Put aside hypothetical worries about bird flu: Regular flu already kills elderly Americans in droves every winter because the vaccine simply doesn’t work as well inside aging bodies as young ones.
The National Institutes of Health wants to strengthen flu shots destined for the elderly, part of a push to get the nation to start treating influenza’s yearly attack as seriously as the threat of some super-flu striking in the future.
The message: Why wait for a pandemic to benefit from better flu vaccines and treatments?
"My great frustration (is) in trying to shake the cage and say, 'We have not, by any means, optimized how we approach seasonal flu,'" Dr. Anthony Fauci, the NIH’s infectious disease chief, told The Associated Press.
Improving protection
Topping his do-better list: testing whether higher vaccine doses or adding immune-boosting compounds to the shots — some of the same compounds already being studied to fight bird flu — would improve the elderly’s protection against regular winter influenza.
Chiron wouldn’t say if it plans to eventually bring that shot, called Fluad, to the United States; it sells about 20 million doses abroad. Instead, Chiron’s U.S. focus has been on testing whether MF59 could improve experimental vaccines against bird flu.
But Fluad is among the approaches catching Fauci’s interest as he plans new research into improved elder vaccines.
Also, at least one well-known vaccine research center, at St. Louis University School of Medicine, is planning a study of higher flu vaccine doses for the elderly this fall.
Changes in immune function
And NIH recently began recruiting 150 U.S. volunteers to study just which parts of the immune system change as we age to make flu a more serious threat, basic biological underpinnings that remain a mystery despite influenza’s unrelenting yearly toll.
Just as the body’s physical abilities typically slow with age, the immune system can become sluggish. It’s not impossible to rev it back up. Some earlier research suggests that giving four to six times the normal dose of a flu vaccine component could double the elderly’s immune response, says Dr. John Treanor, a University of Rochester vaccine specialist.
The question is whether pumped-up vaccines for the elderly would provide enough extra protection to be worth it. Some previous attempts have found only slight improvements, and souped-up vaccines cost more to make.
“Until recently there was a lot of reluctance to do anything that would make the vaccine more expensive,” Treanor says, speculating that cost might be a key reason that Chiron debuted its Fluad shot in Europe.
A stronger vaccine might also come with more side effects, cautions Dr. Donald J. Kennedy of St. Louis University.
Still, there are low-risk strategies to test. Aside from the simple higher-dose study his university colleagues are planning, Kennedy wonders if giving seniors a flu shot plus a second vaccine — the FluMist nasal spray made of live but weakened flu virus — might activate different immune pathways to improve protection.
Ultimately, what may protect the elderly the most is when flu’s main spreaders — healthy young people, especially schoolchildren — start getting vaccinated in high-enough numbers to stem the virus’ tide.
For the first time this fall, all children from age six months to 5 years will be recommended for a flu shot. Until now, the government pushed childhood flu vaccine just for chronically ill youngsters and healthy tots up to age 2.
Expect even more children to be on the vaccine list as early as 2007; already under discussion is the 5- to 9-year-old crowd.
And with a record 120 million vaccine doses expected this year — far more than the most ever given, 83 million doses — the government is preparing to encourage inoculations for healthy 20-, 30- and 40-somethings this fall, too.