Goodbye, Flumist: Why science is important

The Pediatric Insider

© 2016 Roy Benaroch, MD

Yesterday the CDC announced that its Advisory Committee on Immunization Practices (ACIP) voted to stop recommending the nasal spray flu vaccine, Flumist, for anyone. Bottom line: it doesn’t work. Though their recommendation against the use of Flumist still has to be approved by the CDC director to make it “official”, it’s pretty much a done deal. The AAP’s president has already endorsed the announcement, too.

Bye, Flumist. We’ll miss the ease of use and the not-scaring-children part, but the data’s clear. The mist doesn’t work. There was a sliver of good news, though—we have solid surveillance data from last year re-confirming that the traditional flu shot does work, with an estimated effectiveness of 63% last year. That’s not outstanding, but it’s pretty good. From a public health point of view preventing 63% of influenza cases can have a huge impact. Remember: every case prevented is one fewer person out there spreading influenza. Effective vaccinations not only help the person who got the vaccine, but the whole family and community.

Older data, at one point, had shown that Flumist was as effective (or even more effective) than the flu shot. For a few years, the mist was even considered the “preferred product” for children, because it seemed to work better.  Last year, Flumist lost its “preferred” status when data emerged showing that it wasn’t looking as good as the shot. Now, enough newer data has accumulated to show that at least against the strains that have been circulating recently, Flumist doesn’t work at all.

There’s going to be a scramble (again!) this year to ensure an adequate supply of injectable flu vaccine. I don’t know if MedImmune will suspend the Flumist program, or if they’ll still try to sell their product – but I am sure that there are a lot of docs out there scrambling this morning, trying to cancel Flumist pre-orders and increase our orders for alternatives. In the long run, that will be better for everyone. In the short run, it’s a problem. Families ought to plan to get their flu shots as early as possible this year, before they run out.

Science isn’t a set of answers, or a body of knowledge etched on a stone somewhere. It is a method of arriving at the truth, involving repeated observations and the continuous re-assessment of data. Estimates of vaccine effectiveness (and safety) are initially based on licensing studies, but they’re then adjusted by real-world data that continues to be collected, year after year. We should always make the best decision we can, based on the best data, even if that means we have to sometimes admit we’ve made a mistake, or that we have to change our minds. That’s not a weakness of science or medicine – that’s a strength. We can’t always promise to get it right, but we’ll keep studying and learning and trying to do it better.

Squirt!

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6 Comments on “Goodbye, Flumist: Why science is important”

  1. Ashley Says:

    My kids got the flu every year that we did flu mist. I never really thought about that being the connection. Just thought we had bad luck. Maybe our flu days are behind us!!

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  2. Bettina Says:

    I had the flumist and work in preschool. Many of the kids and grown ups had the actual flu! I had no flu! It worked for me!

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  3. JR Says:

    Anyone know why the delivery vehicle would matter with different strains of the flu? As in why would the mist have been effective in the past but no longer? Seems like all that changed was the strain of virus right? Or is there more to it.

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  4. Dr. Roy Says:

    There’s more to figure out, here. It may be that repeated exposures to Flumist lead to a less-robust response (tho the fall off seems almost too precipitous for that.)

    Another idea: the licensing studies were under ideal conditions. This recent data is from real-world experience. Maybe the Flumist vaccine, when shipped and stored, etc, is more fragile than we thought, and loses its punch?

    Just ideas. We really don’t know yet.

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  5. terri Says:

    “Estimates of vaccine effectiveness (and safety) are initially based on licensing studies, but they’re then adjusted by real-world data that continues to be collected, year after year.”…the problem here is when government agencies make these ‘required’ even with only licensing studies. Yes, science evolves, why force it on people as human trials when we should study it a bit more? Make it optional and use those studies..there are too many required vaccines with minimal studies or biased/controlled licensing studies.

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  6. Dr. Roy Says:

    Terri, I suppose anything could be “studied more”. There is no theoretical point where all studies are complete, and all questions are answered. if you want that kind of certainty, you’re not going to find it anywhere or any time. There are no medical products or medicines that are as well-studied in larger numbers of people than vaccines.

    Ironically, many people who seem distrustful of vaccines (or medicine in general) are very willing to accept the unstudied proclamations of alternative-health providers. How often do you hear from chiropractors that something they’re doing has been discovered to not be effective, or that something a naturopath is doing needs to change? Never. There is no drive to refine or study or learn — a fundamental difference in philosophy.

    The science based approach to medicine isn’t perfect, of course. But it’s the best system that there is.

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