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Medical chief questions idea of universal flu shot

From Wednesday's Globe and Mail

Ottawa — The idea of vaccinating all Canadians against influenza is compelling, but it is not a priority given the limited money available for public-health programs, Canada's chief medical officer of health says.

"In theory, it makes sense to immunize everyone. But in practice, I'm not sure that's where all the provinces and territories want to spend their scarce health-care resources," David Butler-Jones said in an interview yesterday after addressing the Chronic Disease Prevention Alliance of Canada.

"Are we better off providing flu vaccine to more healthy people, or doing more chronic-disease prevention? I think we would probably get a lot more benefit from investing in chronic disease."

Dr. Butler-Jones was responding to a report by the Canadian Task Force on Preventive Health Care, which says that Canada should become the first country to vaccinate all residents over six months old against flu.

The blue-ribbon panel of scientists said that doing so could lower the number of flu cases by as much as 93 per cent, preventing thousands of deaths and saving the economy hundreds of millions of dollars annually.

Dr. Butler-Jones praised the panel for its work and said he does not question the science. But he added that the jury is out on the real-world benefits of universal vaccination against flu.

"Conceptually, it makes sense to immunize everyone. The impact would be tremendous." But he questioned whether enough people would get the shots to make a difference.

Dr. Butler-Jones said that before making a firm recommendation on universal vaccination, he wants to examine the results of research being conducted in Ontario. The province is the largest jurisdiction in the world to offer free vaccine to all its residents, but fewer than half take advantage of it. Most other provinces and territories offer the vaccine free only to those at high risk: young children, people over 65 and people with chronic illnesses.

When the Ontario program was launched, largely in response to overcrowding in emergency rooms during flu season, health officials said each case that was prevented would save the health system $40. But there is no solid evidence that universal vaccination reduced the number of cases of flu or saved the health system money.

Alberta, which follows the recommendations of the National Advisory Committee on Immunization, covers the cost of the vaccine for those at risk of serious complications related to the illness, such as the elderly, the very young and their immediate families.

Alberta Health spokesman David Dear said the report "interests us" and will be examined, but it is too early to know whether its recommendations will be adopted.

Vaccinating all 32 million Canadians against flu would cost about $125-million a year. About 11 million Canadians are vaccinated, most of them old and suffering from chronic diseases. The cost is about $45-million.

"Cost is the biggest concern I have with a universal program," Dr. Butler-Jones said. "Not the cost of the vaccine itself but the opportunity cost: what we won't be able to do if we spend the money on flu vaccine."

Elinor Wilson, chief executive officer of the Canadian Public Health Association, said the group is "very supportive" of universal flu vaccination. "The flu is very problematic in terms of lives lost and the economic impact, so universal vaccination ranks quite high as a prevention measure."

Dr. Wilson said it would be a "great idea" if everyone, including healthy adults, were immunized, because doing so would lower the chances of those at high risk contracting flu.

But she added that the public-health association does not have a formal position on whether the vaccine should be offered free in every province and territory.

About one in five Canadians contracts flu each year. In healthy adults and older children, the illness causes fever, cough, headache and muscle pain. The symptoms usually abate in three to four days. One-third of those who fall ill visit physicians or emergency rooms. Flu is the leading cause of absenteeism at school and work during the winter months.

For those at higher risk, such as children under 2, the frail elderly and people with chronic conditions, such as pulmonary and heart disease, flu can be deadly. Flu and pneumonia claimed 4,725 lives in 2002, Statistics Canada says.

Because influenza viruses mutate, vaccines must be taken annually. Each year's flu shots protect against three predominant strains. This year, the vaccines marketed in Canada protect against A/New Caledonia, A/Wyoming and B/Jiansu.

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