Why The Swine Flu Vaccine May Not Help Those That Need It Most

This month’s Atlantic magazine features a frightening and fascinating look at both the swine flu vaccination and influenza vaccinations in general. As people across the country line up for swine flu vaccinations, demand the supply increase faster and beg their doctors for Tamiflu, and as parents debate the pros and cons of giving their kids an “emergent” vaccination–rushed into being because of the pandemic—the whole idea of a flu shot may be moot.

“Shots In The Dark” by Shannon Brownlee and Jeanne Lenzer in the November Atlantic, challenges the conventional wisdom that vaccinations are the best way to prevent flu (and flu pandemics) and raise doubts that they protect those most in need of protection. Many of the experts quoted in the story claim just the opposite, that for those who need the protection–like the elderly, very young children and those with compromised immune systems—flu shots and antiviral drugs may provide little to no protection.

Brownlee and Lenzer write that public health officials consider vaccine their most

“formidable defense against the pandemic—indeed, against any flu—and on the surface, their faith seems justified… But while vaccines for, say, whooping cough and polio clearly and dramatically reduced death rates from those diseases, the impact of flu vaccine has been harder to determine. Flu comes and goes with the seasons, and often it does not kill people directly, but rather contributes to death by making the body more susceptible to secondary infections like pneumonia or bronchitis.”

Researchers who study the impact of flu vaccination look at deaths from all causes during the season, and compare the vaccinated and unvaccinated populations. But these kinds of comparisons, say the article’s authors, skew the results, which state that people who get the shot in the fall are about half as likely to die that winter, but from any cause, not just the flu. Vaccine skeptics say the claim is suspicious. First, influenza causes a small minority of all deaths in the U.S., even among the elderly. Researchers from the National Institute of Allergy and Infections Diseases included all deaths from illnesses that flu aggravates, like lung disease or chronic heart failure, and found 10 percent of winter deaths among the elderly can be attributed to flu. So how could a flu vaccine possibly reduce TOTAL deaths by half?  According to the article:

“Tom Jefferson, a physician based in Rome and the head of the Vaccines Field at the Cochrane Collaboration, a highly respected international network of researchers who appraise medical evidence, says: ‘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.’ ”  After a lengthy explanation of how mortality reduction is calculated and why the method is flawed (it’s based on ‘cohort studies” that compare death rates in large groups of people who choose to be vaccinated against death rates of those in groups who don’t) we’re left feeling like the conclusions drawn from these studies are at best, likely biased and at worst, completely inaccurate.

Jefferson told the authors that the vast majority of flu vaccine studies are flaws. “Rubbish is not a scientific term, but I think it’s the term that applies,” he is quoted as saying. (He is not the only critic of flu vaccinations in this article either.) Part of the problem, say researchers, is that the only way to really know if someone has influenza—H1N1 or other strains—is to run a test on the patient, and that’s just not done that often. Other viruses cause flu-like symptoms. Another problem is that the people who most need protection from the flu are generally those with immune systems that are least likely to respond to a vaccine. The elderly often don’t have a very good immune response to vaccine; neither do those with compromised immune systems like infants with severe disabilities, those with cancer, AIDs and diabetes.

So here’s the rub, say the authors: Is vaccine necessary for those in whom it is effective, namely the young and healthy? On the flip side, is it effective in those for whom it seems to be necessary—namely the old, the very young and the infirm? The only way to know with any accuracy if a swine flu (or any flu) vaccine really works—and for whom–is to do placebo-controlled studies, where half the test subjects would get the actual vaccine and the other half a dummy shot, says Jefferson. Which means we will probably never know, because the medical community believes it is unethical to do such a trial in populations that are recommended to have the vaccine. Perhaps it is, but the logic seems circular. Jefferson is quoted as saying he finds it scientifically backwards. “What do you do when you have an uncertainty? You test.”