Should you have the flu vaccine?

The question of whether or not to have the flu vaccine confronts us every year. To some this is a non-question. They are either in the camp where they have the vaccine religiously every year without question or they are in the camp where vaccines are not welcome.

The battle with the anti-vax campaigners has been on going for many years and reached a crisis point when Dr Andrew Wakefield published a paper in 1998 that resulted in a vaccination scare. The paper he published was subsequently retracted and discredited. The impact on the population was enormous with a significant decline in vaccination rates because parents were scared of causing their children harm. Over time this has subsided but it has by no means gone away. Parents struggle to explain the symptoms of their child and quite often find a temporal relationship between a vaccination and the onset of an illness. This is particularly true of children with autism and also children with PANS PANDAS. There have been numerous studies that show very clearly that there is no link between autism and vaccination but the ant-vax campaigners keep knocking on the door and this clearly affects some parents. As a paediatrician I have to ensure that I give the best advice in the interests of my patients. That will continue but this year the landscape has changed, we now have COVID-19.

Normally, in the UK, 8,000 people die of flu each year. This year we are currently at around 50,000 deaths with COVID-19 and climbing. The final figure will be much higher without a doubt (and the figure for excess deaths is much higher). When the pandemic first started I estimated that without any intervention there could be in the region of 400,000 deaths in the UK from COVID-19. Others said that a figure of 500,000 was not unreasonable. This is why on March 23rd we went into lockdown. With lockdown, social distancing, common sense and a selfless attitude we can keep this figure below 100,000. Without all of those elements I fear the final figure will be much higher.

There is no vaccine yet but thanks to all those amazing boffs that we have, we may have a vaccine within the next 2-3 months and certainly within the next 6 months. These very clever people are working 24/7 and we really should be clapping for them every day. Whether the vaccine is effective, only time will tell. I hope so, because if it isn’t then our whole way of life will change. This is with a virus that has a 1-2% mortality rate.

We do however have a flu vaccine. Normally the flu epidemics in the southern hemisphere precede the northern hemisphere (because they have their winter whilst we have our summer and this virus is a seasonal infection). This year,because of lockdowns and social distancing, the southern hemisphere did not have a significant flu outbreak. Makes sense right? Ok, so what about the northern hemisphere? The news is not so good. I fear we may be heading into the perfect storm.

In the UK lockdown has been released, schools are back and university’s have restarted. I’m not going to go into whether this is right or wrong. The government has an incredibly difficult job in balancing the impact of the economy against deaths from COVID-19. The fact is, that is where we are. So, influenze will increase, most likely on a larger scale compared to the southern hemisphere. And what happens when you get both flu and COVID-19? The news again is not good. There appears to be some interaction between these two viruses that results in a doubling in the risk of death when you have both viruses. Here is a link so that you can read some evidence to support that statement (https://doi.org/10.1136/bmj.m3720).

This year, the difference is that we are not only having to consider the impact of COVID-19 and flu on ourselves  and our children but also on the wider population and the people that we care about. So should you have the flu vaccine? Absolutely 100% yes. There are only 30 million doses available in the UK so only one in two people will be able to get it. If you are offered it, please accept it. This is something that you can do that may have a positive impact on everyone.

There are of course sub-groups of patients where eg there might be an allergy and you can’t have the vaccine. I totally understand that but as patients and parents you will need to weigh up the pros and cons. I have seen some messages from my PANDAS patients (which is an immune mediated condition) and where they fear that giving a vaccine may result in a permanent deterioration in their childs symptoms. My experience is that any flare in symptoms with this group of patients can be managed using planned anti-inflammatory medication, ie that you can mitigate the impact. Compare this to getting the wild-type virus which is likely to create a much bigger inflammatory response and which will be unplanned.

This year the choice that you make with the flu vaccine will impact you, your family and the wider population. Choose wisely.