Mayo Clinic Vaccine Researcher Calls for Universal Flu Vaccine for Elderly

Gregory Poland, M.D., Mayo Clinic vaccinologist, pleads for the universal influenza vaccination of the elderly (individuals 65 and older) in an editorial entitled, "If You Could Halve the Mortality Rate, Would You Do It?" to be published in Clinical Infectious Diseases Aug. 15 (published online for subscribers only July 19). The study he editorializes finds that influenza vaccination of elderly patients in three HMOs over two flu seasons reduced the mortality rate by 38-50 percent.

Dr. Poland says that an important responsibility rests with physicians and health-care systems in achieving high influenza vaccine-coverage rates in the elderly.

"Sadly," he says, "the data at hand lead to the undeniable conclusion that health-care providers as a whole may actually be a barrier to preventing death and hospitalization due to complications of influenza. Physicians and health-care systems have been aware of the benefits of the influenza vaccine, as the advantages have been repeatedly demonstrated in high-quality clinical and population-based studies for at least two decades. Despite long-standing national recommendations that make influenza immunization the standard of care, progress in improving influenza coverage rates has been unacceptably slow at best, taking decades to achieve coverage rates of 60 percent."

Dr. Poland compares the health-care community's slowness to promote the influenza vaccine among the elderly to the rapidity with which he believes it would take action against the HIV virus.

"If an equally safe and effective vaccine to prevent HIV infection were available next month," Dr. Poland asks, "would it take us decades to offer it to 60 percent of the at-risk population?"

Dr. Poland offers several potential strategies to achieve universal influenza vaccination of the elderly:

* Standing-order programs that allow nurses to screen and immunize patients for influenza and pneumococcal disease without a physician's order in hospitals

* Development of clinic office systems designed to increase immunization rates, such as reminder systems, flu clinics and standing-order programs

* Reimbursement by Medicare and other third-party payers for the cost of the vaccine and its administration

* Insurance of adequate influenza-vaccine availability and new vaccine development by academic investigators, manufacturers and federal agencies, such as the FDA and the NIH (e.g., a safe and effective nasal spray vaccine)

Dr. Poland's editorial sounds a serious warning to the medical community about the state of influenza vaccination of the elderly and possible consequences of failure to improve vaccination rates.

"We must devise and learn how to achieve high influenza immunization rates for the eventuality of the next influenza pandemic and for the possibility of bioengineered influenza used as a bioweapon of mass destruction," Dr. Poland says. "Now is the time to get it right and begin the process of saving thousands of lives."