Influenza prevention failure worsens during 2020

One of the first commissioned Influenza (influenza) The vaccine trial was conducted in 1942 in 8,000 psychiatric patients at two hospitals in Michigan.

It was unconventional, To say the least.

A research team at the University of Michigan School of Public Health, led by Dr. Thomas Francis Jr., was funded by the U.S. Army during World War II to help U.S. soldiers abroad with years of research in Francis vaccine science. Prevention that can be done.

The team’s influenza vaccine was given to tens of thousands of Army specialized training program participants in a double-blind, placebo-controlled trial between 1943 and 1944. The effectiveness of the vaccine was so important that it was ordered in 1945 to be given to all members of the US Army.

However, in reality, Francis, Soak, and colleagues administer the vaccine to institutionalized patients before exposing 100 patients to the flu itself to reduce the time it takes to observe the effectiveness of the vaccine. I did it only a few years ago.

This story contextualizes how desperate the country was in responding to the flu, apart from serving as yet another anecdote of the non-ideal values ​​that underlie important moments in history. I have.

The country had sent troops to Europe for the first time in 30 years for World War II, and the fears learned from the beginning signaled their new steps. The epidemic and devastating spread of the 1918 influenza pandemic through US camps during World War I was as memorable as the Western Front, or mustard gas. Defense had to be prepared to mitigate everything faced.

Francis, a young man in the midst of a 1918 pandemic, did not have to remind himself of what was at stake for the military as well as for society when assessing the flu vaccine for the first patient. .. A pandemic that can kill millions and affect billions without warning or discrimination, as he experienced, is of relatively greater risk to solve than other medical problems. there is.

The memory of the first epidemic of our time goes beyond the conscience of the people of 2020. Nor is influenza recognized as a threat but preventable disease.

In responding to this year’s pandemic, the era showed indifference, if not contempt, to the issue of influenza.

Response failure

Writing has been on the wall for months now. Experts have warned of what an uncontrolled coronavirus 2019 (COVID-19) pandemic will look like in the winter months since summer. In particular, they emphasized the combined effects of the unchecked influenza season: “twindemic” was a popular term for matching events.

However, given that the first pandemic vaccine is still undergoing Phase 3 trials, social distance and masking practices to reduce the potential for a combined effect of COVID-19 and influenza. Only the flu vaccine could be added. 2020-21 season.

The medical system played a role. Vaccine makers, including AstraZeneca, produced more than 25% of their annual flu dose this year.Chain pharmacy Walgreens and CVS have launched a television advertising campaign for influenza vaccination In mid august.. And experts, already overwhelmed by the demands of COVID-19 messaging, have returned to the long-standing challenge of advocating vaccines and educating those who have been hesitant for many years.

“More than ever this year, reducing respiratory illness with influenza vaccination is a key factor in public health,” said hospital epidemiologist and infection prevention doctor Dr. Saskia Popesque, MPH. Told to sister publication Contagion®.. “Patients with respiratory symptoms that are not specific to the already stressed healthcare system will put more strain on supply, staffing, and even testing capacity. If that burden can be reduced as much as possible. , Must do so. “

Little came from the population itself, due to all this preparation leading to the most suffering flu season in modern history.

As of early November, only 49% of adults in the United States have been vaccinated for this flu season. Survey data from research institute NORC At the University of Chicago. Another 35% said they would not be vaccinated.

The percentage of self-reported vaccinations is up 5 percentage points from the 2019 data reported by NORC, and the percentage of the most at-risk age groups over the age of 60 is at a new high of 71%, but investigators Seen the same old line explaining vaccine hesitation in an important part of the US population.

More than half of the respondents who did not plan to get vaccinated said that any of these reasons helped their decision.

• Concerns about vaccine side effects (63%)
• Belief that vaccines are not effective (65%)
• Concerns about getting the flu from the vaccine (60%)
• They have never had the flu (57%)
• Belief that they are very unlikely to get sick with the flu (54%)

“Unfortunately, I think many people don’t take these infections seriously,” said Caroline Pearson, senior vice president of NORC. HCP Live®.. “That’s disappointing.”

Some of the main reasons for avoiding the flu vaccine are falsely informed, totally false, and vaccinations not only for patients but also for homes and communities. Some of the idea of ​​good protection is inherently selfish.

Pearson shared the frustration felt by many public health professionals on the issue of many who still believe that vaccine-induced flu can actually get sick: popular and unfounded. How would you describe your fear?

The local and requested effects of annual influenza vaccination, such as malaise, pain at the injection site, and mild fever, are sufficient to perpetuate this growing myth, at least among the population. Supports sex.

“In reality, it doesn’t matter if people think they have the flu or just have bad side effects,” Pearson said. “People don’t want to feel sick, and they really don’t want to get sick, but they don’t want to feel sick as well.”

In addition, there continues to be a lack of understanding of how influenza vaccines benefit people beyond their overall protection from the virus. People “do not fully understand” the benefits of vaccines to reduce the risk of hospitalization and serious illness from the flu, Pearson said. It’s just the false idea of ​​providing complete immunity from infection.

“Forks doesn’t really seem to appreciate the advice,” Pearson said. “The challenge is that no one thinks the worst consequences will happen to them.”

The issue of COVID-19, where so many legislators and public health authorities acted as a rally for influenza vaccination, could actually exacerbate the problem. Only about one in five people who oppose influenza vaccination say they avoided direct vaccination because of the social distance from the pandemic. Many others may be refraining from vaccination to point out that it is linked to the COVID-19 debate, Pearson said.

“Like many aspects of our society, as stakes went up this year, everyone’s preconceptions solidified,” Pearson said.

In some cases this year, influenza was not a serious problem in public health and was recognized as a point of comparison in the pandemic debate.

Wrong equivalence

Much of what was understood about SARS-CoV-2 very early in the pandemic was that it was a respiratory infection that generally spreads through droplets and airborne transmission and presents with flu-like symptoms. was. Not surprisingly, even the general public and leaders have linked the two illnesses primarily as a way to know how to identify and mitigate mysterious viruses.

What was not intended from such an analogy was what happened. Comparison of risk assessments based on mortality, duration of illness, age and health suddenly downplayed the overall threat of COVID-19.

Indeed, the comparative conversation between influenza and coronavirus became so great in April and May of this year that scholars and public health officials began to fight false information as well.Perspectives published in JAMA Internal Medicine In mid-May, it simply stated that the average risk of death from COVID-19 increased 20-fold over influenza, based on CDC data that did not represent the current peak of pandemic-related mortality across the United States. I proved it.

“Authorities may say that SARS-CoV-2 is” just another flu, “but this is not true,” the researchers emphasized. “According to our analysis, SARS-CoV-2 mortality and seasonal flu mortality should be compared using apple-apple mortality, not apple-orange mortality. By doing so, the real threat to public health from COVID-19 is better demonstrated. “

This link between COVID-19 and influenza not only mistakenly downplayed the pandemic threat from the beginning, but also likened influenza to a non-threat respiratory virus. This is slightly worse than a common cold.

Meanwhile, the United States has just exceeded 300,000 deaths associated with COVID-19, and the majority of adult influenza vaccinations are not guaranteed.

“It’s a lot of misinformation, many people minimize risk, don’t understand the data, and obviously it bothers us,” Pearson said.

Impressive future

A year after the flu shot began, Francis was awarded the US Freedom Medal. Ten years later, Soak’s polio vaccine was released to the public and helped develop the field of vaccineology to new heights and capabilities.

Just 4 days ago, Pfizer and BioNTech have been granted an Emergency Use Authorization (EUA) for their mRNA vaccine BNT162b2 as the first indication vaccine to prevent COVID-19 in the United States. Immunization of health care workers and residents of care facilities began this week, with the hope of immunizing millions more Americans in 2021.

The story of the development and distribution of the COVID-19 vaccine is remembered as the biggest medical story that will occur in 2020. It can even be likened to the historic work of Francis and Soak one day.

However, contrasting acceptance of influenza vaccines, known and already available products that may have reduced the need for these miraculous COVID-19 innovations, is public health awareness and prioritization. Represents the shortcomings of this year’s trademark in.

Seventy-five years after the vaccine became available, the ongoing struggle from the United States to truly adopt an annual influenza prevention strategy seems unlikely to improve in the coming decades. As NORC observed, 51% of Americans aged 18-29 did not plan to be vaccinated this year.

Another 43% of adults with children under the age of 18 who live at home said they did not intend to vaccinate their children.

Pearson recommends influenza vaccination rates for children and young adults, primarily due to reduced risk of mortality / morbidity, widening the gap between the US health system and young adults, and the guidance of parents who hesitate to vaccinate. It remains the worst of all.

There is still an opportunity to learn lessons from COVID-19 about public health preparedness, physician-patient communication, and misinformation about vaccines, especially given the impediments to the distribution of new vaccines.

All three of these factors contribute to the ongoing challenge of prioritizing influenza prevention, and by improving them in potential next-generation patients, vaccines that are unmatched in decades. You can set a precedent for inoculation.