Europe falling short of flu targets

All but one European country are failing to hit the World Health Organisation (WHO) target of immunising 75% of its older citizens against influenza, the first EU Flu Summit has heard.

The WHO set the 75% as a minimum goal in 2003 but only the Netherlands met the target during the 2010/2011 flu season.

“In 2011, most of the European countries do not even come close to the WHO recommended vaccination rates, despite European health care systems being amongst the best in the world,” said Dr Ab Osterhaus, Head of Department of Virology, Erasmus Medical Centre Rotterdam, the Netherlands and Chairman of the European Scientific Working group on Influenza (ESWI).

He said influenza still claims more lives than traffic accidents, especially among the risk groups, which include the elderly and patients with chronic diseases like asthma, COPD, diabetes, heart disease.

The European Flu Summit, which took place in Brussels, was organised by ESWI and agreed that collaboration with Northern American countries could help improve immunisation rates.

Bringing the vaccines to the people

In the US, officials had been aiming for 80% immunisation rates but recently shifted to a new goal of universal vaccine coverage. The approach there, said Dr Arnold Monto of the University of Michigan is much different to the European strategy.

“We’ve taken the view that you’ve got to bring the vaccine to the people rather than bringing people to the vaccine. So you’ll find vaccination in the workplace, in shopping malls, and even in airports,” he told journalists at a media workshop after the formal summit.

Pharmacists also play a major role in vaccination in the US, something European pharmacy groups would like to see on this side of the Atlantic. WHO and European Commission representatives at the summit said partnership between health authorities and healthcare groups will be important if Europe is to reach its 75% target.

However, the role of GPs will remain central to immunisation campaigns. The conference heard how French authorities had decided to bypass GPs during the H1N1 flu pandemic in 2009 because they did not wish to put too much pressure on family doctors. However, Dr Monto described this as “an absolute disaster” resulting in very low coverage.

Lessons learned

The 2009 pandemic took experts by surprise, the conference heard, primarily because most scientists and health authorities were watching for avian viruses emerging from Asia. They expected to have time to put response plans in place before the virus moved west but, as it turned out, the virus was of mammalian origin and was first identified in America.

“The big fear was that it would come from Asia. All our planning was based on dealing with an Asian virus, probably of avian origin. Nobody expected it to begin on America,” said Prof Derek Smith of the University of Cambridge.

The experience has made authorities more vigilant in responding to potential threats wherever they may occur in the world.

Dr Osterhaus said transparency is one of the lessons learned from the H1N1 pandemic and noted that ESWI is upfront about their members’ links with industry.

“It’s virtually impossible not to work with industry. The public sector has basically pulled back from making medicines. We as scientists – if we really want to make a difference and see new medicines taken to large trials and ultimately reach patients – we have to cooperate with industry,” he said.

Flu: a severe disease

Research on public attitudes to vaccination after the pandemic has also been instructive, according to Dr Monto. He pointed to a study showing that 38% of parents who decided against vaccinating their children did so because they feared side effects. 33% were concerned about getting another serious illness from the vaccine, while 31% did not trust the advice they were getting from public health officials.

He said flu is too-often trivialised because most people make a full recovery. This, said Dr Monto, misses out on the large numbers of patients who suffer severe bouts of influenza.

“Flu is a severe disease; it’s not the common cold. We need to communicate over and over again that flu is a severe disease.” He added that flu outbreaks bring a hidden economic cost by increasing the number of days that parents are missing from work and children are missing from school.

Vaccination still best option

Dr Monto told the media workshop that vaccination remains the best strategy for battling seasonal flu and against any future pandemic strain that might emerge.

He said antiviral medicines can be effective in severe cases but giving prophylactic antivirals is not cost effective. In addition, Dr Monto warned that resistance to antiviral medicines is also a concern.

Discussing the effectiveness of vaccines, he noted that while clinical trials have demonstrated good efficacy, observational studies are underway to confirm effectiveness. Dr Monto said observational studies may play a greater role in determining the effectiveness of flu vaccines in light of the US recommendation of universal vaccination coverage.

“It’s going to be hard to do clinical trials given that the recommendation [in the US] is for universal coverage. How could you get approval for a randomised clinical trial where some people are in a control group [and therefore not vaccinated] at a time when experts agree that everyone should be immunised?”

Role of the media

The role of the media in getting the right message to the public was repeatedly highlighted during the press workshop. While scientists view the media as having a responsibility to disseminate public health information, most commercial media outlets see their primary role as producing interesting content for readers.

Journalists have no interest in being inaccurate, but they need quick and clear information – something which can cause tensions with scientists keen on presenting a complex message about the range of permutations in how a pandemic might spread.

In summarising the presentations given at the summit, Dr Osterhaus gave an overview of a presentation by Dr Hanns Neubert, Chairman of the EU Science Journalists Association. He said Dr Neubert told the summit that journalists need authorities to be more transparent. At the same time, he acknowledged that the media have their own set of conflicts of interest in that they must meet the demands of their audience rather than the demands of public health officials.

Dr Neubert also reportedly highlighted the difference between specialist science journalists and general reporters who often cover ‘big’ stories like flu pandemics. Many of the tensions that arise between scientists and the media come when science hits the front page.

Dr Monto, of the University of Michigan, said experts face a dilemma when reporters call looking for quick comments. “The press wants certainty but it’s not always possible for scientists to give certain answers.”

Europe’s flu season ends

Major disparities in flu vaccine coverage

Read more about how the composition of the seasonal flu vaccine is decided