Do Flu (H1N1) Vaccines Work? Two Studied Opinions
Compare the Views of Two Giants of the Vaccination World
(Watch the Videos)
THE EMAILS keep coming in. Nervous mothers asking me to support their views about vaccination for H1N1, or to write a critique of some pro or con article that a friend is brandishing in front of her face as proof that whatever she’s doing (or not doing) is wrong and potentially harmful to her family.
Like I have the answers. Like I’m qualified to discern the truth in this matter of H1N1 vaccination when even those seeped in it, those medical doctors and researchers whose careers are made from it, are in vociferous debate.
There’s an old joke about economists. If you laid head to feet all the economists in the world you still wouldn’t reach a conclusion. Well, epidemiologists can now supplant economists in that quip.
So, returning to those emails beseeching me to clear the air…I have two answers:
1. I’m simply not qualified to make a decisive declaration; and
2. There’s no one single definitive answer for all.
That said, what I can do is share what I’ve read, and I’ve finally read two good countervailing articles about this conundrum of whether the H1N1 vaccine works and for whom.
I will summarize them in this long post, but I ask you to please read both Wired.com’s An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All, and then, just as you begin to think you finally have the answer, read The Atlantic’s Does the Vaccine Really Matter?. (If you don’t read them, you will miss two well-crafted stories and more data than my summary below contains.)
We’re fortunate to have these two articles to juxtapose because they pitch the views and research of two formidable scientists (and their collaborators) with opposing views about the H1N1 virus.
In the “Get Vaccinated” camp is a prominent vaccine inventor, Dr. Paul Offit, a favorite target for vilification by anti-vaccine groups, particularly those that claim vaccines can, and do, cause autism in children. (Read and watch what Robert Kennedy, Jr. has to say about it.)
In the “Don’t Bother” camp is Dr. Tom Jefferson, who even his detractors reluctantly admit knows the flu-vaccine literature better than anyone else on the planet.
(This thing about “literature” is an important part of the puzzle, it turns out, because one of the “anti-vaccine” crowd’s most damming argument concerns how “pro-vaccine” studies were conducted, which I address below.)
So, now I’m going to attempt to distill their arguments…
Wired.com’s article focuses on Dr. Offit and the point of view of the pro-vaccinators, which can be summarized thus (all info and statistic, except in parentheses,from the article):
–>Vaccines save a tremendously greater number of lives than they negatively effect.
Smallpox killed an estimated 500 million people before eradicated with a vaccine. Sixty years ago, polio paralyzed 16,000 Americans every year, while rubella caused birth defects and mental retardation in as many as 20,000 newborns. Measles infected 4 million children, killing 3,000 annually, and a bacterium called Haemophilus influenzae type b caused Hib meningitis in more than 15,000 children, leaving many with permanent brain damage. So, the clear inference is, ditto for the H1N1 vaccine — it will protect you.
–>Vaccines do not cause autism.
The only negative effect widely publicized is that vaccines can cause autism in children, a claim Dr. Offit strenuously denies. He says that many parents ignore the facts presented by peer-reviewed evidence showing no connection between vaccines and thus agonize about whether to vaccinate.
The explanation for this irrationality is that the human brain has a natural tendency to pattern-match — to ignore the old dictum “correlation does not imply causation”, and stubbornly persists in associating proximate phenomena. If two things coexist, the brain says they may be related. Some parents of autistic children noticed that their child’s condition began to appear shortly after a vaccination. The conclusion: “The vaccine must have caused the autism.”
–>Even a tiny percent of people opting out puts whole neighborhoods at risk.
According to the CDC, in states where opting out of vaccination is allowed, 2.6 percent of parents did so last year, up from 1 percent in 1991. In some communities, like California’s affluent Marin County, just north of San Francisco, non-vaccination rates are approaching 6 percent. (Interestingly, higher rates of non-vaccination often correspond with higher levels of education and wealth, Marin County being one of the richest in the U.S.)
A recent study by the Los Angeles Times indicates that the impact of even this small percent can be devastating. Though only about 2 percent of California’s kindergartners are unvaccinated, they tend to be clustered, which disproportionately increases the risk of an outbreak of such largely eradicated diseases as measles, mumps, and pertussis (whooping cough).
The clustering means almost 10 percent of elementary schools statewide may already be at risk. (This seems in conflict with Japan’s experience which suggests that when 50% of school children are vaccinated, the community’s risk falls by two-thirds; at 70% vaccinated, the risk plummets to 4%. Read the full story here.)
To get a sense of Dr. Offit and some of his arguments, watch this video. Below the video, I examine Dr. Jefferson’s anti-vaccination views as reported by The Atlantic article.[youtube]http://www.youtube.com/watch?v=hGrOS75I66g[/youtube]
Now, let’s turn to The Republic’s article which focuses on Dr. Jefferson and the point of view of the anti-vaccinators, which can be summarized thus (this longer summary than the one above reflects the much greater length of the article… all data presented is from the article):
–>As currently tested, it’s near impossible to evaluate the effectiveness of flu vaccines.
Flu is seasonal and is often not the direct cause of death, but a contributing factor in that it makes the body more susceptible to secondary infections like pneumonia or bronchitis. For this reason, researchers studying the impact of flu vaccination typically look at deaths from all causes during flu season, and compare the vaccinated and unvaccinated populations.
Such comparisons have shown a dramatic difference in mortality between those who vaccinate and those who do not. Numerous studies find that people who get a flu shot in the fall are about half as likely to die that winter—from any cause—as people who do not. Get your flu shot each year, the literature suggests, and you will dramatically reduce your chance of dying during flu season.
Yet in the view of several vaccine skeptics, this claim is suspicious on its face. Influenza causes only a small minority of all deaths in the U.S., even when adding senior citizens — the most vulnerable group — as well as deaths to which flu might have contributed indirectly.
When researchers from the National Institute of Allergy and Infectious Diseases included all deaths from illnesses that flu aggravates, like lung disease or chronic heart failure, they found that flu accounts for, at most, 10 percent of winter deaths among the elderly. So how could flu vaccine possibly reduce total deaths by half?
Dr. Jefferson’s answer: “For a vaccine to reduce mortality by 50 percent and up to 90 percent in some studies means it has to prevent deaths not just from influenza, but also from falls, fires, heart disease, strokes, and car accidents. That’s not a vaccine, that’s a miracle.” (emphasis mine.)
(Note: More than 50 percent of health-care workers say they do not intend to get vaccinated for swine flu and don’t routinely get their shots for seasonal flu, in part because many of them doubt the vaccines’ efficacy.)
–>Though declared dangerous and a pandemic, we don’t know how bad it is yet.
In August, the President’s Council of Advisors on Science and Technology projected that this fall and winter, H1N1 could infect anywhere between one-third and one-half of the U.S. population and could kill as many as 90,000 Americans, two and a half times the number killed in a typical flu season.
But precisely how deadly, or even how infectious, this year’s H1N1 pandemic will turn out to be won’t be known until it’s over. Remember, flu is seasonal — most people get infected in the fall and winter. In the Southern Hemisphere, winter has ended.
What happened there?
Most reports coming from the Southern Hemisphere in late August (the end of winter there) says that H1N1 is highly infectious, but not particularly lethal. For example, Australian officials estimated they would finish winter with under 1,000 swine flu deaths—fewer than the usual 1,500 to 3,000 from seasonal flu.
Among those who have died in the U.S., about 70 percent were already suffering from congenital conditions like cerebral palsy or underlying illnesses such as cancer, asthma, or AIDS, which make people more vulnerable.
–>The “healthy-user effect” may mean that vaccines only help the healthy.
If true, this puts the prevailing wisdom that vaccines are essential for the vulnerable on its head! The “healthy-user effect” posits that the mortality difference between the vaccinated and the unvaccinated might be because more people who are healthier get vaccinated then those who don’t, and are consequently less likely to die over the short term.
Unfortunately, those who most need protection from the flu also have compromised immune systems that are least likely to favorably respond to vaccine. Studies show that young, healthy people have the intended immune response to seasonal flu vaccine, and their response reduces their chances of getting it. But they aren’t the people who die from seasonal flu. The elderly, by contrast (particularly those over age 70), don’t have a good immune response to vaccine—and they’re the ones who account for most flu deaths. (Infants with severe disabilities, such as leukemia and congenital lung disease, and people who are immune-compromised—from AIDS, or diabetes, or cancer treatment—make up the rest.)
Dr. Lisa Jackson, a physician and senior investigator with the Group Health Research Center, in Seattle and three colleagues set out to test this healthy-user effect. They analyzed eight years of medical data on more than 72,000 people 65 and older. They looked at who got flu shots and who didn’t. Then they examined which group’s members were more likely to die of any cause when it was not flu season.
The result? Their findings show that outside of flu season, the baseline risk of death among people who did not get vaccinated was approximately 60 percent higher than among those who did.
This is a bit tricky to understand. Remember, this is outside of flu season indicating that the cause of death is not flu. Hence, if more people of one group died than the other, it would not be from the flu, or – ergo – from the vaccine designed to defang it.
Dr. Jackson’s study supported the hypothesis that on average, healthy people chose to get the vaccine, while the “frail elderly” didn’t or couldn’t. In fact, the healthy-user effect explained the entire benefit that other researchers were attributing to flu vaccine, suggesting that the vaccine itself might not reduce mortality at all.
–>Flu vaccination history suggests reasons other reasons to doubt claims that flu vaccination reduces mortality.
In 2004, there was a vaccine production shortage resulting in a 40 percent drop in immunization rates. Yet mortality did not rise. Vaccine “mismatches” occurred in 1968 and 1997, and no one, in effect, was vaccinated. (In both years, the vaccine that had been produced in the summer protected against one set of viruses, but come winter, a different set was circulating). Yet death rates from all causes – including flu and the various illnesses it can exacerbate – stayed the same.
Dr. Sumit Majumdar, a physician and researcher at the University of Alberta, in Canada, offers another historical observation: rising rates of vaccination of the elderly over the past two decades have not coincided with a lower overall mortality rate. In 1989, only 15 percent of people over age 65 in the U.S. and Canada were vaccinated against flu. Today, more than 65 percent are immunized. Yet death rates among the elderly during flu season have increased rather than decreased.
–>The Atlantic article’s conclusion: Vaccination may not help, but it’s unlikely to hurt.
Despite presenting formidable arguments against the efficacy of flu vaccines, The Atlantic’s article concludes thus:
“… what people should do when faced with a decision about whether to get themselves and their families vaccinated. There is little immediate danger from getting a seasonal flu shot, aside from a sore arm and mild flu-like symptoms. The safety of the swine flu vaccine remains to be seen. In the absence of better evidence, vaccines and antivirals must be viewed as only partial and uncertain defenses against the flu. And they may be mere talismans. By being afraid to do the proper studies now, we may be condemning ourselves to using treatments based on illusion and faith rather than sound science.”
To get a sense of Dr. Jefferson and some of his arguments, watch this video… also, please read my invitation beneath it:[youtube]http://www.youtube.com/watch?v=7HdJ4n0Ewu4[/youtube]
If you look in the sidebar on the right of your screen and click “Flu/Virus” under “Topics”, you’ll find several other posts on this H1N1 topic.
Please consider using the Comments section to share your views. Have you, or do you intend to have yourself and children vaccinated? If not, why?
Also, as you know, many people are confused about whether to vaccinate. If you think this post might help inform them, please share it.