Global seasonal influenza disease and vaccination: a paradox with substantial public health implications

Bram Palache


Evidence of the global benefits of seasonal influenza vaccination has been collected in a multitude of studies over 50 years, from many countries and under many epidemiological conditions. WHO recommends the use of influenza vaccines for annual vaccination of specific at-risk groups. Despite the global recommendation, there is a wide held belief, including amongst health care professionals, that current influenza vaccines are only modestly effective. Since health authorities use national health data to define and implement national health policies, influenza vaccine effectiveness data often comes from national or local studies which are substantially affected by special and temporal epidemiological circumstances, such as antigenic match, extent of virus circulation, and pre-vaccination immune status of the study population. Still other countries, with insufficient influenza-related disease surveillance systems in place, fail to offer seasonal influenza vaccination, due to insufficient data, exposing persons at serious risk to otherwise preventable influenza infections and avoidable serious health outcomes. Rather than defer implementation of seasonal influenza vaccination, pending better local evidence of influenza vaccine benefits, it is proposed that the pool of available evidence on influenza vaccines, the “global file on influenza vaccines”, should be used as the basis for vaccination policies globally. This would make immediate the benefits from current influenza vaccines, for which the benefit-risk ratio is overwhelmingly favourable. The “global file on influenza vaccines” could be updated every 3-5 years, and could be utilized by health authorities for positive social media interactions and conversations with the public on the health value of seasonal influenza vaccination.

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