Universal Flu Vaccine Recommendation May Be Coming

The time may soon come when doctors recommend that every American man, woman and child be vaccinated every year for influenza — an idea offered Wednesday by a leading expert in vaccines and preventive medicine.

Dr. Gregory Poland, director of the Vaccine Research Group at the Mayo Clinic in Rochester, Minn., testified Wednesday at a meeting of the Advisory Committee on Immunization Practices (ACIP), the subcommittee at the Centers for Disease Control and Prevention that issues federal recommendations for the use of vaccines in the United States.

In his testimony, Poland recommended that the United States should move to a so-called "universal recommendation" for vaccination against influenza, the virus that causes the flu.

A universal recommendation would make official that Americans of all ages should receive an influenza vaccination every year. The testimony came at a time when the committee is considering a smaller step of recommending that all school-age children receive a yearly vaccine.

"I think it's a good idea to expand [vaccination] to all school-age children," Poland said. "But a better idea is to say, 'let's not just go age group by age group; let's just recommend that everybody get it.'"

Review of recent changes in the CDC recommendations shows that ACIP has been steadily increasing the indications for a flu vaccine for several years. Current estimates are that more than 70 percent of the U.S. population now meets one of the 15 published criteria for recommendation of a yearly flu vaccine.

"We've changed the recommendation every year or two since '97," Poland said. "It's sort of a creeping incrementalism."

Instead of marking out ever-increasing numbers of groups that should get the flu vaccine yearly, Poland espoused a universal recommendation that all Americans should be getting the shot, with particular emphasis on vulnerable groups.

"Let's just make a universal recommendation — that all Americans should get vaccinated. But then note that there are particular high-risk groups that should be particularly recommended to get the vaccine."

How Do You Deliver 300 Million Vaccines?

Such a move would not come without difficulty. Currently, less than 40 percent of America's 300 million people receive yearly flu shots — and many of those for whom it is recommended do not receive their immunizations.

Other vaccine experts pointed out that any effort to vaccinate all Americans would face many logistical hurdles. Concerns included the availability of enough flu vaccine for the entire American population and the lack of a public health infrastructure to deliver that many vaccines.

"If a universal flu vaccine is recommended, it would need a plan," said Ira M. Longini Jr., a professor in biostatistics and biomathematics at the University of Washington School of Public Health. "Right now, if you look at vaccine supply, we can't make 300 million dose of vaccine and get them to the right people. Even if we could make enough dose, we would need to put in place a program to reach everyone."

A move to vaccinate everyone could also face significant financial hurdles.

"Who is going to pay for all of this?" asked Dr. William Schaffner, chair of the department of preventive medicine at Vanderbilt University. "For example, we know that there are 40 million people who don't have medical insurance. Who is going to get the vaccine to those people?"

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