Elderly Patients

Kenneth J. Smith, MD, MS, on a Universal Influenza Vaccine With Dr Ken Smith

Universal influenza vaccines boast various benefits, including extended protection over multiple years. A potential universal vaccine specifically for older adults was recently investigated by a research team in the United States.1 We spoke with the lead author on the study for more details.

Kenneth J. Smith, MD, MS, is a professor of medicine and clinical and translational science at the University of Pittsburgh in Pennsylvania.

Infectious Disease Consultant: A universal influenza vaccine would be ideal for older adults who are at high-risk for influenza infection. Can you tell us more about the universal influenza vaccine you and your colleagues studied?

Kenneth Smith: Since a universal vaccine is not yet available, we estimated the effects of a theoretical universal vaccine compared with available seasonal vaccines. We then used decision analysis modeling techniques to determine the level of potential benefits necessary to consider a universal vaccine as a good health care investment for older adults.

ID CON: The past few influenza vaccines created may be seen as ‘suboptimal’ in preventing influenza in the geriatric population. How does the effectiveness of a universal vaccine compare with these other standard-dose vaccines?

KS: Universal vaccines, at least in theory, should be more reliably effective than current seasonal vaccines. Current vaccines are formulated based on predictions of future circulating influenza strains, which can be erroneous or confounded by viral mutations in predicted strains or vagaries in vaccine production. Universal vaccines are being designed to be effective regardless of the circulating strain. Another important factor in influenza vaccine effectiveness, particularly in geriatric patients, is host response to vaccination; it is unclear how host response might differ with a universal vaccine.

ID CON: Another point you and your colleagues explored in your study is the potential cost of a universal influenza vaccine. How might the cost of a universal vaccine influence patients’ decision to receive it?

KS: In geriatric populations, the influence of universal vaccine cost would likely depend on whether it was covered by Medicare. Coverage depends, in most cases, on whether the vaccine is recommended by the Centers for Disease Control and Prevention for use in older adults. Those recommendations are largely based on evidence of vaccine effectiveness and safety, and, to a lesser degree, the cost effectiveness of the vaccine.

ID CON: Do you think a universal vaccine is more appealing to older patients?

KS: A universal vaccine that does not need to be given every year would probably be appealing to many older patients—a yearly flu shot can be a pain.

ID CON: Overall, what is the key takeaway from your research that you want health care professionals to keep top of mind?

KS: Because of the many influenza vaccine choices available to older adults (and to the professionals who care for them), a future universal influenza vaccine could be a clinically and economically reasonable choice if its effectiveness is comparable with currently available vaccines and is effective for 3 or more years.


  1. France G, Wateska AR, Nowalk MP, et al. Potential cost-effectiveness of a universal influenza vaccine in older adults [published online December 14, 2018]. Innov Aging. https://doi.org/10.1093/geroni/igy035