Flu Vaccine

Last month,, in a step tantamount to heresy in the public health world, scientists at the Center for Infectious Disease Research and Policy at the University of Minnesota released a report saying that influenza vaccinations provide only modest protection for healthy young and middle-age adults, and little if any protection for those 65 and older, who are most likely to succumb to the illness or its complications. Moreover, the report’s authors concluded, federal vaccination recommendations, which have expanded in recent years, are based on inadequate evidence and poorly executed studies.

“We have overpromoted and overhyped this vaccine,” said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy, as well as its Center of Excellence for Influenza Research and Surveillance. “It does not protect as promoted. It’s all a sales job: it’s all public relations.”

Dr. Osterholm, who says he is concerned that confidence in current vaccines deters research into identifying more effective agents, comes from the world of public health and the Centers for Disease Control and Prevention. A bioterrorism and public health preparedness adviser to Tommy Thompson, the former health and human services secretary, he served on the interim management team during a transition period at the C.D.C. in 2002.

Perhaps one of the most balanced articles on this topic was published in the well respected Scientific American in October of 2012.

One oft-cited claim, based on several large meta-analyses published more than a decade ago, is that seasonal flu shots cut the risk of winter death among older people by half. But the research behind that claim has been largely debunked. A 2005 study published in the Archives of Internal Medicine noted that influenza only causes about 5 percent of all excess winter deaths among the elderly—which works out to one death from flu per 1,000 older people each season—so it’s impossible for the shot to prevent half of all their winter deaths. The following year, a study reported that as vaccine coverage increased among the elderly in Italy in the late 1980s, there was no corresponding drop in excess deaths. In another 2006 paper, Lisa Jackson, an infectious disease epidemiologist at the Group Health Research Institute in Seattle, and her colleagues showed that although vaccinated seniors were 44 percent less likely to die during flu season than unvaccinated seniors were, the vaccinated ones were also 61 percent less likely to die before flu season even started. “Naturally, you would not expect the vaccine to work before the thing it protects against is going around,” says Lone Simonsen, a research professor in global health at George Washington University and a co-author of the 2005 study in the Archives of Internal Medicine.

Researchers now attribute these odd findings to a “healthy user” effect. People who don’t get vaccinated often “are the most frail or [those] whose health has gone down dramatically in the last few months,” explains CDC epidemiologist David Shay. People who choose to get flu shots, in other words, are already healthier and therefore the least likely to die.

Flu Vaccine for the Elderly is Ineffective

New York Times entitled, Doubts Grow over Flu Vaccine in Elderly, by Brenda Goodman, notes that more and more scientists, especially those in the fields of immunology and epidemiology, are admitting that the flu vaccine doesn't work very well in the elderly population -- the same group that suffers three-quarters of all flu deaths.

A new study published in August of 2008 in the prestigious British medical journal, The Lancet, suggests that earlier studies supporting the effectiveness of the flu vaccine in the over 65 population were based on a misinterpretation of the statistical data. Although there are still many skeptics who still think the elderly should be vaccinated for influenza on an annual basis, more and more scientists are seeing that this assumption was based on lousy science. Although the science was shoddy it did support an entire multi-billion dollar industry created to produce and distribute millions of flu shots to the elderly each year.

The new Lancet paper by Michael L. Jackson and colleagues at the Group Health Center for Health Studies in Seattle, Wa., looked at the medical charts of thousands of elderly HMO patients. Their study showed what many have suggested in the past, that the elderly who were most likely to get the flu shot were those who were generally healthy and concerned about staying well and thus less likely to succumb to the flu even if they contracted it, while those who were frail and had trouble bathing and dressing on their own were much less likely to get to their doctor's office or local clinic to receive the flu shot. Obviously the frail group was closer to death to begin with and was more likely to die of any cause. This statistical oversight has caused scientist to assume that those who did not get vaccinated for the flu were the more likely to die. Instead what Michael L. Jackson and colleagues have shown was that the effectiveness of the flu vaccine was grossly over estimated because the people who died were of very frail health and the people who received the flu vaccine were, statistically speaking, in much better health and less likely to die. The assumption that the flu vaccine was responsible for saving lives was based on what scientists refer to as a "frailty selection bias." When the frailty selection bias is removed from the data it becomes clear that the flu vaccine is generally ineffective in the over 65 population.

Although this latest Lancet paper was recently published ion August 2008, for almost a decade there have been numerous anecdotal reports and many smaller studies suggesting that people who have been vaccinated for the influenza virus still contract the flu. It was not until 2005 that the medical and scientific communities had begun to consider this as a very real possibility, especially as it relates to the over 65 population -- the same population at greatest risk of complication and death from the influenza virus and the same population at which the mass flu vaccine marketing campaign has been directed.

In a 2005 publication of a landmark paper in The Archives of Internal Medicine, Dr. Simonsen of the National Institute of Allergy and Infectious Diseases (NIAID) in Bethesda, Md., found that the data supporting the use of influenza vaccination in the over 65 population just did not make sense. Her research showed that even though the percentage of older people who were vaccinated for the flu more than tripled from 1980 to 2001 there was NO DROP in the death rate. She also notes that influenza likely caused just 5 to 10 percent of all winter-time deaths in the elderly yet earlier studies stated that the flu vaccine was responsible for reducing an elderly person's risk of death by 50 percent. You don't have to be a math whiz to realize that something here just doesn't add up! Dr. Simonsen's paper was the first suggestion that "fuzzy math" might be responsible for the discrepancy between the reality of an unchanged death rate despite a tripling of the vaccination rate. As you might imagine her paper set off huge debate sparking many angry editorials from those who had difficulty grasping the fact that the flu vaccine statistically doesn't work in the over 65 population.

You may ask why the flu vaccine doesn't work. There are numerous reasons and when you add them all up you realize that the risks of experiencing a side effect from the flu vaccine, although small, may out weigh any benefit. Here are the reasons the flu vaccine is not effective in the elderly and may not always be effective in younger individuals as well:

• The elderly and very young tend to have reduced immunity making it difficult, if not in many cases impossible to develop immunity in response to the vaccine.

• The vaccine itself may not be directed to the current strain of the influenza virus. Vaccine production must take place almost a year in advance requiring an educated guess as to which strains to include in the vaccine. This is exactly what happened in 2003-04 and 2007-08 when the Center for Disease Control admits that the strains included in those flu vaccines missed the mark. See the CDC website for the facts surrounding this issue: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm57e215a1.htm

• The influenza virus by nature mutates and changes its protein coat as it moves through a population. It is impossible to make a vaccine that will remain effective even if it starts out effective.

What about side effects? As with any vaccination there is always the very real risk of side effects. Most side effects are relatively minor however the possibility of a life threatening allergic reaction is real, especially if you have an egg allergy as eggs are used in the production of the flu vaccine. The most devastating side effect is estimated to result from one in 100,000 flu shots. This is a severe disorder leading to extreme muscle weakness and paralysis as a result of nerve injury.
A Holistic Note: If you are a young, healthy individual should you get a flu shot? The holistic view is that your immune system needs to be occasionally challenged in order to remain strong. Not unlike your muscles, your immune system needs "exercise" to remain strong. Although experiencing a bout of the flu is never pleasant, in the long run it will usually strengthen the immune system of most otherwise healthy, young people.

What about my elderly grandparent? We must all admit that the longer we live and the more frail our health becomes the greater the risk of death. From the beginning of time Mother Nature, or if you prefer -- God, has used infectious disease as a way of transitioning souls to the other side. In this day and age of high-tech biomedicine death by infectious disease has been dramatically reduced allowing us to live longer and longer. Since the discovery of antibiotics the more common causes of death have become cancers and chronic diseases such as cardiovascular disease or stroke as well as neurodegenerative diseases such as Alzheimer's and Parkison's diseases often resulting in a slow, miserable death filled with suffering for the patient and their family. Personally, when I'm old and it is my time to transition to the other side I would rather die from influenza than from cancer or Alzheimer's disease and frankly, I should not be prevented from taking that risk if I so choose.

James T. Prado, D.C.
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