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Flu is most dangerous for infants and older people, but schoolchildren are more efficient at spreading the virus. Because flu vaccines work better in schoolchildren than in older people, might it be more sensible to vaccinate schoolchildren instead? A mathematical modelling study concludes that under certain conditions (low population mixing and low viral transmission), switching vaccination to schoolchildren could eventually reduce sickness and death in older people. But the same strategy would not work, and could be disastrous, in epidemics with high rates of viral transmission. When transmission rates were moderate, switching vaccination to schoolchildren had complex effects on older people, making things worse at first, then better, then worse again.
The impact of a switch in policy would be sensitive to changes in parameters we don't fully understand, say the authors. For example, in this model the authors assumed that the two different populations—schoolchildren and older people—would be largely separate. This may not be true in cultures where grandparents often live with grandchildren. Until we know more, governments should proceed with caution, perhaps supplementing but not replacing vaccination of older people with vaccination of schoolchildren.