A vaccine for all seasons?

Talk about the best of times and the worst of times. This bumper year for vaccines is overshadowed only by the devastation that unfolded in their absence, and by the urgency with which their manufacture and distribution still needs to happen. I’m talking about the vaccines against Sars-CoV-2, of course (controversially overlooked in the Nobel prizes, partly on technicalities that one feels might have been waived). But now there’s also a vaccine against malaria, an affliction that currently kills around 400,000 people annually in sub-Saharan Africa. The indirect effects of the Covid-19 pandemic in disrupting prevention and treatment of malaria there might kill more people than the virus itself. So the decision to start using the RTS,S/AS01 vaccine developed by GlaxoSmithKline to protect children against malaria is deeply heartening.

But in all that excitement, another potentially transformative development in vaccines has been somewhat overlooked. One of the laissez-faire objections to efforts to control the spread of Sars-CoV-2 is that we routinely accept thousands of deaths from influenza every year, so why worry so much about a few thousand more? But Martin McKee of the London School of Health and Tropical Medicine has suggested to me that this is the wrong way round to look at it: we shouldn’t accept so many flu deaths, and indeed we try not to.

Flu vaccines already make a big difference – the US Centers for Disease Control and Prevention estimates that in a good year they reduce serious illness by 40–60% – but not as big as we might like. Partly that’s because a vaccine has to be tailored to particular flu variants – but there are lots of them, and we can’t be sure in advance which will predominate in a given flu season. The ideal solution would be a universal flu vaccine that conferred protection against them all.