• Angela Tufvesson - Hong Kong

1Q5A: Making the case for universal flu vaccination

In the US, influenza vaccination is recommended for the entire population, while in some others countries it is limited to at-risk groups. Professor Larry Sperling, US-based founder of the Emory Center for Heart Disease Prevention, advises universal influenza vaccination.

(PART 2 of 5) Re:solve Global Health’s latest Q&A series examines the positive association between influenza vaccination and cardiovascular health. We asked five experts in diverse locations, and from varied backgrounds, including cardiology, pharmaceuticals, and health economics, to answer this crucial question: How can we make best use of influenza vaccination to improve cardiovascular health?

What is the case for universal influenza vaccination?

We know the influenza vaccine helps prevent respiratory-related complications of the flu. We now have strong evidence that the influenza vaccine can also help reduce heart-related complications of the flu.

It's especially true for those at higher risk for heart disease. But when we think about the general population globally, that's a large percentage of the adult population that fits into this category—and many people are unaware of this.

As we consider influenza and cardiovascular disease prevention, there is an important, compelling story that is building with significant scientific basis. And that is, we should think about influenza vaccination as a strategy for heart disease prevention, just like we think about counselling patients to stop smoking or take a statin or treat their high blood pressure.

Where influenza vaccination is unique is that it is a once-a-year therapy versus taking a longitudinal pharmacotherapy. So, if it can be implemented widely, it is a single-dose strategy.

Can universal influenza vaccination offer population-wide benefits?

When we've talked about vaccinations over the last number of years in the midst of the covid-19 pandemic, we've often referred to a term called ‘herd immunity’. When we talk about universal recommendations for influenza vaccination to benefit cardiovascular health, I like to think about this in terms of 'community immunity'.

It means even though there may be people at higher risk for influenza-related disease, whether that be respiratory disease or cardiovascular-related complications of influenza, this community immunity approach is a way to not just help increase an individual's immunity, but extend that to families, neighbours, communities and the greater population at large.

How is universal influenza vaccination more effective than targeting at-risk groups?

At-risk strategies are often more complex to implement and there can be many significant barriers. These barriers are often related to age, as younger people who are at risk are less likely to be vaccinated. In fact, most patients are unaware of the potential cardiovascular benefits of influenza vaccination. Many, many clinicians are also unaware of the cardiovascular benefits of influenza vaccination. Other barriers are largely related to social determinants of health.

So it’s really a question of health equity and health systems approaches, and the conversations that the system should have with clinicians and clinical teams, and of course, with patients. Establishing protocols and procedures for influenza vaccination for all, and building them into routine visits or encounters, means implementation rates will go up.

Given the links between covid-19 and cardiovascular ill-health, can universal influenza vaccination offer additional health benefits?

As we've talked about during the pandemic, we have not had big waves of influenza in the last couple of years, which is likely related to some of the public health strategies that have been put in place related to covid-19.

But each year there will be the potential for a coincident, higher peak of covid-related illness and influenza—and, of course, there are other viruses out there as well. We always need to anticipate in order to be at the front end of these peaks and not the reactive end.

How can healthcare systems ensure influenza vaccination is truly universal?

People who do not have a regular clinical team or do not regularly touch base with clinical care or do not have access to clinical medicine, or have lower income or lower education, are less likely to receive influenza vaccination. Local pharmacies in the US now give free influenza vaccinations, as well as free covid-19 vaccinations.

When we think about the extended care team and the concept of safety and trust, using local pharmacies and pharmacists in addition to primary care teams and primary care networks is the best strategy for implementation.