Dr Max Pemberton: Is the flu jab a waste of time?

Over the years of working in hospitals I’ve seen old people die from it, and as I lay there four weeks ago, floored by flu, I finally understood just how this virus could kill anyone who was elderly, frail or had other health complications.

At first I wasn’t sure what was happening. I felt achy but shrugged it off as a sign of overdoing it at the gym. A few hours later though, I developed a headache that made me wince it was so painful. For a moment I wondered if it was flu but instantly dismissed the idea: after all, I’d already had my jab, as I do every year.

But that night I woke up drenched in sweat, shivering. I felt awful: there was no doubt, this was flu. Until you’ve had it, it’s hard to describe quite how dreadful it is. I was uncontrollably hot yet my whole body shook violently.

My head pounded – my whole body was in pain – and I poured with sweat. There was no way I could get up. This went on for about a week and I didn’t feel fully recovered for a further week.

The flu virus is incredibly clever and easily mutates, meaning that the vaccine is not always effective

Doctors often say the difference between a cold and flu is that someone with a cold is sitting up watching TV telling you how awful they feel, while someone with flu can’t even raise their head off the pillow.

One of the infuriating things when you’ve had proper flu is people with a heavy cold saying they’ve ‘got a touch of flu’. Little do they know.

This is part of the problem – we tend to lump colds in with the flu and this makes us complacent: the fact is, flu is in another league altogether.

This is why I am such as passionate advocate for the flu jab – I’m always first in the queue come September when they start offering the jab to NHS staff and tell everyone I know to have it. Yes, yes, I had the flu jab this year and still got it. So why am I still such a fan?

The flu virus is incredibly clever and easily mutates, meaning that the vaccine is not always effective.

There are also different strains, and the strains tend to change from one year to the next, so predicting which strain will dominate is difficult. As a result, the vaccine can’t protect against every case of flu. Last year, it didn’t work for 50 per cent of people (although there’s some evidence that if you’ve had the jab and still get the flu, the symptoms are less severe).

But half the time the jab does work and having experienced the horrors of flu, I’d do anything to ensure my loved ones and patients avoid it.

And this is an important point – it’s not just you that you’re protecting with the jab, it’s those around you. Every elderly person I have seen die of flu got that virus from someone, most likely a family member. What an awful thought.

It’s not just the elderly: flu can be devastating in the very young, too: about half of severe cases of flu in babies are caught from older siblings, and it can kill them.

The tragedy is that this is so easily preventable if young children get the vaccine when they’re offered it. For me there’s no debate: the flu vaccine saves lives and it’s all our duty to get it.

Flu scientists are predicting that this year we’re on the brink of one of the worst outbreaks in half a century. This is based on the recent epidemic in Australia – our flu season follows theirs – where there were twice as many cases, and deaths, as the year before.

Others think we’ll get away with a milder version, because of the UK’s programme to vaccinate young children. So what does this mean for you and your loved ones? We spoke to the experts to find out…


This year’s Australian ‘flugeddon’ was down to a particular strain of the flu virus catchily named H3N2. There are three main types of flu virus – A, B and C – and hundreds of different subtypes, explains John Oxford, professor of virology at Queen Mary University of London.

The A virus has caused some of the worst outbreaks in history, including the Spanish flu in 1918 and swine flu in 2009. It mutates about three times faster than B, making it more likely that a new strain of A will cause a pandemic. The H3N2 that just caused the outbreak in Australia was an A virus.

‘H3N2 is a particularly vicious winter bug because it tends to get deep into the lungs and can lead to bronchitis and pneumonia,’ explains Helen Bedford, a professor at the University College Great Ormond Street Institute of Child Health.

The A virus has caused some of the worst outbreaks in history, including and swine flu (pictured) in 2009

‘For this reason, it is especially serious in older people and young children who may not have strong immune systems.’

Older people are also vulnerable because they don’t have natural immunity to the H3N2, which only appeared in 1968. Your natural immunity (or original autogenic immunity) is determined by the first flu virus you ever were exposed to and developed antibodies to.

‘People over the age of 60 usually have original autogenic immunity to the H1N1 strain which appeared in 1918 and persisted until 1957,’ says Professor Oxford. ‘That’s why they were largely untouched by the H1N1 or swine flu epidemic of 2009,’ he says – it was younger adults and children who suffered.

But with older people having less protection against H3N2, this year’s flu could be particularly dangerous for them.


Every year at-risk groups are offered the jab free – this includes anyone aged 65 or over, anyone affected by respiratory conditions or other diseases such as diabetes; those in a residential care homes and the main carer of an older or disabled person; children aged two to three and pregnant women.

Children up to school year four are offered a nasal spray form of the vaccine, to protect them but also adults around them (children are considered ‘super spreaders’). ‘But I feel everyone should have a flu jab,’ says Professor Oxford. (Prices normally range from £9 to £12.99, though Asda is cheapest at £5)

Not all agree: Chris Exley, a professor in bioinorganic chemistry from Keele University, suggests the jab should be used sparingly and not by healthy adults.

‘Since it is well known that flu vaccines are the least effective of all vaccines, it is good advice to only have it if catching flu will predispose you to a much more serious illness.’

Every year at-risk groups are offered the jab free – this includes anyone aged 65 or over


The flu jab contains three or four types of virus, with two A types and one or two B. What goes into the vaccine is decided by a global flu surveillance team, with input from World Health Organisation labs in Atlanta in the U.S., London, Melbourne and Tokyo.

Their decision is based on what has happened during the previous winter in the southern hemisphere. The recommendations are made six months in advance to give manufacturers time to develop and distribute the vaccine before the season starts here.

But flu experts can get it wrong or the virus can mutate too fast. Last year four in ten people who had the jab didn’t get ill. This was less effective than usual, although the children’s nasal spray vaccine performed better, at 57 per cent.

Will this year’s vaccine work better? The evidence is not promising. An analysis of the Australian experience, published in the journal Eurosurveillance just a few weeks ago found that the vaccine had ‘low’ effectiveness against type A viruses (in other words, the ones that seem worse for elderly people) with just 10 per cent of people being protected, the rest got flu. Overall, the vaccine effectiveness against other flu strains was 33 per cent, compared with the usual 40 to 60 per cent effectiveness of flu vaccines.

Dr Tom Jefferson, an honorary fellow of the Oxford University Centre for Evidence-Based Medicine, who has produced reports for healthcare experts Cochrane, believes the majority of clinical studies into flu vaccines’ effectiveness have been badly run, with results from studies funded by pharmaceutical companies released selectively to show positive results.


No. Many people experience soreness and swelling at the jab site, and some will develop cold-like symptoms including a mild fever, sniffles and a headache.

‘The injected flu vaccine contains inactivated strains and cannot cause flu,’ says Professor Oxford. ‘The spray contains forms of the flu virus which is live but weakened to such an extent it cannot cause typical flu clinical disease in humans.’ It seems the ‘flu-like’ symptoms are caused by the body’s immune response producing antibodies to kill the real flu virus.

‘Or symptoms could be because you already had a virus when you got the jab’, says Professor Oxford. ‘That’s one reason you can still get the flu after you have been vaccinated because you were already incubating the virus.’

Some flu jabs are made using egg protein, but this is unlikely to cause problems unless someone is extremely allergic, she adds.

Doctors often say the difference between a cold and flu is that someone with a cold is sitting up watching TV telling you how awful they feel, while someone with flu can’t even raise their head off the pillow


Last year, uptake of the flu vaccine – given free to NHS staff -was disappointing for health authorities, as low as 20 per cent in some trusts. Numbers are rising this year, but Professor Bedford agrees that uptake is notoriously poor among medical staff.

‘There are many reasons including the inconvenience of getting vaccinated, misperceptions about the vaccine causing flu, considering themselves not to be at risk and not fully appreciating that by being protected themselves this will protect their patients.’


If you’re feeling ill with a fever, it’s best to delay your jab until you’ve recovered as it could take longer while your immune system is trying to get you better as well as producing antibodies to the flu virus. But there’s no need to wait if you’re just under the weather.

‘Depending on your age, flu vaccines can take from one to two weeks to have a protective effect,’ says Professor Oxford. In other words, you can still catch the flu during this time.

But there may be an upside to being under the weather during this time: ‘If your immune system is already primed by another bug, it could create a stronger immune response in a shorter space of time, developing antibodies to flu faster.’


‘The best practical measure is to practise good hygiene,’ says Dr Richard Pebody, head of influenza and other respiratory viruses at Public Health England. ‘When you cough or sneeze, catch it in a tissue, bin the tissue and wash your hands after.’


Helen Watts, 43, a photographic assistant, lives in Pembrokeshire with husband Lee, 47, an instrument engineer, and children Lauren, 15, and Harri, 12. I’D had a flu jab for as long as I can remember because I’m asthmatic. During the winter of 2015 I didn’t get around to it – and it almost cost me my life.

It started with coughing and wheezing and within two days I was struggling to breathe so much so that Lee rushed me to hospital, thinking it was a bad asthma attack. Two days later, my breathing was so laboured I was transferred to intensive care. Blood tests showed I had flu and I was put into isolation.

Over the following week, I drifted in and out of consciousness. I remember coming round at one point and hearing doctors telling Lee my state was ‘critical’ and they were going to ventilate me. I knew that meant putting me in a coma and I was petrified. I don’t know if it was sheer willpower but I managed to regain full consciousness soon after.

After three weeks I was discharged, but for six months I struggled to breathe and it was a year before I could work.

I will never miss a flu jab again.

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