The flu vaccination for children is a good idea, but only sometimes helpful

The United States has been recommending it for almost twenty years: every child should get a flu vaccination starting at the age of six months, advises the US Centers for Disease Control and Prevention (CDC). And this should be done every year until adulthood. Parents in Finland, Great Britain and other European countries are given similar advice. Even the World Health Organization believes that a vaccination against influenza can save children so many visits to the doctor and life-threatening complications that it is essential.

In Switzerland and Germany, the responsible bodies have decided differently. The Swiss Ekin, the Federal Commission for Vaccination Questions, and the German Stiko, the Standing Committee on Vaccination, only recommend the injections to parents with children who are particularly at risk, such as premature babies or children with chronic heart or lung disease.

The year before last, Switzerland began to think about "new strategies". The ECIN discussed a "widespread vaccination of school children". The reason: It is known that waves of influenza often start in community facilities, kindergartens and schools. The Commission therefore considered whether a childhood vaccination could protect the elderly, who are particularly at risk.

This winter, the virus has given its supporters new arguments. The number of flu sufferers is reaching record levels - children are particularly affected. Hospitals are reporting an unusually high number of cases among six-year-olds who are being admitted with breathing problems, severe fluid loss or seizures.

Wouldn't it be time to encourage parents in Germany and Switzerland to provide such protection for their children? Experts have different opinions on this.

Stiko chairman Reinhard Berner, director of the Clinic for Pediatrics and Adolescent Medicine at the TU Dresden, says: "In an ideal world and if it were only a matter of purely medical questions, I would recommend such a vaccination because it can be beneficial but does no harm."

But that is not the way the world is, and that is why he hesitates to make this recommendation. It can hardly be denied that only very few parents can be motivated to vaccinate their children. For this reason alone, the desired effect cannot be achieved.

In addition, influenza cannot be treated with just one or two injections. Children would need to be vaccinated every year. Infants and young children would even need to be vaccinated twice. This is because their immune systems are still completely untrained to deal with the pathogen.

And then there is the question of how well the vaccination really works. Compared to protection against measles, mumps or rubella, the vaccination against influenza performs below average. This is mainly because the pathogen changes slightly every year. But the pharmaceutical companies have to produce their vaccines before the flu season, so year after year they can only guess how the pathogen will develop. Sometimes they are right, sometimes not.

When the vaccination is administered also plays a role, because the effect wears off over time. In some years, an average of 60 percent of all visits to the pediatrician and clinic can be prevented, in others only 10. "You can therefore never tell parents that their child is protected with a high degree of certainty," says Berner.

This winter, pharmaceutical companies have speculated relatively well . Initial studies estimate the current protective effect at 50 percent. But most children are simply unvaccinated. What also helps to explain the record epidemic is that minors in particular are extremely susceptible to the type of virus that is currently particularly active. The German National Reference Center for Influenza Viruses has found that many children have a weak spot in their immunity to precisely this influenza B pathogen this time.

This weakness was probably due to the fact that the 2020/21 and 2021/22 influenza seasons were cancelled during the coronavirus pandemic. At a critical time in its development, the immune systems of boys and girls therefore had no chance to learn how to fight this pathogen. And so they now have to stay after school.

Ulrich Heininger, head of pediatric infectious diseases and vaccinology at the University Children's Hospital of Basel, represents the other faction. He would personally recommend the vaccination to all parents. "Because it has been proven to reduce the risk of serious illnesses." Only by the aforementioned 10 to 60 percent, but still.

According to studies, every year one in every thousand children is admitted to hospital with the flu. 46 out of 1,000 infected minors develop a bacterial middle ear infection because an immune system that has been weakened by influenza is less able to fight off bacteria. Infants and young children are particularly at risk.

But even those who are not so severely affected could benefit from the vaccination, according to Heininger. "Because in protected children, the course of the disease is more often mild." Serious side effects, on the other hand, are very rare.

It is now up to the two vaccination commissions, Ekin and Stiko, to weigh up the pros and cons. From a societal perspective, are the costs of the vaccines proportionate to the saved treatment costs? Things like this must also be considered. The task of commissions is to think on a larger scale. Or: Can we expect society as a whole to benefit? Because the spread of the pathogens is slowed down. If you look at countries like Great Britain, you can expect vaccination rates that will not achieve this.

What makes these considerations even more difficult, says Ekin President Christoph Berger of the University Children's Hospital Zurich: One of the most popular vaccines among pediatricians is not available in Switzerland. It was withdrawn by the manufacturer. The spray from AstraZeneca works just as well as the competing products, is just as safe, but is less painful. In Germany, the spray can be sprayed into the nose of children from the age of two.

If the commissions soon recommend flu vaccinations for all children, parents would benefit from lower costs. In both Switzerland and Germany, health insurance companies have so far only had to pay for the measure for children who are already officially recommended to have the shot. If parents have their children vaccinated who are not in a risk group, it is up to the health insurance companies to decide whether they will contribute to the costs. In Germany, parents can generally rely on this; in Switzerland, there are both generous and stingy health insurance companies. In this discussion, an Ekin decision would at least provide those affected with good arguments. The freedom to decide for or against a vaccination would remain completely unaffected.

In both countries, no vaccinations are allowed for children younger than six months. They can only be vaccinated indirectly. When mothers protect themselves against influenza during pregnancy , their immune systems produce antibodies that are then passed on to the child. The child is therefore able to fight off flu viruses for several months. This is a measure that is already being recommended to all mothers by both vaccination committees.