137,500 cases of flu had been reported – more than double the 53,159 cases confirmed by the same time last year.

The main reason for the severity of the Australian epidemic is that the H3N2 component of this year’s southern hemisphere flu vaccine has been shown to be relatively ineffective. The vaccine being administered in the Republic contains the same strain of A (H3N2), prompting concerns about its likely effectiveness.

For production reasons the components of our northern hemisphere annual flu vaccine are chosen by the World Health Organisation in February. It requires a certain element of educated guess work on the part of experts. Most years the vaccine is about 50 per cent effective; however, the latest figures from Australia suggest a vaccine effectiveness of 33 per cent.

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HSE director general Tony O’Brien has referred to research suggesting the northern hemisphere experience in the coming flu season will be different: regardless of the strain of flu, he suggests, the vaccine among older people and those at risk is 50-60 per cent effective in preventing hospitalisation and 80 per cent effective in preventing death.

However, mounting concern about the knock-on effects of a severe flu epidemic on an already struggling health system, rather than the effectiveness of this year’s influenza vaccine, is the core issue. A long-standing shortage of intensive care beds in the Republic could become a choke point for the health service in the event of a severe flu outbreak, as some flu victims will require ventilation in order to overcome the acute viral infection. There are concerns that cancer surgery – as well as the annual seasonal curtailment of elective surgery – will need to be cancelled for a period of up to 10 weeks.

There is little that can be done in the short term to remedy decades-old deficiencies in the public health service. However, the HSE must work to ensure the highest possible influenza vaccination rates in the weeks ahead. The value of the vaccine in reducing the severity of illness in those who contract flu must be promoted. And health service staff, whose vaccine uptake in the past has been notably poor, must show leadership by getting the jab themselves.