There is
not enough evidence to support the policy
of immunising people against seasonal flu,
an expert has claimed.
Given the huge resources involved in
yearly vaccination campaigns, an urgent
re-evaluation is needed, Tom Jefferson
says in the British Medical Journal.
Mr Jefferson said when he studied the
data much of the work was flawed and he
found little proof of the jab's merit.
BMJ editor Fiona Godlee criticised the
way the UK evaluated the merits and costs
of jabs and called for change.
The government's drugs watchdog, the
National Institute for Health and Clinical
Excellence (NICE), has already said it
would be happy to take over this job.
Ms Fiona Godlee said: "The problem is
that the UK has no transparent process
for evaluating the effectiveness or cost
effectiveness of vaccines.
"NICE would like to take this on. The
government should let it."
Currently, the Joint Committee on Vaccination
and Immunisation (JCVI), an independent
expert advisory committee first set up
in 1963, does this.
Policy versus evidence
In the UK, experts say groups most at
risk, such as the elderly, should get
the vaccine during the flu season.
But it is difficult for scientists to
make the vaccine because the influenza
viruses mutate and the strains circulating
vary from year to year.
This also makes it difficult for scientists
to study the precise effects of vaccines,
said Mr Jefferson, who works for the Cochrane
Library - a body that determines the relative
effectiveness of health interventions.
He said the most reliable way to judge
their effects was to use systematic reviews
- impartial summaries of evidence from
many different studies.
But when he did this, he found flu vaccines
had little or no effect on many influenza
campaign objectives such as hospital stay,
time off work, or death from influenza
and its complications.
Most studies were of poor quality and
there was little evidence on vaccine safety.
Mr Jefferson said: "There is a misfit
between the evidence and policy, and tax
payers ought to ask why."
He said it was possible that some of
the sickness labelled as flu was actually
due to other infections, which would cloud
the picture.
Best guess
This is compounded by a lack of accurate
and fast surveillance systems that can
tell what viruses are circulating in a
setting or community within a short time
frame.
In the hurry to prevent sickness and
deaths, vaccine campaigns begin before
more precise information about the circulating
virus is available, he said.
"Given the huge resources involved,
a re-evaluation should be urgently undertaken,"
he said.
Last year's flu campaign cost £115 million.
Dr David Salisbury, director of immunisation
at the Department of Health, said evidence
showed flu vaccines could give up to 80%
protection from infection and prevented
hospitalisations and deaths.
He acknowledged that the vaccines were
not perfect, but said: "We are hopeful
that new vaccines currently in development
may overcome some of the concerns raised
about efficacy."
He said the JCVI's work was open to
public scrutiny and that the committee
would consider Dr Jefferson's research.
Dr Douglas Fleming, director of the
Royal College of GPs' Flu Unit, said:
"We need to support the flu vaccination
programme.