On February 24th, the CDC’s Advisory Committee on Immunization Practices (ACIP) filled in the final piece of its piecemeal influenza immunization recommendations by advising that healthy adults aged 19-49 receive the vaccine along with all the previously targeted groups aged 6 months and older. Thanks to the 2009 pandemic H1N1, now everyone is considered “high risk” for the flu.
But some experts had been urging the move long before last year. Dr. Gregory Poland of the Mayo Clinic had been particularly outspoken, often delivering impassioned pleas to his fellow ACIP members to end the “creeping incrementalism” of adding new risk groups to the list one by one. He urged the committee instead to simply recommend flu vaccine for all. In a 2006 point/counterpoint in our primary care publications with current ACIP chair Dr. Carol Baker of Baylor College of Medicine, Dr. Poland said he believed the time was right; she didn’t.
At that time, many experts agreed with Dr. Baker. They supported the universal immunization concept in principle, but said more evidence was needed to justify it and better infrastructure was required to make it feasible.
At the February ACIP meeting, I asked Dr. Baker what had changed. Her answer: “What we’ve learned is that infrastructure is built after ACIP makes a recommendation. Otherwise, there’s a year to say, ‘Well, we have a year before we have to think about this.'” But she noted that the 2009 pandemic did help expand the use of alternative venues for vaccine delivery, such as schools and retail stores.
Dr. Dale Morse, an ACIP member from 2005-2009 and chair the latter 2 years, said a lack of scientific data and the vaccine shortages of 2004-2005 were among the reasons he had voted against one of Dr. Poland’s motions for universal immunization about 4 years ago. “That was the wrong day, the wrong place, the wrong time,” said Dr. Morse.
Today, the science is more complete regarding the impact of influenza immunization. And, two new risk categories that emerged with pandemic H1N1 — 19-24-year-olds and obesity — are now covered by the universal recommendation.
As Dr. Morse told ACIP, “While we still haven’t reached the levels of immunization that we’d like, we have an opportunity to build on the momentum gained over the past year. If we can’t make a universal recommendation now, when can we? From my perspective, today it’s the right place, the right day, and the right time.”