Haibo Solomon, the head of the National Institute of Public Health, told the paper, and there isn’t much they can do once a patient has been admitted. “What can we do to improve chances of survival?” they asked. This paper provides the best answers yet.

For now, these numbers suggest that at least six percent of people get a flu shot each year, and that’s an improvement from the previous estimate of only one to two percent. The most important takeaway from this is that there’s plenty of room for future improvement.

The National Research Council is trying to identify new approaches to reduce the risks for getting sick from the flu, because people are dying. “In the past, we used observational studies that did not assess the link between the dose of influenza that is given and the outcome of illness,” says Dr. David Katz, an infectious diseases expert who sits on a group of panels that examine vaccines. “Our thinking has changed because we know there is a causal relationship.”

Vaccination should be the final line of defense. But a better question than whether vaccinating or the flu spray is better would be, on what schedule, and whether all those children who are vaccinated are just as likely to survive as those who aren’t.