A €1.2 million European project says mass vaccinations are the most cost-effective way to deal with flu. This should be followed by targeted treatment of those displaying symptoms, not mass issuing of drugs like Tamiflu.

The recommendations come from the world's first extensive cost-effectiveness analysis flu responses. The Fluresp project has written to UK and European governments with a series of recommendations based on its conclusions. The models developed by the project are also available to help governments plan.

Annual epidemics cause 3-5 million cases of severe illness and 250-500,000 deaths worldwide (WHO, fact sheet 211; March 2014). When an epidemic hits, the main factor limiting our response is cost. Governments must take tough decisions on how to allocate limited resources.

The research found mass vaccination of populations was more cost-effective than vaccination targeted at 'at-risk' subgroups, an approach favoured by many European countries. This is because the cost of vaccinations is low compared with the cost of awareness programs.

The production of consistent volumes of vaccines would also ensure vaccine manufacturers can respond adequately to severe pandemics, as well as supporting Europe's medical manufacturers.

Vaccination should be done through existing surgeries. The cost of setting up additional vaccination centres and communicating them, a widely used policy, was an extremely bad use of public money.

The project also identified that, once the epidemic is underway, treating people showing the first symptoms of flu was more cost effective than providing prophylactic treatment (eg issuing drugs like Tamiflu intended to prevent infection).

Project Lead, Dr Ariel Beresniak, Paris-Descartes University, said: "Whereas mass vaccination campaigns are a cost effective and sensible measure, stockpiling prophylactics for everyone is expensive and wasteful, since the number of people who will actually get flu is much lower than the total population. Once the epidemic has begun, it makes more sense to treat only those infected."

The research found that social interventions such as screening programs and hand-washing are not cost-effective on their own, since the costs of the campaign is high. They should only be considered alongside medical responses.

Beresniak adds: "We have written to national governments to inform them of our recommendations and planning approach, which for the sake of national health, we strongly recommend they take on board".