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Wednesday, 9 November 2011

Influenza immunization - the unspoken public health questions

Yes,  I recommend influenza vaccination and something that even healthy people should consider getting.   There are experts,  and back up experts, and other experts,  that have reviewed and combed the evidence  and keep coming up with the same conclusions.  So I shan’t bore you with the reasons.   You can have more fun looking at the anti-influenza immunization propaganda anyway. 
However, we have influenza issues in public health that need resolution.   First, time to stop overstating the problem and celebrating the success.  Without vaccine, some 4000 Canadians would die annually in an average year from influenza.  There is no doubt hundreds to low thousands may die each year, but the widespread use of vaccine, nearly one in 3 Canadians,  makes a huge difference to the hospitalization and mortality stats.  So the message should be influenza vaccine now saves thousands of lives in Canada in each and thousands more hospitalizations.  Where is the data that shows what good we are doing, not the bad that might happen if we don’t do it? Please stop saying that influenza kills thousands in the country annually, that is just not a factual statement anymore.
Supposedly,  H1N1 only killed 428 Canadians.   How do you reconcile the numbers to the public when we immunized 40% of the population and we say that influenza kills thousands in a normal year?  Of course we immunized so many and didn’t communicate the number of lives that were saved – Where are those numbers?  The public will likely never hear how the program was of benefit. 
There are legitimate science question about the vaccine and disease control that the experts will pose and seek answers, and the details of who, how, what and when may get refined over time.  The petty debates that are played out in the public eye contribute to distrust in the vaccine and the system. 
We have 2 and maybe 3 provinces doing universal immunization (Ontario, Alberta  - and Saskatachewan if the resident wants it).  How come we don’t have consensus on the value of the program after nearly a decade in Ontario? Will the politicians decide before the professionals do? Inconsistency is perhaps our greatest enemy. 
The system for delivery is so varied from public health to private practitioners.  Western provinces are moving to pharmacist delivery and where is that taking us?  Public health is great at building things and passing them along, is it time to put influenza vaccine almost solely into the hands of other providers? Are we hanging on to a dinosaur in wanting to retain mass public clinics? 
There are 8 different influenza vaccines now available and it is great that we now have multiple home grown providers.  Where is the proliferation of vaccine types taking us?  Does privatization of production have a cost along with its value?
Influenza vaccine needs to be provided to those who work with the highest risk individuals, yet we continue to play roulette with their lives when we allow non-immunized staff or others to set a foot into high risk facilities.  The vaccine is not great in those that need it the most, so we should use the old public health approach and build the circle of protection.
The Weather Channel, Google and others have developed more effective surveillance systems for public communication while public health practitioners have utilize the old stand-bys that are not as sensitive.  
The vaccine is changing the natural progression of the disease, and this is probably a good thing.   We in public health need to change with the times too.  Influenza will be with us no matter what. The major vaccination fights have been won and it is time to move on to other important public health issues and leave the operational delivery to others to maintain.     

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