Healthy Skepticism Library item: 6418

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Publication type: news

Blackwell T.
Free flu vaccine fails to reduce cases study: 'Rates haven't decreased and there's been lots of money spent'
National Post 2006 May 2

Full text:

Canada’s first experiment in universal, free flu vaccine has cost Ontario taxpayers more than $200-million, but appears to have done nothing to cut the spread of influenza, a new study suggests.

Per-capita flu rates in the province have not fallen at all since the program was introduced in 2000, concluded the University of Ottawa research, published in the journal Vaccine.

In fact, the average monthly incidence of the virus jumped over the first five years of the program, though researchers say it is too early to say that numbers are really on the rise.

“All we do know is rates haven’t decreased, and there has been a lot of money spent,” said Dianne Groll, the University of Ottawa professor who led the study. “The program was designed to reduce the incidence of flu, and this hasn’t yet happened.”

The heavily publicized offer of free flu shots to all 12 million Ontarians was launched in 2000 to try to ease pressure on emergency wards from flu patients, and cut the incidence and severity of the illness.

Dr. Groll said it might be wise to focus on better targeting the vaccine at high-risk groups — the very young, the elderly and the chronically ill — perhaps by giving shots to anyone who comes into an emergency ward.

She also said the province failed to collect detailed “baseline”
information on vaccination patterns before the plan started or similar data since then to compare, making it difficult to thoroughly evaluate the program.

Some infectious disease specialists warned yesterday the study is seriously limited, partly because it compares the rates of laboratory-diagnosed flu before and after the program started. Cases that are confirmed by a lab test represent a small fraction of the total amount of flu and may not give a true picture of the situation, said Dr.
Allison McGeer, one of the country’s leading influenza experts.

The Ottawa research correctly and interestingly analyzed the data available but is “irrelevant,” concluded Dr. McGeer, infection-control officer at Toronto’s Mount Sinai Hospital and a strong proponent of universal immunization. She acknowledged there is simply very little evidence with which to evaluate the program.

“That we would publish this study is a marker of desperation.”

Dr. McGeer said there is other research, not yet published, suggesting the campaign has resulted in more chronically ill seniors being vaccinated and has reduced the seriousness of some illness.

The Ontario initiative, the world’s first universal flu campaign, distributes about five million vaccine doses a year at a current cost of
$50- to $55-million, including promotion, according to the Health Ministry.

Dr. Groll looked at the number of cases of laboratory-diagnosed flu reported to Health Canada between 1990 and 2005.

She found that the rate between 1990 and 2000, when the program started, was 109 per 100,000 Ontarians. After the campaign’s launch, it jumped to 164. The data was analyzed by Queen’s University statistician David Thomson, who concluded there are not enough statistics yet to prove the numbers are on the rise.

The researchers also found the Ontario flu rates did not change relative to other provinces. And, though the number of laboratory tests conducted has gone up, it has not increased compared with the rest of Canada.

Dr. Michael Gardam, infection-control specialist at Toronto General Hospital, also stressed the limitations of the study, noting the vaccine in one of the years after the program started did not match the strains circulating in Ontario.

Still, he admitted that emergency rooms at his hospital are no less busy and that “Ontario still gets flu outbreaks like anybody else.”

“The most we can say from this study is that clearly this program is not a home-run success,” he said. “If there is success, it’s subtle. If the results are that subtle, should the money be spent elsewhere? That is a very good question.”

Dr. Groll noted the campaign was instituted in 2000 without any “baseline” data — information on what sort of people were getting vaccinated before, how many of those got the flu and whether flu patients used hospital emergency wards.

Nor has such information been gathered since, making it very difficult to effectively evaluate the global vaccination plan, she said.

“The program just lacks the baseline information you would need — that anybody would need — before anybody put this kind of multi-million-dollar proposal together,” Dr. Groll said.

John Letherby, a spokesman for the Ontario Health Ministry, defended the flu program, though, saying it does have many “ancillary benefits”
apart from the impact on overall rates.

Those benefits include less emergency-room crowding and less absenteeism, but Mr. Letherby said the ministry does not itself collect such statistics.

tblackwell@nationalpost.com