Each year the chief medical officer writes to general practitioners and other health professionals reminding them of the need to identify and vaccinate patients at risk of the complications of influenza—that is people who have chronic heart, chest, or kidney disease; people who have diabetes; people who are immunocompromised owing to treatment or disease; and people living in residential accommodation. Routine immunisation of elderly people is not recommended. Current data on the efficacy of influenza vaccine indicates that up to 70% of clinical cases could be prevented,1 2 an important finding as in 1989, 26 000 people, mostly elderly, or those recommended for vaccination, died in the United Kingdom from influenza and its complications.3 That year there was a good antigenic match between the epidemic strain and the one used in the vaccine, yet only one third to one half of all patients who would have benefited from vaccination received it.4 I investigated the implementation of current vaccine policy. In September 1994, 64 general practices in the county of Gwent, with a registered population of 291 …