Strictly Politically

Health Secretary Andrew Lansley has now confirmed that a majority of pregnant women have not had flu jabs:  more than 70% remain unvaccinated.   Given the low immunity and raised vulnerability of this women expecting babies this is a very serious concern.

In past years there has sometimes been a mixed message on flu shots from midwives and others who were worried that any vaccination in pregnancy would be inadvisable; but now, just as this unsubstantiated concern is (thanks to better professional training) beginning to recede, the Conservative Health Secretary has sanctioned a situation in which the normal annual public health promotion for flu jabs has disappeared.   Lansley says:

We decided not to institute an autumn mass advertising campaign to encourage flu vaccination, because this would have wastefully focused on the entire population when only at-risk groups are being invited for vaccination…  GPs have been inviting those at-risk groups to receive the flu vaccine since October, and the lack of an advertising campaign this year has had no discernible impact on uptake of flu vaccine. 

Maybe it all depends on what you mean by ‘at-risk groups’. 

As early as 2002  Government health advisers reported that vaccinating babies (one to four year-olds) could cut health costs by preventing flu epidemics and the expense of treating them.  Indeed,  they also noted American research suggesting that if four out of five children aged six months to 18 years took up the flu vaccine the incidence of the disease within the general population would fall by 91%.  The recommendation in the United States since 2008 has been one of universal vaccination for children ages six months of 18 years, thereby reducing both illness and health costs.

In 2002 however the risk of flu to small children was regarded in the UK as less significant than the risk to older people, and there was a reluctance to pursue this idea. 

But the strain of H1V1 in 2010/11 is thought to be dangerous for even healthy children, so with the incidence of infection in under-fives almost doubling in the first week of 2011, is this group not also ‘at risk’?. 

Other research suggests that vaccination, already recommended for pregnant women to reduce their risk of influenza complications, also gives the added benefit of protecting infants from influenza virus infection up to six months – the period when infants are not eligible for vaccination but are at highest risk.

In short, there is every reason to promote flu vaccination for a wide range of people, some of them very vulnerable to the infection.   David Salisbury, the Department of Health’s director of immunology, may claim it is extremely difficult to get out the message that at-risk people under 65 benefit from being vaccinated in the same way as over-65s; but the obvious response to that is, more actively promoted public health information, now.

Infant mortality, even more than other indicators, is regarded as a measure of the health of human populations and, when it rises, of state failure; it is an indicator of a country’s level of health or development.

Andrew Lansley’s predecessors have recognised that they have an active role to play in promoting flu vaccination.  Lansley, by his own admission (above), ‘decided’ not to go down that road.

If Lansley’s claims that saving money has not been a greater priority than preventing avoidable infant and other morbidity and mortality have substance, he needs to spell out very quickly the whys and wherefores of his decision to pass responsibility (and the buck) for flu vaccination onto GPs.

This is not, to reference the harsh judgement of some commentators, alarmist for the sake of it.  In the recent words of Registrar Zana Ameen, a medical doctor whose three year-old daughter was tragically taken by the illness:

I can’t think of any medical reason not to make the [flu] vaccine available to young children. The only reason can be cost.