In Public Health, Defending The Status Quo Isn’t Good Enough

Public health programs, which is to say their funding, are under assault by Il Trumpe and the Republicans (WORST BAND NAME EVAR). Recently, they announced they would cut programs that track and combat infectious disease in other countries–for those of you keeping score at home, this is really, really stupid. It’s important to defend these programs. But that’s not enough. We have many public health needs that are not being met; here’s one (boldface mine):

“My colleagues who are over age 65, everybody wanted basically the Fluad or the Protein Sciences vaccine, Flublok,” said Dr. Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota. (Fluad, made by Seqirus, contains an adjuvant; Flublok is produced in insect cells.)

The pickiness of flu experts underlines a truth not widely known to the general public: There are a host of different kinds of flu shots, and not all are created equal. In fact, in an incredibly crowded sector, four companies offered a total of 12 different influenza vaccines this year, bringing to market roughly 152 million doses.

The proliferation of products, many of which have a tweak or two on the standard three-in-one shot used for years, has left some people wondering whether public health officials should do more to steer flu vaccine consumers towards Vaccine X or Vaccine Y

But influenza experts at the CDC argue they aren’t in a position to indicate a preference for some vaccines, because there simply isn’t much evidence to say with certainty that the vaccines people believe are more protective truly are….

Late next week the CDC is expected to release interim estimates of how well flu vaccine is working this year, and will follow up at the end of the season. But those studies aren’t large enough to assess how each individual brand of vaccine performed; they would need to be substantially larger to generate enough data to answer those questions, said Osterholm, who argued for increasing the sample size to prize out detailed effectiveness information.

I would be very surprised if we had enough [use] in our network to actually look at those two specific vaccines this year,” lamented Alicia Fry, head of epidemiology for the CDC’s influenza division.

This is not an abstract, pie-in-the-sky question (though we should answer more of those too!). Thousands of people die every year from influenza. If we can improve the efficacy of our vaccination strategy, then we should do so. This is one example, but all across our public health system (and food safety system as well), we have unanswered questions that need answering. We need to fight for these too.

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