The Politics of Flu Vaccination.
September 4, 2002 8:02 AM   Subscribe

The Politics of Flu Vaccination. When the next deadly Flu pandemic sweeps the world, will you be able to get a vaccination? Are you an infant, elderly, or a nuclear power plant worker? Due to economics, the yearly flu vaccinations are unreliable.
posted by Secret Life of Gravy (17 comments total)
 
From the CDC vaccination guidelines (first link):

EFFECTS ON OTHER ESSENTIAL SERVICES (HUMAN INFRASTRUCTURE) -

In contrast to typical natural disasters...an influenza pandemic may also pose significant threats to the human infrastructure responsible for critical community services due to widespread absenteeism in the workforce. Examples of such services (and personnel) in the non-health sector might include highly specialized workers in the public safety, utility, transportation and food service industries, and will likely vary from jurisdiction to jurisdiction. State and local officials should carefully consider which services (and key personnel within relevant firms or organizations) are "essential" -- i.e., which services, if interrupted, and which workers, if absent, would pose a serious threat to public safety or would significantly interfere with the ongoing response to the pandemic.
posted by Secret Life of Gravy at 8:05 AM on September 4, 2002


Yikes! Is this the most boring Post, ever?

Apparently I'm the only one who finds it rather haunting that the local, state, and national officials have already drawn up their lists as to who will be expendable and who will be required when the killer flu or bioterrorist attack hits.

Bus driver, National Guardsman, garbage collector? Check.
Housewife, college student, artist? Back of the line, buddy.
posted by Secret Life of Gravy at 11:16 AM on September 4, 2002


Not only might the supply of vaccines be unreliable, but vaccines themselves are not without serious risks that are not often communicated to recipients. At least where I live, vaccines are not mandatory. But you'd never know it from talking to your School Nurse.

So, I'm more concerned having the right to opt out. Don't worry, Secret Life, I'll give you mine.

(I held off posting cause I know I'm a little off-topic, but since it was quiet...)
posted by BinGregory at 11:28 AM on September 4, 2002


Well, Bin, since you brought it up...I have never gotten a flu vaccine. But I can't help but think about the great Spanish Flu epidemic of 1918 when a disproportionate number of previously healthy 20 to 40 year olds were killed. I think in that case (or in the case of a bioterrorist release of smallpox, for example) I would want the option of a vaccination.

What started me thinking about this was I just finished reading The Devil's Flu and the author mentioned that it was easier to buy heroin on the streets of San Francisco in the year 2000, than it was to buy a flu vaccination.
posted by Secret Life of Gravy at 11:40 AM on September 4, 2002


Heh. I talk big now; anthrax might change my mind.

it was easier to buy heroin on the streets of San Francisco
Yeah, but is that the least bit hard? :)

Right, the Spanish Flu. Back in the 70's, there was a massive immunization program to combat swine flu, which everyone thought was going to be the next Spanish Flu. I don't know how many non-vaccinated people died of the swine flu, but 25 died and 500 were paralyzed by the vaccine. Yikes!

Vaccines have their place; I'm not saying they don't. It's just the hype with which they're pushed. When the chicken pox vaccine came out, suddenly there were stories in the paper about the vicious childhood plague, the scourge, the pox, and the heroic efforts of the medical industry to stamp it out. Chicken Pox! Come on. But I'm sure now it is as vigorously shoved on parents as all the rest of them. grumble grumble
posted by BinGregory at 12:22 PM on September 4, 2002


Before chickenpox vaccination became available, approximately 9,000 people in the U.S. were hospitalized with the disease, and about 90 people died from complications from chickenpox annually. There is an economic cost to the disease above and beyond hospitalization or fatal outcome. Source: American Academy of Pediatrics (AAP)
posted by fold_and_mutilate at 2:47 PM on September 4, 2002


About the flu vaccine, it's easy for politicians and observers to lament the system by which it's distributed, but strangely, none of them have a solution. Why? Because there doesn't appear to be one, and to understand why, you have to understand how the vaccine comes into being every year. And here's a hint: it's not economics that serves as the bottleneck.

There are a ton of different serotypes -- strains, if you will --- of the influenza virus. Each of the serotypes is different enough from all the others that there's no single vaccine that covers them all; instead, a vaccine needs to specifically be targeted against each of the strains individually. Because this isn't possible (e.g, new serotypes arise all the time, there's no logistical way to manufacture vaccine against the hundreds or thousands of known serotypes, and there are serotypes that are rare enough to not warrant attention), the annual vaccine only targets three of the strains. The trick of the entire issue lies in the how the three covered strains are chosen.

We've discovered, through decades of surveillance, that the predominant disease-causing strains in Asia from March through September are the ones that will then cause the most burden of disease in the Western hemisphere. Thus, there's aggressive surveillance in Asia throughout the March-to-September time period, and the three strains most responsible for disease are the ones that are included in that year's vaccine in the United States. Yep, that's right -- each year, the vaccine is totally different from the year before.

What does this mean? Each year, the manufacturing process needs to start anew, with brand new tissue cultures of the flu viruses, brand new processing of the cultures into the various components of the vaccine, brand new assembly of the vaccine, and then shipment out to clinics and hospitals. Added to this, the flu virus takes a relatively long time to grow, and there's no hurrying that stage up.

So, each year, while the first supplies of the vaccine are starting to enter the fulfullment pipe, health care providers need to prioritize who will most benefit from early access. People with some medical susceptibility to the flu, and people with bad lung disease, clearly have greater need than healthy people who are at annual physicals, and that's just a fact; while it's annoying, the flu isn't going to kill your average, healthy person, but it very well may kill a ten year old kid with cystic fibrosis. Thus, the CF kids will probably get the vaccine earlier, as will neonates with respirator-induced lung disease, sickle cell patients with histories of acute chest syndrome, and a bunch of other classes of patients.

Now, on the side issue of vaccines in general: Bin, in most school systems in the U.S., vaccines are mandatory -- and for good reason. As a parent, I wouldn't want my kid in a school with kids who aren't vaccinated -- I don't want there to be a chance of a measles outbreak, or H. influenzae (which, until the vaccine was created, was the single leading cause of pneumonia, pharyngitis, ear infection, and meningitis in the pediatric population). As a school administrator, I don't want dozens of kids with the terrible diseases that we've done so much to wipe out.

Another way to think about it: people who don't get vaccines are taking advantage of the fact that so many others do. It's easy to say how wise your decision is to not get your MMR when the chances of you contracting measles, mumps, or rubella are made so much lower by the fact that every other kid around you was vaccinated against it; when communities stop getting the vaccine, then those communities serve as foci for outbreaks.
posted by delfuego at 4:37 PM on September 4, 2002


F&M: And now?
I don't deny chicken pox can be deadly. I'm saying the vaccines can be too. I'd like to decide which. From my link above:
VAERS data made public today, it was reported that VAERS had received 67.5 adverse event reports per 100,000 doses of chicken pox vaccine sold between March 1995 and July 1998 for a total of 6,574 reports. 82 percent of the adverse event cases occurred in individuals who received chicken pox vaccine only. Admitting that underreporting made the figures "highly variable fractions of actual event numbers," the authors revealed that approximately 4 percent of cases (about 1 in 33,000 doses) were serious, including shock, convulsions, encephalitis, thrombocytopenia and 14 deaths.


As a parent, I wouldn't want my kid in a school with kids who aren't vaccinated
If your kid is vaccinated, he has nothing to worry about, no? If my kid gets sick, it's on me. People should be responsible for their own health. That should include the right to choose to vaccinate or not, and in Michigan we still have that right. For those of you who have lost that right, think about what that means. You wouldn't let the government dictate how you live in your home, but your own body is surrendered without a second thought. I'm not trying to make that more sinister than it is; I'm not a black helicopter dude. But to not have the choice?
How easy is my decision? I've had measles and mumps, chicken pox too. That's how I acquired immunity, and I'm healthier for it. The philosophy behind vaccines makes no sense to me; as though if we can only develop enough vaccines, no one will ever fall ill?
posted by BinGregory at 5:23 PM on September 4, 2002


If my kid gets sick, it's on me. People should be responsible for their own health.

That's internally inconsistent -- you should be responsible for your own health, but when it comes to the health of your children, you don't have absolute rights. For example, nobody would say that you have the right to not bring your child into the ER when they appear to have appendicitis, and there's on-point court precedents in the U.S. for removing parent's rights to make healthcare decisions when those decisions go against what's best for the child (e.g., refusal of blood transfusions). I don't believe a court has ever been asked to apply this to the area of vaccines; my personal opinion is that it'll take an epidemic of a vaccination-preventable disease to get to this point.

You wouldn't let the government dictate how you live in your home, but your own body is surrendered without a second thought. I'm not trying to make that more sinister than it is; I'm not a black helicopter dude. But to not have the choice?

Bin, you have the choice -- you can keep your kid at home, in homeschooling. Public health has always been something that involves balancing personal rights with those of society; for example, you can't choose to not get treated for tuberculosis without also being hunted down by your state department of health and enrolled in directly-observed therapy by court order.

And whether or not my kids are totally protected with vaccines, the answer is no -- vaccines aren't 100% effective, although they are damn close. In addition, there are kids who have a legitimate health reason why they may not get vaccinated exactly when they should (for example, they are sick on the scheduled vaccination day, or they have an undiagnosed chronic condition on the day that they are due to get their pertussis vaccine). Because of that, the country has also placed a premium on herd immunity -- getting society to be, on the whole, less susceptible, so there's a generalized lower risk for anyone and everyone.

The philosophy behind vaccines makes no sense to me; as though if we can only develop enough vaccines, no one will ever fall ill?

No sense? What's illogical about doing everything we can to use a low-cost injection to prevent diseases with huge financial and medical burdens? Honestly, I wasn't making up the H. flu information -- it's a disease that was the leading cause of a ton of massive morbidity and mortality in the era of my teachers, and now, I haven't seen a single case of it. Less kids with meningitis (and the consequential death, time in an intensive care unit, physical handicaps and learning disabilities), less kids intubated and on respirators for epiglottitis, less kids with chest tubes for pneumonias. Three shots in the first 15 months of life, and I've never seen it. Ever.
posted by delfuego at 7:30 PM on September 4, 2002


(Wait -- I didn't mean "internally inconsistent" in the first paragraph above, but rather that it's a non sequitur -- having the right to choose for yourself has nothing to do with whether or not you can choose for your child.)
posted by delfuego at 7:32 PM on September 4, 2002


Having a pediatrician tell me I am not responsible for my own child... *fumes* That's why I avoid you folks in the first place. If this was one of your patient contact drills with the actors that you practiced this spiel (sp?) on during med school, you would have just failed. Factually correct, the overseeing would have said, but you pissed off the patient.

Don't get me wrong, Doc. I believe in seeking healing when I am sick. I just don't believe in putting myself at risk to be sick to avoid the risk of getting sick. First do no harm, right? Will you deny that vaccines cause death and permanent damage every year to children across the country? Never mind the alleged links to autism and SIDS, simple adverse vaccine reactions can and do kill and permanently damage previously healthy babies. I think that is indisputable. The decision to make vaccines mandatory is a policy decision, not some kind of natural self-evident truth.

vaccines aren't 100% effective, although they are damn close.
Vaccines are almost 100% effective, and yet the whole system is threatened by my nonparticipation? You can't have it both ways, Doc. Maybe the question is, is the risk to my child from getting a vaccine greater than my unvaccinated child's risk to all your children with damn close to 100% immunity? How damn close was that again?
posted by BinGregory at 8:50 PM on September 4, 2002


Having a pediatrician tell me I am not responsible for my own child... *fumes* That's why I avoid you folks in the first place. If this was one of your patient contact drills with the actors that you practiced this spiel (sp?) on during med school, you would have just failed. Factually correct, the overseeing would have said, but you pissed off the patient.

Nonsense. A good pediatrician will tell parents point-blank when they are being irresponsible. That's part of their job. Contrary to what you seem to think, a pediatrician's concern is your child....not you. (And most pediatricians will tell you that parents are usually more of a problem than the children.)

Your child will be healthier for receiving vaccines. The benefits of the vaccines outweigh the risks. Public health measures such as vaccines are the real success stories of medicine...responsible for the vast majority of decreased mortality and morbidity throughout the world.
posted by fold_and_mutilate at 11:33 PM on September 4, 2002


On the efficacy of varicella vaccination:

"Varicella vaccine has been demonstrated to be very effective. Prelicensure, controlled, clinical trials demonstrated varicella vaccine to be 70% to 90% effective for preventing varicella and more than 95% effective for preventing severe varicella. A postlicensure study of 148 children performed during an outbreak of varicella in a child care center in DeKalb County, GA, found that varicella vaccine was 86% (95% confidence interval [CI], 73%-92%) effective for preventing varicella and 100% (95% CI, 96%-100%) effective for preventing moderate to severe disease. Varicella was less severe and resulted in fewer days of absence from the day care center among immunized compared with unimmunized cases.Two more recent studies found that varicella vaccine was 86% (95% CI, 67%-94%) and 84% effective (95% CI, 60%-94%), respectively, for preventing varicella and 100% effective for preventing severe varicella. "Breakthrough" disease following exposure to wild-type varicella-zoster virus (VZV) occurs in about 1% to 4% of vaccinees per year, and the rate does not seem to increase with length of time after immunization.18 "Breakthrough" disease is usually of short duration and mild with fewer than 50 lesions and low-grade or no fever."

On the potential side effects cited above ("the authors revealed that approximately 4 percent of cases (about 1 in 33,000 doses) were serious, including shock, convulsions, encephalitis, thrombocytopenia and 14 deaths."):

"Serious adverse events, such as encephalitis, ataxia, erythema multiforme, Stevens-Johnson syndrome, pneumonia, thrombocytopenia, seizures, neuropathy, and death, have been reported rarely in temporal association with varicella vaccine. In some cases, wild-type VZV or another causal agent has been identified. In most cases, data are insufficient to determine a causal association. "

Source: Amercian Academy of Pediatrics Policy Statement Volume 105, Number 1
January 2000, pp 136-141

posted by fold_and_mutilate at 11:50 PM on September 4, 2002


I've learned better than to argue too much with parents who just plain don't agree, which is why, instead of continuing to serve as the pediatrician for kids whose parents refuse to immunize, I help them find another pediatrician. But I can't resist arguing with the entire vaccines-cause-autism and vaccines-cause-SIDS notions.

First, let's be clear about that which we're talking. The only data that ever came out linked the MMR vaccine -- measles, mumps, and rubella -- to autism, and the DTaP vaccine -- diptheria, tetanus, and pertussis -- to SIDS. No other vaccines.

Now, as for autism, I've written about the lack of a demonstrable link on my site before. The entire association was attributed by a single researcher in England, a man who has since completely reversed himself; likewise, the latest and best research clearly demonstrates that there is no link, nor is there any physiologic mechanism that could cause a link. At this point, the thought that MMR could cause autism is a debate that is brought up mostly when teaching about how myths and bad science can get out of control fast enough to cause a real health problem in the pediatric population.

As for SIDS, likewise: the latest and best data shows no link between DTaP and SIDS. There are two good double-blinded, randomized, case-controlled studies, one in 2001 and one in 2002, both of which show no increased incidence; there is even a decent study from 1999 that shows that DTaP may have a protective effect. And importantly, one of the largest SIDS advocacy and research groups acknowledges that there isn't a link.

(Honestly, the only reason I refute any of this is that I'd be pretty annoyed if a parent read this thread, saw no response, and decided not to vaccinate his or her kid because of it. If you are said parent, please feel free to email me personally if you have any other questions; I'm happy to talk about it more.)
posted by delfuego at 4:03 AM on September 5, 2002


Mornin'
Et tu, F&M?
Don't tell me vaccines will make my child healthier because he is already in a state of health. The chance that vaccines will make him resistant to a future illness is greater than the chance they will injure or kill him, that's all you can say. I'll take no kill with my cure, thanks all the same.
Well, if I can't convince the most consistently radical guy in this place, then I guess I better stop.
But I'll stand by this:
the right to informed consent to any medical procedure which carries the risk of injury or death is a human right.

...quote found here
posted by BinGregory at 7:04 AM on September 5, 2002


Bin, do you let your children eat honey? The risk of getting botulism -- meaning paralysis, intubation, ventilation, and all that goes along with it -- from honey is on the same order of magnitude as having an adverse event with an administration of the MMR vaccine.

Do you take your children in a car? The risk of serious injury from car accidents is significantly higher than having an adverse event from a vaccination.

Do you let your kids swim? Same thing.

I could go on and on; I won't, because I think this dead horse has been beaten enough. I just wanted to make the point, if not to you, then to others, that people rarely apply the same risk-benefit analysis to medical decisions as they do to non-medical ones.
posted by delfuego at 5:22 PM on September 5, 2002


I know how you feel. I like to have the last word too.

Your point makes mine. This world is a crapshoot, Doc. Nobody knows when, where and how they’ll be born, and nobody knows when, where and how they will die. I don’t have the numbers, ‘cause I don’t live my life that way, but I imagine the risks from driving a car are greater than the risks from *catching the chicken pox the old-fashioned way*. The point is that I choose to manage my risks (and those of my children, dangit) how I see fit. I can wear a seatbelt, drive defensively and move out of Detroit if I want to minimize my risk. If I fall ill, I can seek out the treatment modality (dja like that?) that I feel will serve me most effectively. With vaccines, though, that choice is taken away, and I have no way of managing my own risk. You know, you know , by the very same statistics you’re living on, that some healthy child somewhere will DIE from the jabs you’re (pl.) doling out. You just have no idea which one. It could be the very next kid you jab. And that is a violation of the Hippocratic Oath.

Yes, I know every technology in the allopathic bag of tricks, from pharm drugs to surgical procedures, has some risk of ill effect, up to and including death. But in those cases, the patient is sick and has come to you for help. If they die on the operating table, you have done your best for a willing patient, and God bless you for it. But with mandatory vaccines, your patient is not sick and not willing. If that patient dies, you alone must answer for that.
posted by BinGregory at 5:40 AM on September 6, 2002


« Older There's Something About Mary - Miraculous...   |   Recommendations Newer »


This thread has been archived and is closed to new comments