Winter is now well underway in the southern hemisphere, and so is the annual push to persuade everyone with a pulse to get a flu vaccine. Interest in this topic was high among members of my EmpowerEd health and nutrition education program, so I decided to run a Deep Dive webinar on flu vaccination, which will take place at 8 pm (AEST) on Tuesday 26 June, 2018.
I’ve previously written numerous articles on influenza vaccination and prevention strategies (Should you get a flu vaccine this winter?, Vaccines: Science, Undone Science and Anti-Science, Flu vaccination and faith-based medicine and Flu prevention: safe, effective strategies). However, when preparing for a Deep Dive webinar, I always delve into the latest research to ensure I’m presenting the most accurate and up-to-date information to EmpowerEd members.
Cochrane, the world’s most respected and independent organisation for assessing the evidence base of medical practice, is always my starting point, because Cochrane Reviews are, according to the National Health and Medical Research Council, Australia’s peak funding body for medical research, “internationally recognised as the benchmark for high quality information about the effectiveness of health care.”
Cochrane does not conduct medical research itself. Instead, the independent network of researchers that comprise Cochrane conduct systematic reviews and meta-analyses of the published medical literature, assessing the methodological soundness, risk of bias and other measures of research quality, and consolidating vast amounts of data into clinically useful guidance.
Interestingly, Cochrane updated and ‘stabilised’ 3 of its long-running reviews on the topic – Vaccines for preventing influenza in healthy adults, Vaccines for preventing influenza in healthy children, and Vaccines for preventing influenza in the elderly – in late January 2018.
The reviews’ author team, led by Tom Jefferson, head of Cochrane’s Vaccines Field and a man who “knows the flu-vaccine literature better than anyone else on the planet” (and who describes most of that literature as so deeply flawed that it’s “rubbish”) described their rationale for stabilising the reviews – which means they will not be updating them again unless certain criteria are met – as follows:
- The existing scientific literature provides “little or no data” on several important outcomes, including whether influenza vaccination decreases the risk of serious complications of the flu (such as pneumonia), decreases the death rate from flu, decreases transmission of flu in the community, or reduces the number of work and school days lost to respiratory tract illnesses. (Note that government-sponsored flu vaccination campaigns claim that vaccination does achieve all these outcomes, flying in the face of the evidence presented by Cochrane – which they contribute to funding.)
- There is “low-certainty evidence” about the effect of influenza vaccines on the occurrence of influenza-like illness (ILI), the clinical syndrome of fever, body aches, headaches, cough and runny nose that causes people to seek medical attention. The WHO and individual governmental health departments – including our own – monitor the occurrence of influenza and the emergence of new viral strains, in order to inform the development of seasonal and pandemic flu vaccines, but they don’t keep track of ILI itself:
“Few states produce reliable data on the number of physician contacts or hospitalised cases due to ILI, and none tie these data to the proportion of ILI caused by influenza. We do not know for certain what the impact of ILI is, nor the impact of the proportion of ILI caused by influenza.”
- Few clinical trials that provide any useful information by comparing flu vaccine to an inactive placebo have been published since Cochrane last updated their reviews. While vaccine proponents insist that depriving the control group of vaccination would be unethical, Jefferson has pointed out that the absence of credible evidence that influenza vaccination is effective for the population group that needs it most – the elderly – makes the use of placebo control the most ethical step to undertake:
“What do you do when you have uncertainty? You test,” he says. “We have built huge, population-based policies on the flimsiest of scientific evidence. The most unethical thing to do is to carry on business as usual.”
- The understanding of the relationship between immunity, vaccination and the development of the clinical presentation of influenza, on which the entire pharmaco-industrial-political complex which develops, distributes and markets flu vaccines is built, is fundamentally flawed. Vaccines are judged ‘effective’ if they stimulate an antibody response in the recipient, yet the extent of this ‘serological response’ bears little relationship with the likelihood of the recipient becoming ill with ILI: “Antibody responses are poor predictors of field protection.” There is more to getting sick than merely being exposed to a virus, and more to staying well than mounting an antibody response against the invader. As Jefferson and his co-authors put it,
“The vaccination selection and production programmes are based on aetiological assumptions which are neither explanatory nor predictive, as shown in our reviews.”
- Researchers focus on vaccine efficacy – the ability of the vaccine to prevent colonisation of the recipient by the particular viral strains targeted by the vaccine – rather than field effectiveness – the ability of the vaccine to stop someone getting sick with ILI. The most absurd manifestation of this “narrow and retrospective focus on influenza viruses at the expense of overall ILI ” is the so-called “case-negative study”.
In this study design, people who present to a doctor with ILI are swabbed to see whether they test positive or negative for vaccine-strains of influenza. If they do, they are considered ‘cases’, and if they don’t, they’re called ‘controls’. The laboratory efficacy of the vaccine is then calculated on the basis of what percentage of cases previously got the flu vaccine, vs the percentage of controls. If more controls than cases were previously vaccinated, the vaccine is considered to be effective.
Can you see the problem here? Everyone in the study was sick! If you’re the poor sod who is running a fever, aching all over and coughing up your lungs, do you think you’re going to feel better if the doctor comes to your bedside and tells you, ‘Well, least the vaccine worked – you don’t have flu’? There are over 200 pathogens that can cause ILI, and on average, 7-15% of people with ILI who undergo testing are found to be infected with an influenza virus. So no matter how ‘effective’ the flu vaccine is at protecting you against the particular flu virus strains that it was developed to combat, it’s highly unlikely to be ‘effective’ in the sense that most people would understand that word to mean – that is, effective at stopping you from getting sick. - Even worse, there is evidence that influenza vaccination may increase the risk of developing ILI from a non-influenza pathogen: “In 115 participants, those who received trivalent influenza vaccines had higher risk of acute respiratory infection associated with confirmed non-influenza respiratory virus infection (RR, 4.40; 95% CI, 1.31–14.8) compared to placebo recipients. The agents were mainly rhinoviruses and coxsackie/echoviruses; ILI episodes occurred shortly after a peak of influenza activity.” In plain English, that means that people who got a flu vaccine are, on average, over 4 times more likely to get a flu-like illness than people who don’t, especially just after the height of flu season.
Jefferson and his co-authors’ conclusion is damning:
“We await to see whether anyone has the interest or the courage to develop effective ways to control upper respiratory viral syndromes. Meanwhile our reviews will remain as a testimonial to the scientific failure of industry and governments to address the most important clinical outcomes for patients.”
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