Bad science perpetuated - influenza vaccine revisited

[Dragar]

I can't find the 2013 version; the 2012 version is available but doesn't contain that little rant, Godfry.

The general message I'm taking home from skim reading is that while efficacy of the vaccines is pretty well established, effectiveness is not. And the data is crap.

[LadyShea]

This article was a pretty balanced look at both sides, and again I am finding no extreme or irrational claims....certainly nothing to lead me to the conclusion that there must be a bunch of kickbacks involved to explain encouraging vaccination.

Analysis finds limited evidence for HCW flu vaccination | CIDRAP

He also cautioned that the meta-analyses focus on nursing homes, which are very different from hospitals, where patient turnover is higher and there are often people in the facility who aren't HCWs. Even with 100% vaccination rates in employees, the roughly 60% protection offered by the vaccine creates a gap in which workers can still get sick and spread the virus to patients, he said.

"We really don't have a good grip on the epidemiology of influenza in the healthcare setting," Kelley said.

Still, it’s clear that vaccination is the best strategy to minimize getting flu, he said. "It makes sense to vaccinate healthcare personnel. The evidence is just not as strong as most organization like to suggest, which this study highlights."

"It's the best intervention we currently have, so we need to keep using it while working toward a better flu vaccine," Kelley said.

[godfry n. glad]

Originally Posted by Dragar

I can't find the 2013 version; the 2012 version is available but doesn't contain that little rant, Godfry.

The general message I'm taking home from skim reading is that while efficacy of the vaccines is pretty well established, effectiveness is not. And the data is crap.

Yep. Vaccines may work, particularly if they are well matched (which sounds like a huge annual crapshoot by WHO, to me). But they will only address those viral infections caused by the viruses targeted...what, three or four?...while the remaining over 200 ILI are largely unaddressed.

I don't think that the 2013 version of the "...in Healthy Adults" review is freely available online. I suspect that to obtain it, you would need to get it through an institution which subscribes.

Also, using your link above, it goes to the review of "Vaccines to prevent influenza in healthy children", rather than to the "Vaccines to prevent influenza in healthy adults". There is a whole series of various reports on research carried out with various populations, including several higher risk populations. There is also a review of "Vaccines to prevent influenza in health care workers who work with the elderly". Each review has a slightly variant set of discussion and recommendations, and each report seems to have fairly frequent sets of updates. It seems the most recent update of each report requires accessing through an institutional holder (probably thanks to the publisher, Wiley).

Also, I've found that it is best to move from the abstracts in to the full report and read the discussions therein...which is where I stumbled across the snarky remark about the CDC....which I posted because it seemed to conflict with the LS typification of CDC as 'conservative' in their assessments.

[LadyShea]

I posted because it seemed to conflict with the LS typification of CDC as 'conservative' in their assessments.

Did you read the CDC page? Did you personally find it to be such an enthusiastic endorsement of the benefits of the flu vaccine that it indicated vaccine producer kickbacks?

I didn't, but that's my opinion.

[godfry n. glad]

Originally Posted by LadyShea

This article was a pretty balanced look at both sides, and again I am finding no extreme or irrational claims....certainly nothing to lead me to the conclusion that there must be a bunch of kickbacks involved to explain encouraging vaccination.

Okay. That's fine. But a major health sciences research institution which is mandating unnecessary global vaccination in the face of the leading research review organization in the world recommending against it...well, that certainly makes me want to "follow the money" to garner an explanation of why. Who gains? Who pays?

[LadyShea]

leading research review organization in the world recommending against it.

Wait a minute. Where did they recommend against it? To recommend against it, they would have to find that it is in some way detrimental.

Concluding that universal vaccination of HCW is not necessary is not the same thing as recommending against it.

You are really reading into things being said.

Originally Posted by from the OP

There is no evidence that only vaccinating healthcare workers prevents laboratory-proven influenza or its complications (lower respiratory tract infection, hospitalisation or death due to lower respiratory tract infection) in individuals aged 60 or over in LTCIs and thus no evidence to mandate compulsory vaccination of healthcare workers.

[LadyShea]

As to why, the quote I posted summed it up best I think...to paraphrase "It's the best we got at the moment."

Why don't you email whomever the deciders are at this institution and ask them who pays, who gets paid, and why they are mandating in the face of good research showing that mandates are unnecessary?

[godfry n. glad]

Originally Posted by LadyShea

Wait a minute. Where did they recommend against it? To recommend against it, they would have to find that it is in some way detrimental.

Concluding that universal vaccination of HCW is not necessary is not the same thing as recommending against it.

You are really reading into things being said.

From the Cochrane review, Influenza vaccination for healthcare workers who care for people aged 60 or older living in long-term care institutions (2013), within the discussion of the full article:

Implications for practice

All three cluster-randomised controlled trials (RCTs) contributing outcome data to our review are at high risk of bias and pooled data found no effect on the outcomes of direct interest, namely laboratory-proven influenza, lower respiratory tract infections and admissions to hospital and deaths from lower respiratory fract illness, with the 95% confidence interval (CI) in each case including unity. We conclude that there is an absence of high-quality evidence that vaccinating healthcare workers against influenza protects people aged 60 years or older in their care and thus there is little evidence to justify medical care and public health practitioners mandating influenza vaccination for healthcare workers who care for the elderly in long-term care institutions (LTCIs).

My bold. Warranted, it is not hospitals, but long-term care institutions for the reputedly most fragile and at-risk types of the general population.

I'm reading that as mass vaccinations being 'unjustifiable'.

[Dragar]

Originally Posted by godfry n. glad

Also, using your link above, it goes to the review of "Vaccines to prevent influenza in healthy children", rather than to the "Vaccines to prevent influenza in healthy adults". There is a whole series of various reports on research carried out with

Ah, thanks.

I had a look at the 'healthy adults' and again they make the point that the data is pretty crap.

I suspect - based on a very limited reading and understanding of all this stuff - that the influenza vaccines thing is basically a very cheap way of in principle (i.e. from the labwork etc.) reducing influenza especially amongst the elderly where medical complications arise quickly, and we don't know if it's all that good, but it's cheap and doesn't do much (if any) harm, so why not try since it's better than grandma snuffing it this winter?

NHS recommendations in the UK are for elderly folks to get the flu jab, made with a bit more earnest if there's a bad/quickly spreading strain detected and they know what it is. I don't think there's any claim it's a panacea or that it's worth getting your shot if you're not vulnerable (or, I suppose, in regular contact with old people). The BBC also makes the remark that the jab only works for a particular 'strain'.

This seems to sit with the literature (which seems to be a bunch of solid lab work and efficacy studies, and crap 'real world' effectiveness studies and some tricky meta analysis across all these differing, crappy datasets).

I hate this part about biology, and medicine, I really do. The data is often ridiculously shoddy. Dealing with this stuff as a day job is, especially as a theorist, terribly depressing at times.

As for grandoise claims, maybe it's different in America. The claims from the science folks seems pretty conservative from what I'm seeing.

[godfry n. glad]

Originally Posted by Dragar

Ah, thanks.

I had a look at the 'healthy adults' and again they make the point that the data is pretty crap.

I suspect - based on a very limited reading and understanding of all this stuff - that the influenza vaccines thing is basically a very cheap way of in principle (i.e. from the labwork etc.) reducing influenza especially amongst the elderly where medical complications arise quickly, and we don't know if it's all that good, but it's cheap and doesn't do much (if any) harm, so why not try since it's better than grandma snuffing it this winter?

NHS recommendations in the UK are for elderly folks to get the flu jab, made with a bit more earnest if there's a bad/quickly spreading strain detected and they know what it is. I don't think there's any claim it's a panacea or that it's worth getting your shot if you're not vulnerable (or, I suppose, in regular contact with old people). The BBC also makes the remark that the jab only works for a particular 'strain'.

This seems to sit with the literature (which seems to be a bunch of solid lab work and efficacy studies, and crap 'real world' effectiveness studies and some tricky meta analysis across all these differing, crappy datasets).

I hate this part about biology, and medicine, I really do. The data is often ridiculously shoddy. Dealing with this stuff as a day job is, especially as a theorist, terribly depressing at times.

As for grandoise claims, maybe it's different in America. The claims from the science folks seems pretty conservative from what I'm seeing.

If you want to be even more dismayed, jump over and read through the "Vaccines for preventing influenza in the elderly" review. Since it is a 2010 review, I suspect it should be freely available online. This is the one which brought to view the Lisa Jackson study and elicited Jefferson's snarky comment about vaccine maker claims of 'miracles, not medicine'. From my understanding of the data, vaccine effectiveness/efficacy is far worse amongst the elderly than amongst healthy adults....flu vaccines work for those who don't really 'need' them.

[godfry n. glad]

Originally Posted by Dragar

As for grandoise claims, maybe it's different in America. The claims from the science folks seems pretty conservative from what I'm seeing.

Well, I don't know about 'grandiose' claims, but here on my campus, the institution is pushing global vaccinations with signs plastered all over campus which state "Get the flue vaccine, not the flu - Protect yourself and your patients" and point to the times and locations where 'free' vaccinations can be obtained on campus. The implication is that a vaccination will prevent the vaccinated from getting any kind of ILI.

Then, in tiny print at the bottom, they state, "Non-vaccinated health care staff will be required to wear a mask when within six feet of a patient in a patient care area throughout the influenza 'masks on' period." Non-vaccinated staff, note.

Additionally, ALL staff, whether patient care or not are required to obtain a vaccination, or submit a 'declination form'. Those who submit the form and do not indicate obtaining a recent vaccination from another source, are told that they will be required to 'mask up' in patient care areas. This, I really don't mind, but it is the implication that if a caregiver HAS obtained an influenza vaccination, they will NOT be required to 'mask up'....that, in my estimation, if foolish to the extreme, considering that the vaccine may protect against only three of the over 200 circulating viral respiratory infections.

*facepalm*

[LadyShea]

vaccine effectiveness/efficacy is far worse amongst the elderly than amongst healthy adults....flu vaccines work for those who don't really 'need' them.

Yes, that is true, as the CDC page states as well.

But say one of those who doesn't really need the vaccine, for themselves, like me, is in regular contact with vulnerable people like the elderly, children, and immune-compromised?

Exposure risks:
I work with the public
I have a child in public school

Transmission risk:
I am in regular contact with a Nonagenarian in a nursing facility, a person with an autoimmune disease, two heart patients, several infants, a whole bunch of school age children, and now someone undergoing chemo

My being immunized might, possibly, help protect one of these people in my life at very little risk and no cost to me. Why wouldn't I do it?

As a matter of fact, in formulating this post, I have come to realize that I should have been doing it all along, and will do it yearly from now one.

[LadyShea]

Additionally, ALL staff, whether patient care or not are required to obtain a vaccination, or submit a 'declination form'. Those who submit the form and do not indicate obtaining a recent vaccination from another source, are told that they will be required to 'mask up' in patient care areas. This, I really don't mind, but it is the implication that if a caregiver HAS obtained an influenza vaccination, they will NOT be required to 'mask up'....that, in my estimation, if foolish to the extreme, considering that the vaccine may protect against only three of the over 200 circulating viral respiratory infections.

This is a problem, I agree. It is a policy issue needing to be addressed, because everyone should be taking whatever steps are needed to prevent transmission of all kinds of disease anyway.

However it is not an issue with the vaccine itself. It is not a reason to not get vaccinated.

[godfry n. glad]

Originally Posted by LadyShea

Yes, that is true, as the CDC page states as well.

But say one of those who doesn't really need the vaccine, for themselves, like me, is in regular contact with vulnerable people like the elderly, children, and immune-compromised?

Exposure risks:
I work with the public
I have a child in public school

Transmission risk:
I am in regular contact with a Nonagenarian in a nursing facility, a person with an autoimmune disease, two heart patients, several infants, a whole bunch of school age children, and now someone undergoing chemo

My being immunized might, possibly, help protect one of these people in my life at very little risk and no cost to me. Why wouldn't I do it?

As a matter of fact, in formulating this post, I have come to realize that I should have been doing it all along, and will do it yearly from now one.

See above post #58. Take all due physical barrier precautions and don't rely upon a vaccination to make you feel as though you can forego those precautions. The point, for me, at least, is that the 'great unwashed' seem to adopt the idea that if they've been vaccinated, then they've protected all those folks, when they have not.

[godfry n. glad]

Originally Posted by LadyShea

This is a problem, I agree. It is a policy issue needing to be addressed, because everyone should be taking whatever steps are needed to prevent transmission of all kinds of disease anyway.

However it is not an issue with the vaccine itself. It is not a reason to not get vaccinated.

I think that the mass vaccine approach for influenza infections is a misguided and expensive approach which has exceedingly limited effectiveness and inadequate safety testing, and the general public greatly misinterprets the message...with potentially counterproductive results. Even a major scientific health care research institution has swallowed the propaganda whole and ignored the best review of research available. You can engage in acquiescent complacence behavior if you so wish....I'm not that sheepish.

The next time somebody opines about 'Evidence-Based Medicine', I'll note that it sure would be nice. Maybe some day.

[LadyShea]

Originally Posted by godfry n. glad

See above post #58. Take all due physical barrier precautions and don't rely upon a vaccination to make you feel as though you can forego those precautions.

I don't think the flu vaccine allows me to forgo any precautions. It's not either/or, it's in addition to. Notice I said "might possibly help protect". If there was a strep vaccine I would sure as hell take it too, strep just went through the school and soccer league like wildfire a few weeks ago.

The point, for me, at least, is that the 'great unwashed' seem to adopt the idea that if they've been vaccinated, then they've protected all those folks, when they have not.

I haven't adopted that idea at all, I don't know anyone that has. Once again, notice I said "might possibly help protect". I will possibly protect someone from getting a particular strain of flu. That's it. Again I a unsure who you think is making actual claims otherwise.

[LadyShea]

I think that the mass vaccine approach for influenza infections is a misguided and expensive approach which has exceedingly limited effectiveness and inadequate safety testing

Thank you for finally listing the cons instead of just saying that a mandate is unwarranted...which again is not the same as recommending against something.

Is it expensive? If so, expensive to whom? I don't know. Do we have numbers on that?

Limited effectiveness is better than zero, IMO, so again why not use it if it's the best we have currently?

As for inadequate safety testing...did one of your links address that? If so, I missed it. AFAIK flu vaccines are relatively safe.

[godfry n. glad]

Originally Posted by LadyShea

I haven't adopted that idea at all, I don't know anyone that has. Once again, notice I said "might possibly help protect". I will possibly protect someone from getting a particular strain of flu. That's it. Again I a unsure who you think is making actual claims otherwise.

Well, the tenor of the Cochrane Library reviews is that the vaccine makers are willfully engaging in manipulating the results to cast a better light on their products...pushing 'miracles, rather than medicine'. And, if the flap around the phoney 2009 influenza "pandemic" is any indication, and the intimations arising from that have any credibility, then even the WHO SAGE crowd has been subject to corruption. Lower the bar, then have one of your researcher 'confederates' raise the alarm...when that happens, national governments go into apeshit overdrive to have massive amounts of vaccine manufactured and the taxpayer foots the bill for a vaccine that was entirely unnecessary. Big money in Big Pharm is successfully gaming the system....

And, no...I have no proof, but I still have not seen the results of the investigation that was launched in Europe into the unseemly relationships of Ab Osterhaus, the alarmist, with the pharmaceutical companies. It's big money and big money attracts big scammers, like Big Pharm.

Mayhaps Dragar can enlighten us on the Osterhaus scene?

[godfry n. glad]

Originally Posted by LadyShea

Thank you for finally listing the cons instead of just saying that a mandate is unwarranted...which again is not the same as recommending against something.

Is it expensive? If so, expensive to whom? I don't know. Do we have numbers on that?

Limited effectiveness is better than zero, IMO, so again why not use it if it's the best we have currently?

As for inadequate safety testing...did one of your links address that? If so, I missed it. AFAIK flu vaccines are relatively safe.

Yes...It was particularly highlighted in the full report on "Vaccines to Prevent Influenza in Healthy Children", IIRC. Each report addresses it in the appropriate section, but that one seemed to address it more fully. This is why the vaccine producers like the "pandemic" declaration aspect; all bets on safety are off, as they are absolved of any liability for harms imposed.

[LadyShea]

Originally Posted by godfry n. glad

I think that the mass vaccine approach for influenza infections is a misguided and expensive approach which has exceedingly limited effectiveness and inadequate safety testing, and the general public greatly misinterprets the message...with potentially counterproductive results. Even a major scientific health care research institution has swallowed the propaganda whole and ignored the best review of research available. You can engage in acquiescent complacence behavior if you so wish....I'm not that sheepish.

What acquiescent complacence behavior? Should I be all or what exactly?

A lackluster or minimal upside is not sufficient reason to rage out. If there is a marked downside, such as significant safety risk or great expense to the taxpayer or something, then make that case, please.

[LadyShea]

From the UK. Do we have a similar figure for the US?

The immunisation programme is estimated to cost the taxpayer £115million a year.

Read more: Flu jabs are a 'waste of taxpayer's money', claim scientists who the benefits have been over-hyped | Mail Online
Follow us: @MailOnline on Twitter | DailyMail on Facebook

if the flap around the phoney 2009 influenza "pandemic"

Phony? You have evidence for that?

[godfry n. glad]

Originally Posted by LadyShea

From the UK. Do we have a similar figure for the US?

I'm just trying to find out who authorized how much for the state in which I live...the state Health Department is stonewalling me. So far.

I'm not sure what the US figures are, but the 2009 'pandemic' scare was a massive windfall for vaccine manufacturers, at the taxpayers' expense.

[LadyShea]

I'm not sure what the US figures are, but the 2009 'pandemic' scare was a massive windfall for vaccine manufacturers, at the taxpayers' expense.

Evidence and numbers are needed for discussion

[Dingfod]

It is estimated that many hundreds of thousands of people died world-wide from the 2009 influenza pandemic (105,700-395,600 plus another 83,300 disease-related respiratory and cardiovascular deaths). Was it particularly deadly here in the U.S.? No. Were widespread inoculations responsible for that? Who knows? Actual numbers are notoriously hard to nail down.

[Dragar]

For what it's worth, I agree that a vaccine is no substitute for a face-mask, and vice-versa.