Influenza Vaccine: Policy v. Evidence

Turquesa · Nov 23, 2010

I've been finding some evidence (cited multiple times in this forum) that the influenza vaccine is basically ineffective in most of the major demographics. 
 
<a href="http://info.onlinelibrary.wiley.com/userfiles/ccoch/file/CD001269.pdf" target="_blank">http://info.onlinelibrary.wiley.com/userfiles/ccoch/file/CD001269.pdf</a> (Hooray! Full text!)
 
<a href="http://www2.cochrane.org/reviews/en/ab004879.html" target="_blank">http://www2.cochrane.org/reviews/en/ab004879.html</a>
 
<a href="http://www2.cochrane.org/reviews/en/ab005187.html" target="_blank">http://www2.cochrane.org/reviews/en/ab005187.html</a>
 
<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1720017/" target="_blank">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1720017/</a>
 
<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1720017/" target="_blank">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1720017/</a> (I'm asthmatic and my doctor convinced me three years ago to get a flu vax because of this).
 
Media report: <a href="http://www.medicalnewstoday.com/articles/55507.php" target="_blank">http://www.medicalnewstoday.com/articles/55507.php</a>
 
Editorial: <a href="http://www.bmj.com/content/333/7574/912.full" target="_blank">http://www.bmj.com/content/333/7574/912.full</a>
 
<a href="http://assets0.pubget.com/pdf/17095789.pdf" target="_blank">http://assets0.pubget.com/pdf/17095789.pdf</a> (THIS is interesting...)
 
I figured that because the vaccine issue is so ideologically (albeit not always scientifically) charged on both sides, there would be some sort of backlash, deconstruction, or at least attempts to explain away the aforementioned. 
 
But to my surprise (chagrin, even), there's no talk in the media or other public circles over such a controversy. I've found a couple of pieces buried in journals. 
The first is a <a href="http://assets0.pubget.com/pdf/17095789.pdf" target="_blank">letter to the editor</a> responding to the aforementioned editorial. Another is an <a href="http://pediatrics.jwatch.org/cgi/content/citation/2008/730/3" target="_blank">AAP response</a>, whose full text I'm unable to access). 
 
On the contrary, I heard just yesterday on public radio a PSA disguised as "news" about how we should run out and get an influenza vaccine. I'm sure many of you are getting similar stories in your local "news" outlets. 
The first easy question to surface is why this vaccine is being pushed on the public, forced on many health care workers, and funded by taxpayers....all despite evidence against its effectiveness. But honestly, I don't want to address this question because it only invites speculation. 
 
What I'm really wondering is how the CDC and AAP are--in a forum more public than buried websites and journal pages-- responding to, criticizing, or explaining the aforementioned evidence. Could anybody provide any links? 
 
Also, could any of you respond to, criticize, or explain the aforementioned evidence? Now that I'm in school, I no longer have access to the full text of journal articles. ( I did find this critique of one of the Cochrane metanalyses, but again, I don't have access to the full text). 
 
I just find it interesting that when Andrew Wakefield came out with the "vaccine-autism" study (which actually didn't pertain directly to that!), pundits POUNCED on it (rightfully to a great extent). 
 
But on this issue, there is silence in the public arena. So I'm wondering: Is there truly a gap between policy and evidence? Or is the evidence not strong enough to support overturning the current influenza vaccine policy in the U.S.?

carriebft · Nov 23, 2010

There have been 2 recent studies showing influenza vaccination of mothers has lead to reduction of illness in children. I also just looked through a bunch of studies on influenza vaccination in schools (was looking for other facts) but was surprised to see that these studies looking at the benefits of these programs found reduction in flu like illness, hospitalization and missed school days for the students who got the vaccines.
 
 
So I think there is contradictory evidence out there. There is reduction of influenza and a smaller reduction in flulike illness . When you have a good match, there seems to be a better reduction. There also seems to be a good reduction when you target the right populations such as mothers to protect newborns. There is less or no reduction when we look at 2s and under.
 
 
 
I also disagree with your opening line. Your links provide evidence of reduction in illness in most demographics, save for under 2s (unless you count reduction from mother vaccination) and that direct vaccination is more effective in protecting the elderly than assuming vaccination of health care workers in their facilities will do the trick.
 
There is also "lack of evidence" for many points in your links; lack of does not equate that influenza vaccination is ineffective.

carriebft · Nov 23, 2010

ANd I would add, to your question on the CDC or AAP being open about the shortcomings of the vaccine-
 
They are not open about it. I doubt you could easily find access to the fact that flu vaccination in under 2s hasn't been shown to be effective.
 
I think they feel that they are out there to improve public health; it's kinda like why they have a "one size fits all" vaccination schedule, because they are looking at the "overall", the large population , kwim? Unfortunately, that tends to mean you miss out on the finer details. this is a shortcoming of their way of doing things.

Turquesa · Nov 25, 2010

I was waiting around to see how many responses this thread would amass, (not a lot, apparently, although it is a busy holiday! <img alt="smile.gif" src="http://files.mothering.com/images/smilies/smile.gif">) But I'll go ahead and address yours. 
 
A couple of those links elaborate on how the research does not support the effectiveness of the flu vaccine given to healthy adults...a pretty significant demographic. Also, in sifting through the research, I have come across numerous studies that are favorable to the safety and effectiveness of the vaccine, so I agree that there is definitely contradictory evidence. What I'm having a hard time supporting is policy-makers and medical trade groups basing their call for mass vaccination on all of this "contradictory evidence" and "lack of evidence." If evidence-based policy making is the goal (and for obvious reasons, I question that it is), then these power-holders don't have a terribly stable foundation. 
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Sileree · Nov 25, 2010

<div class="quote-container">Quote:
<div class="quote-block">What I'm having a hard time supporting is policy-makers and medical trade groups basing their call for mass vaccination on all of this "contradictory evidence" and "lack of evidence." If evidence-based policy making is the goal (and for obvious reasons, I question that it is), then these power-holders don't have a terribly stable foundation. </div>
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There are political reasons for why there is now a universal recommendation.
 
These are from 2005:
 
<a href="http://www.washingtonpost.com/wp-dyn/content/article/2005/10/07/AR2005100701808.html" target="_blank">http://www.washingtonpost.com/wp-dyn/content/article/2005/10/07/AR2005100701808.html</a>
 
<a href="http://www.telegraph.co.uk/news/uknews/1501494/Firms-threat-to-limit-bird-flu-vaccine.html" target="_blank">http://www.telegraph.co.uk/news/uknews/1501494/Firms-threat-to-limit-bird-flu-vaccine.html</a>
 
ETA ~ Also this link talks about pushing annual flu shots to get people to be more likely to accept a pandemic vaccine:
 
<a href="http://www.nejm.org/doi/full/10.1056/NEJMp1012333?query=TOC" target="_blank">http://www.nejm.org/doi/full/10.1056/NEJMp1012333?query=TOC</a>

carriebft · Nov 27, 2010

new study- effectiveness of flu vaccination in under 3s, with a subgroup of under 2s:
 
<a href="http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2810%2970255-3/abstract" target="_blank">http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2810%2970255-3/abstract</a>
 
 
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<div>We enrolled 631 children into our study with a mean age of 2·13 years (range 9—40 months). Seven (5%) of 154 fully vaccinated children and 61 (13%) of 456 unvaccinated children contracted influenza during the study (effectiveness 66%, 95% CI 29—84; p=0·003). In the subgroup of children younger than 2 years, four (4%) of 96 fully vaccinated children and 21 (12%) of 172 unvaccinated children contracted influenza (66%, 9—88, p=0·03). We were unable to record any adverse events associated with the vaccination of the children in our study.</div>
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I hope this leads to more study on this and I have to revise my statement earlier that we have no evidence of under 2s effectiveness.

13Sandals · Nov 29, 2010

"We were unable to record any adverse events associated with the vaccination of the children in our study."
 
Does anyone else find that an odd choice of wording? Does that mean they didn't see any adverse reactions in the vaccinated group, or they were 'unable' to record them? I can only see a synopsis of the study, so its hard to tease out the exact meaning.

Influenza Vaccine: Policy v. Evidence

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