US mixed messaging on flu shots alarms experts: ‘Children should not be dying’

As the US reaches record-breaking rates of illness and hospitals scramble to care for flu patients, officials have stopped fully recommending the flu shot, casting doubt on the necessity and effectiveness of the vaccine.

“We are in the midst of a very severe flu season,” said Seema Lakdawala, associate professor of microbiology and immunology at Emory School of Medicine. Despite this, the US is dismantling many of its vaccine recommendations. Flu vaccine recommendations for children changed in early January to “shared clinical decision-making”, which has typically meant a provider recommends the shot.

When asked whether the new restrictions would lead to fewer children getting vaccinated against the flu, “maybe that’s a better thing”, Robert F Kennedy Jr, the secretary of the US Department of Health and Human Services and a longtime vaccine critic, told CBS News last week. “There is no scientific evidence that the flu vaccine prevents serious illness, hospitalizations or death in children,” Kennedy claimed, despite extensive studies, including from the US Centers for Disease Control and Prevention (CDC), showing the effectiveness of the flu shot.

His comments come after Mehmet Oz, administrator for the Centers for Medicare & Medicaid Services, cast doubt on how well flu vaccines work.

“Every year, there’s a flu vaccine. It doesn’t always work very well. That’s why it’s been controversial of late,” Oz said on Newsmax. He instead recommended that Americans “take care” of themselves, so they can “overwhelm” the flu when they encounter it.

CDC press statements have said “the decision to vaccinate is a personal one”, urging people to consult with their doctors to understand “the potential risks and benefits associated with vaccines”. Unlike in previous years, there have been no health advisory notices from the CDC on the new variant, top health officials haven’t publicly received vaccines and a successful campaign called “Wild to Mild” was halted and not resumed.

The dominant flu strain in the US is H3N2, which tends to cause more severe illness, and this particular variant, subclade K, has mutated to get around immune defenses, which means more people may be susceptible to the flu than usual. The last time H3N2 spread through the US, in 2017-18, about 51,000 people died, making it the most severe flu season in recent years.

So far this year, there have been about 15m illnesses, 180,000 hospitalizations and 7,400 deaths from the flu, the CDC estimated in its weekly update on 9 January – with deaths including at least 17 children . “There is still time to get vaccinated against flu this season,” the CDC concluded in the report, in sharp relief to public statements by health officials and new restrictions on the shots.

In an earlier CDC report, about 8.2% of visits to the doctor were for flu-like respiratory illnesses – the highest rate for this point in the season since the 1997-98 season. That rate fell slightly to 7.2% last week, but the CDC cautioned that the drop could be due to delays in reporting or seeking care because of the holidays. Some health systems are requiring providers to wear face masks amid surging cases. New York, for instance, logged the most hospitalizations it has ever seen in the week ending 27 December.

“The flu can be extremely, extremely severe. It can be really scary,” said Megan Berman, professor of internal medicine at the University of Texas Medical Branch, and faculty with the Sealy Institute for Vaccine Sciences.

Berman has seen an influx of patients who need to be hospitalized, and “what they all had in common is actually they had not been vaccinated”. Even patients who have already gotten cases of flu A would still benefit from vaccines, she said, because there was often a double peak in flu season with flu B, which the vaccine also protects against.

Early data from the UK, where flu season started early and now seems to be abating, shows that the vaccine is still effective at preventing hospitalizations: 70-75% effective in children and 30-40% effective in adults, a rate similar to previous flu shots.

While the flu shot may not stop transmission, it is still very effective at preventing severe illness, Lakdawala said. But only 42.5% of children and 43.5% of adults have received the shot this year, according to the CDC. Vaccination rates have fallen in recent years after reaching a high of 63.7% of children and 48.4% of adults in 2019-20 – more than half of the US population.

Covid rates are also high, and respiratory syncytial virus (RSV) is increasing, putting more pressure on hospitals. Both of those childhood shots also saw recent restrictions.

The changes in the recommendations will probably further dampen vaccination rates because it “gives the message that it’s not important”, Berman said. Yet “nothing has changed from the science, and I know that physicians are still strongly recommending it to everyone six months and older … Children should not be dying from a preventable illness.”

Antiviral treatments for flu have also fallen in recent years. About 79% of hospitalized flu patients in 2022-23 received antivirals, compared with 90% in 2018-19. The drop was especially pronounced in children; three out of five children hospitalized for the flu in 2022-23 received the medications, compared with four out of five in 2018-19. Only 28% of children under age five who are sick enough with the flu to see a doctor are prescribed antivirals, and only 32% of children who seek care for flu in emergency departments receive the treatments, the CDC says.

At the same time, mortality among children is rising, with nearly 300 children dying from the flu last season – the most deaths from the flu outside of a pandemic since the CDC started keeping track.

If a patient is sick enough to seek care from a doctor, they should receive antivirals, Berman said, and so should patients with underlying medical conditions, pregnant people and older people. There are four antiviral medications for the flu, and they all work well against this variant. It’s best to start them as soon as possible after testing positive.

There’s also a risk, as H5N1 bird flu continues to devastate flocks across the US, of two flu variants mixing to create another, deadlier variant, a process called reassortment.

“What I worry about most with bird flu is, in five years, it will have reassorted to something else,” Lakdawala said.

There are effective ways to control the spread of the flu, Lakdawala said, noting “we have every tool in our arsenal” and “we should use them when anyone’s sick”. In addition to getting vaccinated and taking antivirals, people can wear face masks, improve ventilation, wash hands, cover coughs and sneezes and stay home when they are sick to keep the flu in check.

“We learned something really important about flu transmission during the Covid-19 pandemic, and that is that we can control it. We actually have the capacity to control flu disease burden,” Lakdawala said.

Berman noted that “people are not helpless”, adding: “We can do something.”