Expert insight

A Smart Dose of Flu Shots is Direly Needed Worldwide

4 December 2014

The case has been made time and again: the annual flu shot saves lives. Around 3 to 5 million people suffer from severe flu each year and it is estimated 5% to 10% of people die as a result. Children, pregnant women, healthcare workers and the increasing number of people who live with chronic diseases such as heart disease, diabetes, and asthma are most vulnerable and therefore at risk of suffering from flu.

Impfung bei einem ArztSome countries are making great strides to ensure that each flu season more people get vaccinated. However, many countries are still failing to meet the most basic levels of services: vaccine coverage rates of 75% of the elderly, as recommended by the World Health Organization. During the 2010-2011 flu season, coverage rates among the elderly were reported to be as low as 10% or less in some European countries (Poland, Estonia, and Latvia).[1]

In a period when there is so much talk of Universal Health Coverage and resilient health systems, why is there little focus on reaching the 75% influenza coverage rate agreed a decade ago by all 194 countries at the World Health Assembly?

Systematic global data on influenza vaccine coverage rates do not exist. Therefore, since 2008 we periodically analyze seasonal influenza vaccine distribution. We know it’s not perfect, but it gives a very good year on year gauge of the extent to which flu vaccines are used in 157 countries. The latest study “Seasonal influenza vaccine dose distribution in 157 countries (2004–2011)” shows a huge variation and disparity between countries and regions. It does not automatically boil down to differences between richer and poorer countries, as there are also huge disparities within the same WHO regions.

While different countries have different health priorities and associated policies, including those for influenza prevention, the health benefits of influenza vaccines should be not ignored during policy planning. Policy measures include increasing knowledge, addressing attitudes and practices among doctors, nurses, and other healthcare providers, and designing communications programs targeted to those who are the most vulnerable to seasonal flu.

An interesting finding from the study tells us that current distribution rates of influenza vaccines are in striking contrast to the global efforts for pandemic preparedness. Only about half of the global vaccine capacity for a northern hemisphere seasonal influenza vaccine was being utilized in 2011, and even less for a southern hemisphere vaccine. This could potentially compromise pandemic flu preparedness, as the logistic and manufacturing capacity of the countries remains untested.[2]

Global efforts to prepare the world to deal with a new pandemic (including manufacturing, stockpiling, and system preparedness) require huge investments and considerable resources allocated to multi-year projects. These efforts and investments are indeed necessary, and as a result health advocates analyze whether all those involved in these efforts are meeting their obligations. But how can we square this focus on emerging influenza pandemic with the lack of attention given to underutilized, cheap and existing seasonal influenza vaccines that protect vulnerable patients against an annually recurring high burden of disease?  In terms of the impact to people’s lives and reducing the economic burden of flu, season flu vaccination is essential and worthy of more attention than it receives. What’s more, if we don’t have resilient seasonal flu vaccination programs in place; we won’t have the necessary systems in place to manufacture and roll out vaccination programs in the eventuality of a flu pandemic.

Given the annual burden of seasonal flu, the ample scientific evidence on the safety and benefits of seasonal influenza immunization and the recommendations by the World Health Organization, it would make sense for the public health community to take stock and re-evaluate how best to implement seasonal flu vaccination programs to reduce suffering and costs at a huge scale on an annual basis.

[1] Eurosurveillance 2014 –

[2] Palache et al. 2014; Partridge et al. 2013


  • Abraham Palache