Scientists shill for vaccine manufacturers in doing routine research. This week, HealthDay reports that University of Rochester researchers found lower flu-immunization coverage in states with less Medicaid coverage for vaccination. Instead of asking whether pediatric flu immunization has any public health value, research like this assumes that flu immunization is useful. It helps make sure the vaccine manufacturers sell more flu vaccine.
What is the value of mass immunization of children against flu?
CDC claims that flu is dangerous for children and recommends immunization. This claim seems to be based on the 50 to 150 pediatric deaths attributed to flu each year. Preventing children’s deaths is a good reason to immunize those who might get very sick were they to be exposed to influenza.
But to translate a small number of possibly preventable deaths into a national policy of mass immunization? That takes a special relationship with the vaccine manufacturers (see here and here and here and here for my comments on the collusion of officials with pharmaceutical interests).
The evidence that flu vaccine is effective in children is shaky, as Dr. Tom Jefferson’s exhaustive scrutiny of study data reveals. Immunization of children seems to be weakly effective at reducing influenza-like illnesses in a general population, as Ritzwoller et al. showed in a study published in Pediatrics in 2005. Partial immunization was ineffective — an issue worth considering if more than a single dose is required.
A few studies suggest that mass immunization of children is a way to prevent flu among young adults.
A community trial of immunization of children against flu, published in Vaccine in 2005, showed the ineffectiveness of immunizing children: there was no reduction in acute respiratory illnesses among children in the concurrent or subsequent flu seasons, compared to communities where kids were not immunized. There were slight reductions in ARI incidences among adults in the community where children were immunized — but this study wasn’t designed to show whether it was the immunizing of kids that protected the adults, or something else.
Similarly, a 2000 study published in JAMA by Hurwitz et al. showed that flu immunization of children in day care had the effect of reducing acute febrile illnesses among household contacts, compared to household contacts of daycare attenders who were not immunized (abstract here, full article requires subscription). So immunizing children in daycare might help their parents to avoid getting sick.
In general, there’s suggestive evidence that mass immunization of small children against flu lessens the impact of flu outbreaks among young adults.
But few young adults die of flu. It’s an annoying and sometimes serious illness. The reason the public health authorities are interested in preventing flu among young adults isn’t to reduce suffering; it’s to keep them from staying out of work. Should we immunize children so that the nation’s economic machine doesn’t slow down?
To put it a little differently: should we shift large amounts of taxpayer money into the hands of pharmaceutical and vaccine manufacturers for the purchase of flu vaccine for children, basically in order to spare employers the loss in profits that would arise when workers stay home?
The news from ProPublica this week, that they and associated journalists found many cases of physicians taking money from big pharmaceutical companies, is alarming but comes as no surprise. ProPublica’s new searchable database shows that the seven pharmaceutical companies (collectively accounting for 36% of market share) that provided data together made $257.8 million in payments to physicians.
What’s more alarming is that pharmaceutical companies often don’t even have to bother paying to push their products. That’s especially true when the product is a vaccine. Even flu vaccine, despite its limited and highly variable effectiveness. Policy decisions made by the Advisory Committee on Immunization Practices and CDC, practice decisions by medical organizations, research-grant funding, and so on are thoroughly organized around immunization. Despite the evidence.
This entry was posted on Wednesday, October 20th, 2010 at 7:28 am and is filed under Health Professions, News, Physicians, public health, Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.