Rationalizing recommendations for influenza and COVID-19 vaccines
Jessica A. Breznik, Matthew S. Miller, Dawn M.E. Bowdish
Article 127775
Supplementary Tables and references
Bluesky Explainer here.
I’m excited to share our review “Rationalizing recommendations for influenza and COVID-19 vaccines”, which we feel makes a strong case for universal influenza and COVID-19 vaccination policies. With almost 500 references & 8 supplementary tables it’s a beast so let me break it down for you….1/n
https://www.sciencedirect.com/science/article/pii/S0264410X25010722#ec0005
We started this >a year ago after conversations with immunologists, policy-makers, and the general public. We felt there were misunderstandings about how well COVID-19 vaccines work. We argue that they work as well or better than influenza vaccines so vaccination policies should be similar. 2/n
Like influenza, everyone but newborns has been exposed to COVID-19 through either vaccination or infection so we only reviewed studies in the post-Omicron/post-vaccine era. There is no doubt that the burden of disease has changed in the Omicron/vaccine era, but does that mean COVID is over? 3/n
Comparable data is hard to find, but when we looked at 2022/23 & 2023/24 data we see that deaths are still higher for COVID than influenza BUT looking at % hides the fact that COVID-19 is more contagious and in 23/24 there were almost 3x as many COVID hospitalizations than influenza. 4/n
There’s a common belief that COVID-19 vaccines don’t provide very good protection against symptomatic infection -is this true? These data are very, very hard to compile because the pace of variant replacement and vaccine changes has been dizzying 5/n
Before we get to the data – I just want to give a huge shoutout to @belongia.bsky.social for leading so many high quality studies on influenza effectiveness – look how easy to compare year-to-year. 6/n
Now look at how complicated it is to compare COVID-19 vaccine effectiveness. In influenza studies it is often possible to assess which strain a person was infected with so you can assess vaccine effectiveness by strain. COVID-19 vaccines are almost never matched with the circulating variants.. 7/n
…but despite that disadvantage, levels of protection from symptomatic infection and severe disease are similar between COVID & influenza vaccines. Note that protection against symptomatic infection is VERY hard to estimate because people who don’t get sick don’t get tested. 8/n
There has been some frustration that COVID-19 vaccines don’t last longer but neither does protection from either infection or vaccination for other viruses. When we compare protection < 3 months and > 3 months, COVID-19 vaccines look pretty good, esp considering rapid variant change 9/n
We also make a case to increase to increase the range of vulnerable populations. Canada has been a leader in including congregate living and equity-deserving groups in priority populations (#elbowsup !) but people living with lung and heart issues should be included 10/n.
Vaccine programs are decided by more than efficacy and efficacy – here’s a summary of what the National Advisory Council on Immunization (Canada) includes. Our review doesn’t address the programmatic, cost, and social considerations, which are also important. 11/n
There are still a lot of unknowns, but we feel strongly that universal & free COVID-19 and influenza vaccines would be a good investment in health, health systems, and attendance at work and school. Thank you to the brilliantly detail oriented Dr.@jabreznik.bsky.social and infl Dr Matt Miller Fin!
