Flu: a public health crisis

LAST fall, after many years, my wife, our daughter and I decided to get flu shots. The decision wasn’t popular with our nine-year-old, who doesn’t like having her skin punctured, but we thought that, given the smog season and the health disruptions we faced every winter in Lahore, it was worth the trouble and expense. And it was. Last winter, we had far fewer bouts of illness, despite the smog highs; when we did have symptoms, they were much milder and recovery much faster. My wife and I lost fewer days at work, and our daughter was able to go to school most days. We also relied much less on cough syrups, antibiotics, and similar medications.

It is almost that time of the year again. Flu shots should be available soon, if they aren’t already. Since influenza mutates significantly, the flu vaccine has to be updated often, and shots have to be taken every year. Despite this inconvenience, they are worth it. But it seems they are not very popular or widely available in Pakistan. We had to ask around and find clinics where we could get a flu shot. A muscular injection, they should be available at most, if not all, pharmacies.

Last year, our shot cost around Rs3,000 per head. So, they can be expensive for many households, but, given the cost-benefit, the state should make them available to vulnerable populations free of charge. It is very much a public health issue. The evidence from other countries is clear. The return on investment is indeed significant. Flu shots save the lives of vulnerable people: children, older populations, and people with compromised health and co-morbidities. Hospitalisations are fewer, and symptoms are less severe and more manageable when people fall sick. Even for the healthy, flu shots can collectively save millions of work hours. Children miss school less. And flu shots also create herd immunity. For the cost, could one ask for more?

In the UK, all children are given flu vaccines free of charge. These are administered in September. Since most or all children are in school in the UK, schools administer the vaccine, which is efficient and effective. For children, there is even a version that can be squirted up the nose, so an injection is not the only option. I am sure children are quite happy with that.

It is a story of neglect. There is no public effort to promote flu vaccination.

The elderly also have access to free shots, as do any adults whose health systems might be compromised: diabetes, immune disorders, etc. The National Health Service administers the shots. This is a large campaign and can have significant waiting times, but it gets done. For other adults, shots are available at most pharmacies for £10 to £25 per shot. Given the protection the shot offers, many adults do get them every year. This helps the UK build significant herd immunity.

Given Pakistan’s higher smog levels, elevated child malnutrition, and the fact that about one-third of the adult population is diabetic, one would think that flu shots would be even more important for us and treated as a public health issue. Of course, if we had national campaigns for flu shots, they would be organised differently from those in other countries. Not all of our children are in schools, and we do not have a comprehensive national health service. So, we will need to have a network involving public health institutions (basic health and above) and Lady Health Workers and Visitors.

Availability through private clinics, hospitals, and pharmacies would also need to be ensured. Some mechanism would have to be designed to ensure that vulnerable and deserving populations have easy access to the vaccine at low or no cost (BISP and similar programmes with large outreach). This won’t be easy for our health authorities. But maybe the lessons from Covid vaccinations can be useful here.

Sadly, as usual, it is a story of neglect. There is no public effort to promote flu vaccination. It does not even seem to be on the agenda. Even with visible rising health costs from increasing smog, office and school closures, and other disruptions, there has been no effort to address the issue. Individuals and families largely bear the cost of ill health. If a child falls ill, the child bears the health cost, and the family pays for care. If flu spreads through an infected child, the increased cost is now borne by other children and households. If an adult falls ill and misses work, the cost is again mostly borne by the person, his or her family, and the individual business or workplace. The state does not bear any costs.

There is no realisation of how much this costs society and the economy as a whole. This is something the state should worry about, but since it is not an explicit cost, it does not. If costs rise for businesses, revenues and profits decline; households bear higher costs — all of this is reflected in national output and performance figures. The impact on health, longevity and morbidity is separate from this. Sadly, the state does not care much about them either.

With smog expectations the way they are, we are likely to experience another tough winter. Considering the impact on children and adults, and keeping in view the days missed at school because of ill health, and even school closures, a large campaign to vaccinate schoolchildren and vulnerable populations makes sense. Sadly, since this requires significant preparation, we are likely to miss this season again. Maybe, next year it will be different.

The writer is a senior research fellow at the Institute of Development and Economic Alternatives and an associate professor of economics at Lums.

Published in Dawn, September 11th, 2026