It’s flu season again. The posters are up in the clinics, your GP has a stack of NHS information leaflets and advertisements and articles are appearing in the media carrying the health authority message that it’s time to get vaccinated.
Stirring up fear and apprehension through association is not a new tactic, but among the more troubling aspects of this message is the way that promoting a vaccine for flu places influenza on a par with more devastating diseases such as smallpox and diphtheria. Nevertheless the scare tactics have worked. Flu vaccine uptake among the over 65s, for example, has risen for each of the last three years from 65, to 68 and now 69 per cent against the government target of 70 per cent set three years ago.
The catch phrase on this year’s NHS information leaflet is: ‘If you knew about the flu you’d get the jab’. But if people truly knew about flu, and the lack of effectiveness of the vaccine being offered as protection, would they really be so obedient about getting the jab?
How deadly is the flu?
According to the UK Department of Health (DOH), 3,000 to 4,000 excess deaths are attributable to flu in non-epidemic years. During epidemics this figure rises; in 1989-90 there were apparently 30,000 excess deaths in Great Britain attributable to flu. The new DOH ‘factsheet’ Influenza: The Disease and The Vaccine goes further, estimating that an additional 12,500 people die each year during the flu season in England and Wales. In the US, the Centers for Disease Control and Prevention (CDC) website notes that, on average, 36,000 people die each year from flu in the US.
Contrast these figures with those from the Office for National Statistics, which show that in 2004 only 33 people died of influenza in England and Wales, and the CDC’s own data showing that in 2002 just 753 people died from flu and in 2001 only 257.
The discrepancy between actual deaths and those reported in ‘factsheets’ arises from the practice of combining flu deaths with a percentage of those from pneumonia and other respiratory diseases, making flu appear more deadly than it is.
The most recent CDC National Vital Statistics Report, for example, lists influenza and pneumonia as the seventh leading cause of death in 2002. Break down the figures and you find that only 753 of those deaths were flu-associated, while 65,321 were pneumonia-associated. If all flu-associated deaths are removed, pneumonia-associated deaths would still rank number 7, but influenza would barely register on the medical radar.
The whole truth?
In the UK, total flu deaths are also the result of combining influenza and pneumonia deaths, but the DOH’s influenza factsheet goes further combining data on flu, pneumonia and bronchitis, to paint its dramatic picture of fl u-related mortality. In small print it acknowledges: ‘It is difficult to establish how many people are seriously affected by flu each year as hospital admissions and deaths may be due to complications or the infection making other illnesses worse.’
In other words they are guessing and it is the laziest kind of guesswork since the winter season can bring about a whole range of health complications, including higher cholesterol levels and worsening glucose control, which have nothing at all to do with viruses. In fact, according to a 2002 report published in the British Medical Journal in which British scientists tracked the causes of excess winter deaths over the preceding 10 years, flu accounted for less than three per cent of all excess winter deaths in the UK (a higher figure than in other developed countries). In this country ‘cold stress’ – lack of adequate heating indoors and lack of appropriate winter clothing when outdoors – was the bigger killer.
Health professionals justify combining flu deaths with pneumonia deaths by insisting that ‘influenza leads to pneumonia’, but the facts don’t generally support this. The American Lung Association, for instance, acknowledges over 30 different causes of pneumonia (one of which is influenza). A single bacterium – Streptococcus pneumoniae – is responsible for up to 50 per cent of all cases of pneumonia. Pneumonia is also caused by other bacteria such as Staphylococcus aureus, Pertussis (whooping cough), Streptococci, and Mycoplasma pneumoniae (a common cause of walking pneumonia). There are also many noninfectious causes of pneumonia such as asthma, aspiration of fluids, toxic exposures and immunodeficiency.
Neither the CDC nor the DOH track the specific causes of the pneumonias that result in death. What is clear, however is that influenza is not the major cause of pneumonia and not a major cause of death. What has also become clear is that the flu vaccination does not prevent death.
Earlier this year a report in the medical journal Archives of Internal Medicine dropped a bombshell: although immunization rates in the elderly (people over 65) have increased 50 per cent in the past 20 years, there has not been a concurrent decline in flu-related deaths.
Another year, another vaccine
Vaccines are the sacred cows of medicine, you can’t question their effectiveness or publicise their adverse effects without sustaining a volley of criticism from the medical orthodoxy. Nevertheless we should be sceptical of their necessity and effectiveness, especially for seasonal, selflimiting illnesses like the flu.
There are three types of flu virus – types A, B and C. Influenza A occurs more frequently, is the most virulent and is responsible for most major epidemics and pandemics. Influenza B often cocirculates with influenza A during the yearly outbreaks, but generally causes less severe illness. Influenza C usually only causes a mild or asymptomatic infection similar to the common cold.
Within each of these types there are many different strains of influenza virus. While some are more common than others, there are literally hundreds of flu viruses that can be circulating at any one time. Nevertheless, every February the scientists at the World Health Organization meet to try and divine the three that are likely to cause the most misery the following winter. The viruses they choose – two type As and one type B, say – are then included in that year’s vaccine.
Problematically, in the several months between formulating the vaccine and administering it, the viruses – which are naturally constantly evolving and mutating – may have changed, or new ones may have emerged.
Maybe you will be infected with the virus that matches the vaccine, but then again maybe you won’t; flu ‘experts’ often get it wrong. For example, in 1994 they predicted that Shangdong, Texas, and Panama strains would be prevalent that year, thus millions of people were vaccinated against these viruses. However, when winter arrived, it was the Johannesburg and Beijing strains that circulated through society. It was a similar story in 1996, 1997 and most recently, in 2003 when the vaccine was made from flu strains that were uncommon that season.
While the flu vaccine is vigorously promoted by health agencies as the ‘best’ protection against flu, proclamations of how many people didn’t get flu thanks to vaccination are little more than fantasy; there is no truly reliable way to tell who would or would not have contracted the disease. What is more, studies into the efficacy of the vaccine continually show mixed results.
Health authorities justify the yearly vaccine campaign with data showing that when the match between the vaccine and circulating viruses is close, the flu vaccine provides a 70-90 per cent chance of temporary immunity in healthy persons under 65 years of age – a bizarre justification for the effectiveness of the jab given that healthy people don’t need the vaccine and are not among those targeted by government campaigns.
At any rate, reviews of the benefits of the flu vaccine in otherwise healthy adults show these figures to be overstated. While vaccinating healthy individuals temporarily reduces the number of people carrying the virus, it does not reduce the number people who ultimately go on to develop flu.
Recently doctors at the prestigious Cochrane Collaboration, a respected international organisation that conducts and publishes systematic reviews into the effectiveness of medical treatments, set out to find the answer to a simple question: how effective are flu vaccines for healthy people under the age of 60? They reviewed 25 good quality clinical trials, published in medical journals between 1969 and 2002, in which healthy people between the ages of 14 and 60 years had been randomly given either an actual or placebo vaccine. Their conclusion? Only six per cent fewer vaccinated people got flu, compared to the unvaccinated people. In addition, the influenza vaccine did not reduce the number of working days lost, nor did it reduce the incidence of flu-related complications, deaths or hospitalisations.
In at-risk groups, such as those aged over 65, official figures tell us that the effectiveness rate is dramatically lower than for healthy individuals, around 30-40 per cent. To put this into context most placebos, if enthusiastically promoted by a physician, will work 30-70 per cent of the time. And even if the vaccine contains the ‘right’ strains, not everyone responds to it by producing antibodies (see below). As many as 40 per cent of people over age 65, for example, do not respond to the vaccination.
Declarations of how many vulnerable people didn’t get flu thanks to vaccination are also little more than fantasy, based on ‘after the event’ data collection. The only reliable way to tell who would or would not have contracted the disease is to track illness rates among vulnerable people during the flu season. Last year, for the first time ever, that is what the US federal government did. The CDC-funded study followed health care workers in Colorado, where the 2003-04 flu season started with a vengeance. Results showed that virtually the same percentage of people suffered from influenza-like illness whether they were vaccinated or not, and that the vaccine ‘was not effective or had very low effectiveness’ against flu-like illness.
The results of these and other recent studies have dealt a serious blow to vaccine proponents.
Apart from its low effectiveness against constantly evolving viruses, there is also concern over the various ingredients of the flu vaccine. Most vaccines are grown on animal tissues. The flu vaccine is grown in chicken eggs, which makes it unacceptable for vegans and those with egg allergies.
Flu vaccines can also contain some alarming ‘inert’, or inactive ingredients. The formulation varies between manufacturers but can include preservatives such as aluminium hydroxide, associated with Alzheimer’s disease and seizures, thimerosal – a mercury-based neurotoxin, and phenol, which is a human carcinogen. Antibiotics such as neomycin, streptomycin and gentamycin sulphate are also sometimes included as preservatives.
Vaccines can contain traces of the chemicals used to inactivate the viruses including formaldehyde – a known carcinogen. The flu vaccine can also contain a range of stabilisers including the neurotoxin monosodium glutamate (MSG), potassium phosphate, sucrose and sorbitol.
For this reason opponents of the vaccine say that, for most people, the flu shot does not protect, but instead weakens the immune system making the recipient more vulnerable to illness. The same people who are being targeted for the jab, the elderly, the very young and the immune compromised, are those least able to withstand such a systemic chemical assault.
For some people the adverse effects of the jab – fever, fatigue, painful joints and headache – can be more intense than suffering through a week or so of flu. In some patients the flu vaccine can be a trigger for asthma attacks. Optic neuritis and permanent blindness, vasculitis and joint problems are other rare, but welldocumented adverse effects.
However it is Guillain-Barre Syndrome – a devastating immune-mediated nerve disorder characterised by muscle weakness, numbness, pain and paralysis – that remains the most serious reported reaction to a flu vaccine, and this usually occurs within two weeks of vaccination. The risk appears to vary from year to year, though globally the vaccine accounts for hundreds of cases each year. One possible cause is that flu vaccine contains the disease trigger Campylobacter jejuni, a bacterium found in 40-50 per cent of chickens eggs.
The shortsighted health authority strategy for winter wellness involves improving ‘herd immunity’ – vaccinate the majority to lower the risk for a minority. US health authorities are currently considering implementing universal flu immunization for all Americans, and the UK can’t be far behind in this thinking. But widening flu vaccination programmes to include healthy people will not protect the most vulnerable because exposure to a virus is only a small part of why we succumb to flu.
Logically if exposure was the only factor, each of us would get sick every time we were exposed to a flu virus, yet this is not the case. To understand why some people are more vulnerable to flu than others we need to address the bigger picture of what makes us ill and stop relying on crude calculations of who is most at risk.
While health authorities tend to classify the very young and very old as being the most vulnerable to flu, age per se is not a reliable indication of risk. Social status is much more influential.
In a supposedly classless society this is a contentious assertion. But medical research consistently shows that adults and children of lower socioeconomic status are at higher risk for a wide range of communicable infectious diseases, especially respiratory infections, and their complications.
With regard to flu, this concept has a certain amount of historical precedence. While many authorities promote the idea that the 1918 flu pandemic, which killed around 30 million people worldwide, was an egalitarian disease, a closer look at the data says otherwise.
According to a summary published in the British Medical Journal in 2000, data from the 1918 pandemic showed a striking impact in areas such as sub-Saharan Africa and India, where the death rate was 30 per 100,000 population, compared with five per 100,000 in Europe and North America. The estimated 20 million deaths in India were among those living in poor, crowded and starving conditions. In Europe, the epidemic was more devastating than usual because of the poverty, the run-down immune systems and poor nutritional health of both military and civilian populations following the deprivations of the First World War.
This year the UK Government has tacitly acknowledged the special vulnerability of disadvantaged individuals through its special efforts to target people from black and minority ethnic communities – statistically those most likely to be living in poverty.
People living in poverty face many unique health challenges. Often they live in substandard or crowded housing, with inadequate heating, damp and mould. They are frequently ignorant of basic hygiene measures – such as regular and thorough washing of hands – that can stop the spread of viruses. They may be stressed physically and emotionally, their bodies overloaded with environmental toxins such as heavy metals (ie lead from old paint) and subsisting on a nutritionally poor diet. Children from low-income families are also less likely to have been breastfed, and thus are denied an essential foundation for a healthy immune system.
Wanting to protect the vulnerable is commendable. But in the absence of education, improved living standards and better hygiene, employing a vaccine as protection is like spitting on a raging fire. Yet in a recent consultation document entitled Making Markets for Vaccines – A Practical Plan , produced by the Center for Global Development (CGD), an independent think tank that conducts research and analysis into global poverty and inequality, the very first line says: ‘Vaccines are a very effective way to tackle poverty’. It goes on to say: ‘As well as preventing death and illness, immunization also contributes to greater attendance in school, increased productivity, enhanced lifetime earnings and economic growth.’
Read that again and ask yourself if you still believe that vaccines aren’t being aggressively marketed as cures for social problems. The vaccine as a panacea remains the unshakeable mindset of the medical community. While the CGD report focuses on spreading the vaccine gospel to the developing world, its ethos can be seen in the developed world as well where vaccines are a endorsed as a remedy for so many things that are too complicated (better hygiene, encouragement to breastfeed) or too expensive (winter-proof housing, higher benefit rates) for the government to fix.
Throwing pharmaceutical solutions at social problems never works and is ultimately more damaging to human health and well-being. Nevertheless, encouragement from government and publicity from an acquiescent media means that Big Pharma is currently rubbing its hands with glee. As drugs like Vioxx take big hits in the court and the adverse effects of popular magic bullets such as HRT, Prozac and Ritalin shake people’s faith in drug solutions to common health problems, revenues from vaccines and other panacea drugs are helping to keep drug companies in the black.
Flu vaccines generated about one billion dollars in worldwide sales last year, and the market is expected to double by 2007. In the future, for companies like Aventis Pasteur, Chiron and GlaxoSmithKline, Christmas will come in October and last well into April.
We are currently in the grip of an organised attempt to keep us fearful of even the most innocuous illnesses and, as a result, keep us consuming drugs that do no good whatsoever. The government misinformation campaign and the yearly media circus that surrounds the influenza vaccine is a good illustration of this.
Thankfully the flu vaccine is not (yet) compulsory. People have the choice to either choose or refuse it. The question is: Now that you know more about flu, and the flu vaccine – will you be getting a jab?
COMMON SENSING THE FLU
If you do succumb to flu, two antiviral drugs zanamivir (Relenza) and oseltamivir (Tamiflu) are currently being promoted as the best way to fight back. Taken within a day or two of the onset of symptoms these drugs are supposed to lessen the duration of the flu and reduce debilitating symptoms. In addition, Tamiflu is currently being touted as effective prevention for all types of flu including bird flu (though given that bird flu is exceptionally rare in humans, it’s tempting to ask where the supportive data for this claim comes from).
Unfortunately medical research shows that at best, both drugs provide about a one-day reduction in influenza symptom duration. What is more, there will be pressure for high risk individuals to take drugs like Tamiflu for weeks on end to the exclusion of simpler methods of prevention, and the safety and efficacy of these remedies in individuals at high risk of pulmonary disease, such as pneumonia, has not been established. Fortunately other methods of protection may be just as effective without the risk of adverse effects.
In a perfect world healthy people would recognise that the best protection against a new virus is a successful, managed encounter with the real thing. Rather than trying to avoid flu, consider simple common sense measures to keep virus populations to a minimum while boosting your own immunity:
• Wash your hands. Hands are the main vehicles for transmitting viruses from person to person. Wash thoroughly and frequently during the day, especially after going to the toilet or before preparing food.
• Eat well. Winter diets can be low in essential nutrients like Vitamins C and A. Go out of your way to include fresh, deeply coloured vegetables in your daily diet such as spinach, broccoli, tomatoes and peppers. Avoid foods that destroy these nutrients such as sugar, caffeine, and trans fats.
• Exercise. Regular moderate exercise improves immune function and reduces susceptibility to cold and flu. If you can take exercise in the open air, rather than in enclosed potentially germ-ridden environments, so much the better.
• Watch your stress levels. The ability of stress to depress immune function and
to precipitate and aggravate infectious diseases is widely recognised in medicine and some physicians believe that stress may be the single biggest risk factor for flu. Research shows that it is not just the stress of work and family that are influential – the stress of being lonely and disconnected from your social group is equally devastating to immunity.
FLU VACCINE ROULETTE
This year’s vaccine contains two viruses from last year’s vaccine: type A/New Caledonia/20/99 (H1N1)-like strain and type B/Shanghai/361/2002-like strain.
It also contains one new virus: type A/California/7/2004 (H3N2)-like strain.
Like all flu vaccines it is made from inactivated parts of these viruses. These virus parts correspond to parts of proteins floating around in your body. When the virus latches onto a matching protein, it stimulates the body to produce antibodies that help to destroy the corresponding virus. The catch is that a flu vaccine can only stimulate your immune system to protect you against the viruses in the vaccine, with some lesser protection against very similar viruses. If you are exposed to a different virus or to a mutated form of the same virus, the vaccine won’t keep you from getting sick.
This article first appeared in the Ecologist October 2005