Immunisation polarizes debate. People are portrayed as being either pro or anti vaccination. This ignores the fact that not all vaccines are equally effective and more importantly not all diseases are of equal severity. We should support measures that improve health and reject those that do not.
Every year in autumn (fall) dire predictions are made about the upcoming flu season. Everyone is urged to get vaccinated, as this year will be the worst yet. Six months later one winter flu season is much like all the others and predictions are forgotten.
In March, Professor Paul Van Buynder of the Influenza Specialist Group told Medical Observer “ I’m excited about the fact that we’re having a different vaccine this year. I was worried when I saw what was happening in the US because the flu vaccine they used has not been very effective.” He added, “… we’re going to have a vaccine that is very well matched to the virus strains that are going to arrive”.
So how did that pan out?
Influenza cases were in line with long-term averages but there was a surge in a strain not in the vaccine. Dr Alan Hampson chair of the Influenza Specialist Group said it is “very rare to have a predominance of influenza B in Australia.
He may well be right but what does that leave the confident prediction of his colleague in March?
Professor Robert Booy of the National Centre for Immunisation research and surveillance told Medical Observer that there was no way the spike in the Brisbane strain could have been predicted.
Influenza predictions (on which we all are urged to act) are “crystal ball stuff”.
Perhaps he was misquoted or taken out of context.
Highlighting this is not to belittle those making the claims. The substantive point is that we do not know what strains will be prevalent in winter. The long-term average shows about a 50% effectiveness. Plus the influenza virus causes only one in six cases of flu like illness. And the vast majority will get better in a week anyway.
Those most likely to die in relation to influenza are aged over 85 getting secondary pneumonia. This group is the most likely to be vaccinated.
Why the annual scare campaign about flu? A report in the BMJ reviewing the H1N1 (swine flu) episode showed academics with ties to vaccine makers were more likely to give increased risk warnings than those without. Profit on the H1N1 vaccine was estimated to be close to US$10 billion!
A new vaccine with four strains is predicted to sell for 50% more than the standard three-strain version. The advantage is estimated to be 5%.
In the US flus shot season is just starting. Last years version was 20% effective. Thomas Frieden of the CDC told the Washington Post he was optimistic that this year’s would be more effective. “It doesn’t matter which flu vaccine you get, just get one,” he urged.
My first story for TV last year was about a father who suffered a rare adverse reaction to the whooping cough vaccine. It left him in hospital for months paralyzed and his recovery has been slow and will never be full. The reason he had the shot was as part of a program to “cocoon” newborn’s by giving parents a booster.
A review of 53,148 children born in WA during 2011/12 whilst this program was in place found no difference in the incidence of whooping cough (pertussis) in children less than six months in parents who were both vaccinated compared to those who were not!
The conclusion was that vaccinating new parents against (“cocooning”) pertussis did not protect infants against the infection.
This measure was introduced with no knowledge as to whether it would be effective.
Current thinking is that pregnant mothers should be vaccinated at around 30 weeks. This is based on a study of 60 women. The idea is that antibodies can be passed to the fetus. Professor Tami Skoff told Reuters “There is some data out of the UK showing that vaccination during pregnancy is effective. The early data is very reassuring and promising which is why we’re pushing this strategy”.
“Promising” is not usually the basis for significant health recommendations.
Tetanus, diphtheria and whooping cough have been part of the same vaccine for decades. The former two illnesses are now exceedingly rare. The third has persisted in low numbers. We do not know why.
And therein lies the problem. An approach, which leads to something being done because it can be, and seems like a good idea, is not a basis for public health. Pharmaceuticals cannot come to market until trials of efficacy (usefulness) and safety are performed. Surely public health measures should be subject to the same standard.
Dr Joe Kosterich M.B.B.S is an author, speaker, media presenter and health industry consultant, who wants you to be healthy and get the most out of life. Dr Joe also gives practical, motivational health talks for the general public and organisations where he is known as “An independent doctor who talks about health”.
His latest book “60 minutes to Better Health” is available on Amazon.