Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Controversy

Rebuttal

CMAJ January 09, 2001 164 (1) 41;
  • Article
  • Responses
  • Metrics
  • PDF
Loading

Dr. Schabas maintains that influenza vaccination is efficacious and cost-effective, but he provides no evidence for this. Dr. Schabas claims that vaccine “efficacy is between 70% and 90%,” but this is both wrong and misleading. Vaccine efficacy, as Dr. Schabas uses the term, is probably about 60% (not 70%–90%), and this refers only to the ability of a vaccine to produce antibodies effective against the virus. But this is not the important measure of vaccine efficacy. Instead, we should measure the ability of the vaccine to prevent clinical disease, in this case influenza. By this measure, vaccine efficacy is no greater than 25%.

Given that mass vaccination, even if it can be achieved, will only reduce the number of influenza cases by 25% at most, can it be cost-effective, as Dr. Schabas claims? Arguments for cost-effectiveness cited by Dr. Schabas are inferred from studies done in other countries with different systems of heath care delivery. There are no studies of the cost-effectiveness of vaccination in Ontario. In addition, given the dynamics of influenza epidemics, it is unlikely that the Ontario strategy will achieve any control over the spread of influenza in the community. To achieve such a goal would require vaccination of over 90% of the population, a target that is very unlikely to be achieved.

The Ontario decision to implement mass influenza vaccination has little to do with influenza control. As clearly stated by the Ontario government, the aim is to ease pressure on emergency services during the “influenza season.” There is absolutely no evidence that universal vaccination has ever achieved such a goal.

I doubt that we will ever know the actual effect of this program and its cost-effectiveness, because it was not designed in a way that allows rigorous evaluation. Although I am tempted to applaud Ontario for its innovative spirit, I wonder whether the program should, instead, serve as a warning to other governments. The “let's see what happens” approach to public health should not be emulated.

Footnotes

  • Dr. Demicheli responds to Dr. Schabas:

PreviousNext
Back to top

In this issue

CMAJ
Vol. 164, Issue 1
9 Jan 2001
  • Table of Contents
  • Index by author
  • Canadian Adverse Drug Reaction Newsletter (91-98)

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Rebuttal
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Rebuttal
CMAJ Jan 2001, 164 (1) 41;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Rebuttal
CMAJ Jan 2001, 164 (1) 41;
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Footnotes
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • The analysis by Manuel and colleagues creates controversy with headlines, not data
  • The 2003 Canadian recommendations for dyslipidemia management: Revisions are needed
  • Rebuttal
Show more Controversy

Similar Articles

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2022, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire