Free flu vaccine fails to reduce cases

http://www.canada.com/nationalpost/news/story.html?id=a3febc68-8863-4a2c-802f...


Free flu vaccine fails to reduce cases
study: 'Rates haven't decreased and there's been lots of money spent'


Tom Blackwell
National Post


Tuesday, May 02, 2006


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.

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