DemFromCt's excellent post at DailyKos alerted us to the fact that this year's vaccine appears to have a mismatched influenza B component. Each year vaccine makers try to anticipate the strains that will be circulating 6 months hence, based on surveillance data. They have been fairly good with their guesses but things seem to be getting more complicated in recent years and mismatched strains are becoming more common, that is, the vaccines don't protect as well or at all against the strains that are actually circulating. There are three strains in the yearly "flu shot," two influenza A strains (from subtypes H1N1 and H3N2) and one influenza B strain. Flu B is on average not as clinically severe as flu A but it can be nasty and it takes a toll in morbidity and mortality every year. Some years most of the flu is influenza B. Now Canadian Press's Helen Branswell has a typically high quality and informative piece on it that is well worth reading:
Until about eight years ago, only one family or lineage of B viruses circulated globally at one time. But in 2001 a second emerged from Asia and the two - known as B/Yamagata and B/Victoria - have co-circulated since. Each year one or the other has been dominant, though there is no clear pattern of how or when they alternate.Because the viruses are from distinct lineages, it is thought vaccine made to protect against viruses from one would offer little or no protection against viruses from the other. However, ongoing Canadian vaccine effectiveness studies show that isn't always the case.
"All is not lost if there is that lineage level mismatch, because in the seasons that we have monitored it, we have - at least so far - shown that there has been some cross protection," says Dr. Danuta Skowronski, a flu expert with the British Columbia Center for Disease Control.
Some years that cross protection can be reasonably high, though Skowronski admits other years mismatched B vaccine appears to offer little protection to the people who get it. (Helen Branswell, The Star)
This year vaccine makers put their money on B/Yamagata but in the US, Canada and the UK B/Victoria is predominating. Whether this will continue we don't know yet, but so far there is a B mismatch (the flu/A components so far were correctly predicted). If there's only two B lineages, why not just add the second one to the vaccine? Good question. It seems to make scientific sense. But CDC is doing a "risk benefit" analysis of this:
But Bresee sounds unsure whether the benefits - fewer people catching flu B and fewer people hospitalized because of it - will in the end outweigh the added challenge for manufacturers and the added cost.
"It's easy for us to do the science and do the models. And it's easy for us to give an opinion about the relative health benefits. What I don't know is our FDA partners, our industry partners - what these data mean for them," he admits.
"Whether a good idea meets with practical considerations that make it impossible, I don't know."
The bottom line is the bottom line for the vaccine makers. I understand this perfectly -- from their point of view. But from the public health point of view we should have a steady supply of influenza vaccine and if the market won't support it then we should go back to what we did at the beginning of the 20th century with other vaccines and make them publicly.
Drug companies always complain that making flu vaccine is risky and not very profitable. Fine. Let's make it in a national vaccine institute so we can make decisions on the basis of science and public health, not what "our FDA partners, our industry partners" tell us we must do or not do. That was a pretty telling admission.
And what it told us wasn't so pleasant.
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For what it's worth, I didn't read that as "profitable", but literally "practical". Making flu vaccines is really an awesome task in terms of logistics - in the short span (9 months or so) between the tentative identification of the circulating flu strains the manufacturers have to start from scratch in developing brand-new vaccines every year, including stockpiling embryonated eggs and pulling appropriate viruses out of the freezer to grow on them. I don't know exactly how many eggs, but it's "hundreds of millions, and each new strain presumably adds another hundred million eggs to the process. I can easily see that suddenly telling the manufacturer that they need to find another 200 million eggs in the next couple of months might not be practical.
javork is right. Adding a second B strain is not practical at the moment for logistical reasons. The good news is that several manufacturers are working on cell-culture based influenza vaccines. Cell culture would make it practical to make a 4-component flu vaccine, as it does not require the hundreds of millions of eggs per year that traditional flu vaccines require.
Indeed. Just one more reason to pursue other methods to produce flu vaccines. What's the status of the cell culture/DNA vaccines? I know they are mostly aimed at H5N1, but is there a reason the technique wouldn't work for seasonal flu?
Perhaps in answer to my own question, In the 6th Pandemic Planning update, issued January 9, I found some interesting info, but for some reason Movable Type doesn't like my block quote. See http://pandemicflu.gov/plan/panflureport6.html
At least none of the B strains are showing antiviral resistance.
From the CDC:
"Influenza B viruses currently circulating can be divided into two distinct lineages represented by the B/Yamagata/16/88 and B/Victoria/02/87 viruses. Nine influenza B viruses tested belong to the B/Yamagata lineage and are related to the vaccine strain (B/Florida/04/2006). The remaining 20 viruses belong to the B/Victoria lineage and are not related to the vaccine strain. Seventeen of the 20 viruses belonging to the B/Victoria lineage were from two states.
Data on antigenic characterization should be interpreted with caution given that:
1. Few U.S. isolates are available for testing because of limited influenza activity thus far.
2. The majority of viruses antigenically characterized to date come from only three states and may not be nationally representative.
3. Antigenic characterization data is based on hemagglutination inhibition (HI) testing using a panel of reference ferret antisera and results may not correlate with clinical protection against circulating viruses provided by influenza vaccination."
It's too early to tell if this pattern will hold.
Ren, it is early and the isolates are from only two states, but what we saw last year for H1N1 tamiflu resistance "early" held up all too well for this year and is more widespread this year than last. It's early this year, too, yet CDC has changed antiviral recommendations because of what we know now.
So, it's too early to decide what the entire year holds, but not too early to ask 'what if' questions and plan for 'what if'. In fact, next year's round of 'pick a predominant strain' will be starting all too soon.
influenza vaccines are the worst of 'faith' based medicine...seems to be a growing trend lately.
Here's a thought...why don't we prove that they work and then decide if they are worth the time, effort and the outlay of limited capital resources...that might be better spent elsewhere.
Like I said before...there must be something wrong when 50% of a trained professional at risk population doesn't use the product...even if it can be sold to the unsuspecting public.
>>influenza vaccines are the worst of 'faith' based medicine...seems to be a growing trend lately.
The worst? Compared to, say, homeopathy? Prayer? Acupuncture?
Tom, we all know where you stand on the effectiveness of flu vaccines. You don't need hyperbole to remind us.
And then there's some who agree with what Tom DVM says.
I could agree that the practice of vaccination is more strongly supported by theory than by epidemiology. But I don't see where "faith" comes into it, unless it's the same sort of "faith" practiced by non-engineers in trusting trust their lives to the designers of freeway overpasses.
Tom DVM, you say: "Here's a thought...why don't we prove that they work..."
What part of the following data don't you believe?
CDC states that in years with a good vaccine match, the vaccine can reduce the chances of getting the flu by 70%-90% in healthy adults.
(http://tinyurl.com/26ozkb )
And among elderly persons not living in nursing homes or similar long-term care facilities, influenza vaccine has been reported to be 30%-70% effective in preventing hospitalization for pneumonia and influenza.
(http://tinyurl.com/a4wk7v )
And in a recent bad year (2007-2008): CDC reported that vaccine still had "overall vaccine effectiveness (VE) of 44% for the 2007-08 flu shot. This included VE of 58% effectiveness against the predominant influenza A (H3N2) viruses[.]"
(http://tinyurl.com/95gwwa )
And then there's some who agree with what Tom DVM says.
Posted by: Lea | January 12, 2009 12:53 PM [kill][hide comment]
Which signifies...what, exactly? There's no proposition so crazy that you can't get people to accept it as God's Own Truth.
Seems to me it's not enough to "agree." Ideally, you're supposed to offer evidence, too. If there's strong scientific evidence that flu vaccines are literally the functional equivalent of, say, ear candling or homeopathy, it'd be interesting to read about it.
You're a piece of work Phila. I had thought you'd attack me once I commented. This is hilarious, you're so predictable.
As far as the "faith" bit, Tom DVM will need to reply to that but it's my impression that he DID NOT mean anything religious by the term. At least that's the way I took it.
And as a side, I fully support atheist and agnostic's and their choices while understanding their importance.
On the other hand, I do not support religions although I believe in God.
We all can agree that if there's doubt (and skepticism, along with reproducibility are terrific things to strive for in science), more studies are warranted.
Tom, I'm sorry but working with health professionals, I can tell you that there are many and diverse reasons for putting off flu shots. Some are fair (egg allergy, though that can be managed) and some are bogus (you cannot get the flu from a flu shot). When you work them through, and treat your colleagues with respect, the vax rate goes way up.
Any way, here's a new report i hope revere will comment on.
http://healthday.com/Article.asp?AID=621781
Dem, et al.: I think this refers to the NEJM article from Oct. 2007. The issue here, as elsewhere, is reconciling the results of observational studies (or pooled studies, like this one) with randomized clinical trials. The former almost all show a efficacy. The latter are, at best, equivocal, although the data are much sparser.
As an epidemiologist I have an open mind about the data. As an epidemiologist who has looked at this a lot and a physician who has thought about it a lot, my opinion is revealed by my behavior: I always get a flu shot. Even if it is only partially protective it nets out way ahead of getting a full blown case of the flu. Right now it is the best protection we have, IMO, and not getting it because you think it doesn't work is foolish. Maybe it doesn't work. There are a lot of maybes in this world but I'm voting with my feet on this one.
The basic science is telling us that flu vaccine works. Some data (from RCTs) suggests we keep an open mind, which is fine. Against the RCTs is clinical experience and a lot of immunology. Maybe it's all wrong. But I don't think so. More parsimonious would be to find an explanation for the anomalies that keep the science of immunology intact.
'The basic science is telling us that flu vaccine works'
Revere. I respectfully disagree.
The basic science says if you prevent the virus from naturally genetically drifting, then a vaccine is protective in laboratory animals. Now all we have to do is talk influenza viruses into doing the same.
I also don't think the pooled studies (even as bad as they are) are conclusive.
'This study included more than 400,000 people over age 65 who'd been vaccinated and 300,000 seniors who hadn't been vaccinated. All the study participants lived on their own, not in nursing homes or other long-term care facilities...
..Those who received a vaccine were 27 percent less likely to be hospitalized due to flu complications, compared to the unvaccinated. And, the death rate was 48 percent lower for those who received the annual flu shot, according to the study"
DemFromCT
Did they have paired acute convalescent titres for the 700,000 passive participants in this trial?
'The basic science is telling us that flu vaccine works.'
Revere. I respectfully disagree.
The existing science is telling us that if we artificially prevent the influenza virus from drifting genetically then the vaccine works in laboratory animals...now all we have to convince influenza in the 'wild' to do the same and we may have a solution.
I also don't believe the pooled or observational studies are conclusive in the least.
...and DemFromCT gives a pretty good example of why these studies are fatally flawed with respect to influenza.
'This study included more than 400,000 people over age 65 who'd been vaccinated and 300,000 seniors who hadn't been vaccinated'
Did they have paired, acute and convalescent blood tests to identify a rising titre and therefore conclusive evidence of influenza?
I think we can explain away a small percentage of highly trained professionals choosing to not be vaccinated...but I think the numbers for influenza vaccines are a little high for that.
I was born right in the middle of a Polio outbreak in my town in Ontario. I wonder how many healthcare workers refused the Polio vaccine when it was offered to them?
There is a simple scientific solution to answer these questions. At risk healthcare professionals are split on the issue..why not do the study with paired sera and answer this question once and for all...seems pretty straightforward to me...and I'm sure you wouldn't have much trouble coming up with candidates because no one wants the answer more than healthcare workers ont he frontline.
You're a piece of work Phila. I had thought you'd attack me once I commented. This is hilarious, you're so predictable.
How is asking a reasonable question an "attack"?
If it's predictable for me to do this, I'm glad to hear it. I wish it were as predictable for me to get a straightforward answer.
Also, I probably comment here two or three times a month, on average. Or possibly less. So was there something about this particular subject that made you think I'd "attack" you, or are you just psychic?
Anyway, if you think that having an assertion questioned in a public forum is the same thing as being attacked or victimized, that's really not my problem. Personally, I think you should either answer the question, or ignore it. Calling me "a piece of work" and "predictable" doesn't accomplish much of anything, as far as I can tell.
As far as the "faith" bit, Tom DVM will need to reply to that but it's my impression that he DID NOT mean anything religious by the term. At least that's the way I took it.
Same here. But what does this have to do with anything? Granting the legitimate concerns about the efficacy of certain vaccines, I'm asking whether it's really reasonable to assert that flu vaccinations are on a par with homeopathy, in terms of being "faith-based." You seem to be saying that it is, so I'm (predictably, I guess) asking what evidence you have for that stance?
And as a side, I fully support atheist and agnostic's and their choices while understanding their importance.
On the other hand, I do not support religions although I believe in God.
That's admirable. But what on earth does it have to do with what we're discussing?
You're a piece of work Phila. I had thought you'd attack me once I commented. This is hilarious, you're so predictable.
How is asking a reasonable question an "attack"?
If it's predictable for me to do this, I'm glad to hear it. I wish it were as predictable for me to get a straightforward answer.
Also, I probably comment here two or three times a month, on average. Or possibly less. So was there something about this particular subject that made you think I'd "attack" you, or are you just psychic?
Anyway, if you think that having an assertion questioned in a public forum is the same thing as being attacked or victimized, that's really not my problem. Personally, I think you should either answer the question, or ignore it. Calling me "a piece of work" and "predictable" doesn't accomplish much of anything, as far as I can tell.
As far as the "faith" bit, Tom DVM will need to reply to that but it's my impression that he DID NOT mean anything religious by the term. At least that's the way I took it.
Same here. But what does this have to do with anything? Granting the legitimate concerns about the efficacy of certain vaccines, I'm asking whether it's really reasonable to assert that flu vaccinations are on a par with homeopathy, in terms of being "faith-based." You seem to be saying that it is, so I'm (predictably, I guess) asking what evidence you have for that stance?
And as a side, I fully support atheist and agnostic's and their choices while understanding their importance.
On the other hand, I do not support religions although I believe in God.
That's admirable. But what on earth does it have to do with what we're discussing?
You're a piece of work Phila. I had thought you'd attack me once I commented. This is hilarious, you're so predictable.
How is asking a reasonable question an "attack"?
If it's predictable for me to do this, I'm glad to hear it. I wish it were as predictable for me to get a straightforward answer.
Also, I probably comment here two or three times a month, on average. Or possibly less. So was there something about this particular subject that made you think I'd "attack" you, or are you just psychic?
Anyway, if you think that having an assertion questioned in a public forum is the same thing as being attacked or victimized, that's really not my problem. Personally, I think you should either answer the question, or ignore it. Calling me "a piece of work" and "predictable" doesn't accomplish much of anything, as far as I can tell.
As far as the "faith" bit, Tom DVM will need to reply to that but it's my impression that he DID NOT mean anything religious by the term. At least that's the way I took it.
Same here. But what does this have to do with anything? Granting the legitimate concerns about the efficacy of certain vaccines, I'm asking whether it's really reasonable to assert that flu vaccinations are on a par with homeopathy, in terms of being "faith-based." You seem to be saying that it is, so I'm (predictably, I guess) asking what evidence you have for that stance?
And as a side, I fully support atheist and agnostic's and their choices while understanding their importance.
On the other hand, I do not support religions although I believe in God.
That's admirable. But what on earth does it have to do with what we're discussing?
>>"The basic science says if you prevent the virus from naturally genetically drifting, then a vaccine is protective in laboratory animals."
Is the basic science saying to you that no protection is achieved by anything short of a spot-on antigenic match?
'Is the basic science saying to you that no protection is achieved by anything short of a spot-on antigenic match?'
No Racter. The Science is the science...no more...no less...and of course all of this is only one opinion of the science.
The problem for the last three years has not been the science...it has been the exagerated claims from the science.
Why is this important?
Because it gives one a False Sense of Security.
If I tell you that the vaccine is protective...and lets say you are a counter person at an airport during an epidemic or a pandemic. You would assume that you are at no risk and those you serve are at no risk...
...but with influenza, you are infectious before you get sick...so you could be unknowingly spreading the virus to thousands of persons a day and each of those persons could spread it to thousands of persons each a day...so it is critically important that we examine the issues from every possible angle...
...what if you are a doctor or a nurse in the middle of a pandemic who, rather than looking after sick people, are charged with looking after the existing healthcare problems that exist every day. If I was told that I was protected by a vaccine then I might wander in public without a care in the world. I might not wash my hands because I can't get sick. I might not where a mask. I might not worry about my wife or my children or my grandchildren...get my drift?
The second issue is limited resources. These vaccines are proprietary because unlike the Polio outbreak, everything now is 'for profit'...this makes vaccine very expensive.
You and I were discussing Tamiflu and vaccine, I think in 2005...and I had the same argument then.
We have a limited amount of financial resources...and we must be careful to spend it to the best effect.
Well, They were making the same claims about Tamiflu as a panacea in 2005 like vaccines today. The fact was that when the WHO decided to use the 'Tamiflu shield'in H5N1 hotspots, it was all over for Tamiflu. That is the exact recipe required in the laboratory to provide resistance...and since influenza replicates so quickly, it would achieve it far faster than bacteria with their relatively slow replication rate...
...what we didn't know then conveniently as it turns out, was that the Tamiflu molecule, proprietary as it is, does not break down in nature. So that meant the Tamiflu that wasn't hidden and fed to prize birds directly, was being eaten by mice and rats in the environment.
Lastly, there are the side-effects of Tamiflu when used per the label...and they were supposing without scientific study to back it up...that Tamiflu could be given for weeks at a time...god help every healthcare worker who would have to deal with side-effects at the same time that they had to deal with being on the frontline of a pandemic.
I have been looking for a perfect example from Effect Measure of a few weeks ago that I saved...so I will try and find it and post here in a few minutes. It was a person describing the side effects she felt as a result of taking Tamiflu for a short time.
Tamiflu is one tool in a tool box. It is not a panacea as it was sold to the public by the WHO in 2005 because at the time...it was the line of least resistance.
Therefore, faith based medicine is medicine where claims are being made without the irrefutable scientific conclusions to back it up...
...and in the last 5-10 years, in my opinion, about 80% of claims are faith-based...why this is the case is for another discussion at another time...but basically you have to follow the money!
Here is the quote...I don't have Maura's permission to reprint so I hope this is alright.
"My name is Maura Logan and i would like to show you my personal experience with Tamiflu.
I am 63 years old. Have been on Tamiflu for 5 days now. Formerly had no negative feelings about "Big Pharmaceutical" but this medication has changed my mind. Definitely needed more extensive testing by the FDA.
I have experienced some of these side effects-
Horrible itching started after 8 pills (fourth day) and has lasted for six more days--and counting. Also suffering insomnia, and mood swings--crying and sour temper. Dr. wasn't even sure I had the flu (headache, severe body ache, exhaustion but no cold symptoms). Med seemed to help, but the after-effects are totally miserable. Hugely expensive med and not worth the risk. Absolutely HATE, HATE, HATE this medication!
I hope this information will be useful to others,"
Maura Logan
Posted by: Tamiflu Side Effects | December 12, 2008 2:16 AM
Tom, it sounds to me like your beef is really more with reporters, businessmen, and poorly-informed members of the public than with scientists -- but I don't know of anything in science that meets the "irrefutable" test. "Refutable, but not refuted" is about as strong as it gets.
Sorry for the multiple posting...I kept getting an error message.
No Racter, quite the opposite.
I and other scientists and Health Canada and the Canadian Food Inspection Agency had or were given evidence in 1999 that China was using formaldehyde as a food preservative on products sold in grocery stores as 'Fresh Product of Canada'...and that these products were being exported to the United States as 'Product of Canada'. In response they changed the import parameters only for Formaldehyde and Sulphites but did not change the Food and Drug Act or give the public the right to choose or inform honest Canadian farmers who were proud of their profession.
..so 1) I don't like regulatory professionals who are paid to be complacent...and are rewarded for the same.
I am perturbed with epidemiologists who are unregulated (no one is there to stop me from selling myself as a 'professional' epidemiologist)who are basically 'guns for hire' who frig the data the way the corporation wants them to.
What is the same between Accountants and Epidemiologists...they both can make numbers say what ever they want.
What is different between epidemiogists and accountants. Accountants have a code of ethics.
I am perturbed with pharmaceutical companies and businessmen who sometimes knowingly make false claims for there products...without doing the required science to prove it.
I am perturbed with regulatory agencies that allow the false claims...sometimes so supervisors can be hired by the same companies when they retire.
I am perturbed when things are sold as panaceas...when there are few panaceas in medicine.
I am perturbed by human professionals that are tunnel-visioned and can't quite understand that we are not the masters of nature...most of nature we can't see.
The bottom line for me is that we are currently in an outlier position on the distribution curve for pandemics. That may be meaningless but I have seen a few bugs emerge similar to H5N1 and they all finished...so to speak.
I believe that it is instinctual for humans to be shortsighted...but as it stands, we are going to have only placebos to treat our children.
And we have several effective treatments that are off-patent and cheap and effective...and will save millions of lives...but you don't ever hear the World Health Organization talking about these things, in my opinion because they're boring.
We have a perfectly good bacterial vaccine that would in all likelyhood prevent secondary pneumonias, the leading cause of death in 1918...but we won't have them either.
That 100$ or whatever, a course of treatment with Tamiflu costs should give three or four people the oral treatments required to give their children an even chance at survival without chronic sequelae.
If the influenza vaccine for seasonal influenza only protects say 40% of the population...should we not discuss if that is the most efficient use of limited funds.
It is easy to put a nut on a bolt...but lets see how easy it is in a plane headed directly at the ground at a thousand miles an hour. My point is that the current vaccine will never be produced in a pandemic...in my opinion, and I have had to tighten a few of those nuts, it ain't gong to happen.
So should we not concentrate our limited funds on research that can produce a completely novel type of vaccine in two weeks rather than 6 months...and should we not be actively investing in antiviral research. Many world experts had an extremely difficult time to get any research funds because mainly, my friends at the World Health Organization were adavertising Tamiflu as indestructable and a panacea.
The general public is a victim to this crap...and most reporters can be spun by the expert hocus pocus.
Speaking as someone who works in the flu industry and doesn't want to read all the detailed discussions going on here, I would just like to add a couple of things. Manufacturers don't have 9 months to develop the flu- they have something closer to 6. In order to get the vaccine out by summer's end so hospitals can start vaccinating kids before school starts, companies have to use preliminary data of this year's flu to come to a decision which strains to pick for next year's season. If the flu season is late, they have incomplete data and it's likely that the strain selected is wrong. Scientists do the best they can with the evidence they have, but as iayork says, they have to crack millions of eggs and there just isnt enough time or resources to make new vaccines late in the season.
The whole "flu vaccine makes you invincible" mentality is very naive. The flu vaccine doesn't work for everyone. Moreover, there are dozens of other viruses out there that can make you equally, if not more, sick than the flu. The flu vaccine doesn't protect you from anything else except the flu, and many of those other viruses do not even have vaccines (yet). Those that do take the flu vaccine each year have a significantly higher level of protection than those who don't.
To me, science is logic. When facts are incomplete, the logic can be misleading. That doesn't mean science is bad or flu manufacturers are trying to mislead you. It just means that if you are skeptical, it's up to you to go out there and get the facts and not make outrageous accusations.
"And we have several effective treatments that are off-patent and cheap and effective...and will save millions of lives...but you don't ever hear the World Health Organization talking about these things, in my opinion because they're boring."
So Tom DVM, what are these?
Seriously. What works or might work?
s. The public takes what the industry sells at face value. They have no other choice.
More importantly, a significant porportion of the healthcare community isn't buying.
Not a Scientist.
There are a number of proven off-patent treatments most importantly for the secondary bacterial infections and other supportive treatments.
Broadspectrum antibioitics, oral electrolytes, oral anti-fever medications, oral anti-shock medications There are also masks, gloves and disenfectants that will probably prevent far more infections than either Tamiflu or current vaccines...and as I said, vaccines against secondary bacteria.
There are a number of flu forums that can help if you keep an eye on them.
Not a Scientist
Here is where I got started in 2005.
http://crofsblogs.typepad.com/h5n1/2005/08/outbreak_map.html
It will give you all that you need.
You can also google crofsblog H5N1 and you can also get there that way.
Therefore, faith based medicine is medicine where claims are being made without the irrefutable scientific conclusions to back it up...
There ain't no such animal. Without getting into some extended subdebate on the problem of induction, all science is "faith-based" according to this standard, especially for non-experts. This is a point William of Ockham made a long, long time ago, and if anything, it's more true today than it was then, given our more stringent standards for what constitutes scientific knowledge, and the greater difficulty involved in understanding, let alone mastering, the various scientific fields.
I think that a lot of what you're saying is reasonable. But I don't see how it does any good to equate faith in vaccination -- even misplaced faith -- with faith in homeopathy and other forms of quackery, for which there is no evidence of any kind and which is predicated on a conscious rejection of the theory and practice of science as most of us understand it. In a time when people feel increasingly free to decide what's true based on whether or not they approve of it, or whether it fits neatly into some conspiratorial narrative, it seems wise to observe this distinction.
Just one man's opinion, though.
"If the influenza vaccine for seasonal influenza only protects say 40% of the population...should we not discuss if that is the most efficient use of limited funds".
I think that might be better than to trying to simultaneously discuss that along with formaldehyde, the ethics of accounting, pandemic influenza, and a grab bag of other topics not directly related to the value of seasonal flu vaccines from a public (or personal) health perspective.
Discussing just that is complicated enough. How do we measure "efficiency" in this context? The effect on GDP? Is there a threshold of "lives saved" below which the effort becomes wasteful? Is there a QOL unit we can use?
Assuming that "protection" is the most reasonable rubric, maybe we need to be a little more specific about what we mean by that. I'd be happy to accept your hypothetical vaccine which "protects say 40% of the population" -- except that in the real world, uptake alone is usually not that high, even among high risk groups (gross uptake is more like 30%. If that).
When we talk about 40% protection, we aren't talking about 40% of the people being 100% protected; we're talking about a probabilistic bias due to gradients in the binding properties of antibodies.
There are other ways to induce a favorable bias. Wash your hands a lot, stay out of elevators, etc, etc. None will confer invincibility. For me, invincible isn't on the table anyway. I'll take whatever edge I can get, wherever I can get it, because I don't like my chances against a full-blown encounter with influenza. That includes antivirals. On first onset of symptoms, I'll begin taking both Tamiflu and Amantadine, and if I'm capable of sitting at a keyboard long enough to compose whiny diatribes about the side effects, I'll call it a bargain.
"s" wrote: "Speaking as someone who works in the flu industry and doesn't want to read all the detailed discussions going on here, I would just like to add a couple of things."
THAT says alot right there!
Tom DVM, could you please provide some examples (with links) of WHO officials
Thanks.
http://www.roche.com/media/media_releases/med-div-2008-03-03.htm
"These Data reinforce the World Health Organization (WHO) advisory that Tamiflu is the only antiviral strongly recomended for the treatment of humans infected with the H5N1 virus."
http://www.eurekalert.org/pub_releases/2007-06/k-ept062207.php
"In a time when people feel increasingly free to decide what's true based on whether or not they approve of it, or whether it fits neatly into some conspiratorial narrative, it seems wise to observe this distinction."
Yes, constant vigilance on the information for oneself and for the public, no attachment!
Basically, true science and true faith are convergent. We have experienced lots of wrong doings in the name of science; intentionally or just ignorantly.
Viktor Frankl in his Logotherapy had advised to reverse the years of reductionism; I am not sure how it would apply to medical science in general.
âLet alone mastering", are you sure that we are this job well?
Tom, I do not see how "Tamiflu is the only antiviral strongly recomended for the treatment of humans infected with the H5N1 virus" translates to saying that Tamiflu is "indestructable and a panacea."
Is that the best you could do?
Path Forward
I will let history be the judge...of course in the current era, history is a tool to be manipulated.
As John Prine said so well:
When the SARS outbreak broke...the WHO had 'her hair up in curlers and her pants to her knees'. By the time the WHO pulled its pants up and brushed itself off...the outbreak was over...
...The credit due and the credit owed is to the frontline healthcare workers who knowlingly risked their lives with no support from anyone. Neila Laroza was one of those nurses. She had a family but volunteered to nurse sick healthcare workers who had been isolated in one facility...her bravery cost her her life.
Of course that hasn't stopped the re-invention of history that has occurred in the past five years since. In my opinion...and it is only my opinion, if the World Health Organization spent half as much effort on doing their job and less money on hiring 'spinners' and reinventing history, we all would be a lot better off.
Now, with respect to your last post...other than passing a law forcing sovereign Governments to purchase large quanities of Tamiflu...that is about as strong an indorsement as one can get...I'm sure Roche was quite pleased...and if you notice the recomendation was made in March of this year...which indicates to me again, that the World Health Organization has never met a dead horse that it wasn't willing to 'flog'.
I also have a question for you...kind of in the vein of 'if a tree falls in a forest and no one is there, does it make a noise'...
...Do you think, the citizens of the world, have a right to know if the supervisors that were making these commendations and recomendations, had shares in Roche at the time or if they were receiving monies from Roche for other services provided on a part-time contract outside work hours...
...and do you think the citizens of the world have a right to know if the supervisors that were making the decisions, obiously to the benefit of one drug company, were hired by by the same drug company after they retired from the World Health Organization...
...and do you think the citizens of the world have a right to know what contact a supervisor hired by a drug company may currently have with other WHO supervisors that they might have hired or promoted.
Thanks
Thanks Tom DVM for your time and effort here.
With absolutely no medical background I find these discussions productive and important, even if heads are being bitten off.
What I gathered from what you wrote was frustration in the fact that there are alternatives to Tamiflu and flu shots, that too much hope is being placed in them. And what I also pulled out of your comments was that you're heart broken that people will die needlessly when they don't have to.
Nature will certainly have it's way regardless of any interventions from mankind.
And my dear revere-be, your opinions don't fall on deaf ears here, please don't take my comments that way. There are just some of us who want to go with the other choices. And the "other choices" should be discussed in greater degree and not dismissed a hocus pocus.
Just one woman's opinion.
Lea: You know I don't take it amiss that people don't agree with me, so don't fret.
Tom DVM,
Which off-patent bacterial vaccine protects against the secondary pnuemobia?
Thanks, Tom. Will share.
You're welcome Lea and Not a Scientist.
Sock Puppet.
This is a little out of my league because these are human vaccines...
...interestingly enough, generally speaking, I don't actually like calling them vaccines...I believe we used the term 'bacterin' for vaccines against bacteria...if I am wrong I'm sure someone will correct me.
I believe there are a number of this type of vaccine avaliable. The one that I have read about on the flu forums is pneumovax. If you go to the forums and ask, I'm sure someone will explain them for you...there is a great expertise at this time by that source.
It seems that there can be quite serious local inflammations at injection sites etc. and one should probably seek professional advice before recieving the vaccine as this could cause more serious reactions when you are re-vaccinated later.
If I could mention one other thing:
I believe the science is pretty much sorted out for Tamiflu by now...and hopefully, the excellent group that has started coordinating research for new antivirals is successful...soon.
As far as the influenza vaccine for seasonal influenza or pandemic influenza...the science is inconclusive...and all of us want an answer.
So...we now have an opportunity to answer the question...does seasonal influenza vaccine work?
All we have to do is collect healthcare workers from say five hospitals in different parts of the country. We ask them whether they are vaccinated or not...then we ask that they provide paired, acute and convalescent blood sample if they do get sick...and that should give us an answer...
...the experiment might be slightly skewed by the personal choice to choose vaccine or not might confer other predispositions to contact or not contact the virus...but I don't think it would be significant enough to taint a significant result. A close result or tie, in this case, would go to the conclusion that the vaccine doesn't work.
Just because the present 'ancient' vaccine doesn't work, that doesn't mean that one in the future might work...so research must continue...howerver, when the vaccine is tested in the laboratory, it must not be tested against frozen viruses prevented from genetically drifiting.
The fact that the vaccine does work under laboratory conditions though, even when under artificial circumstances, does give hope that a vaccine might work in the future.
Lastly, I do not want to see the world...or my world for that matter...to face a pandemic without antibiotics etc....therefore, all I ask is that we make sure that we have the stockpiles or manufacturing capability 'surge' protection built in because in my opinion, our world will be permanently scarred if we only concentrate on vaccine and antivirals...and then find out both don't work and have to watch our children die with only 'promises' to treat them with.
"when the vaccine is tested in the laboratory, it must not be tested against frozen viruses prevented from genetically drifiting."
I think this is a little like saying that you can't really be sure you have accurately adjusted the sights on a rifle until you've demonstrated that you can hit a moving target.
Thanks Racter. You are right!
What I meant to say was...when the vaccine is tested in the laboratory, it must not...just...be tested against frozen viruses prevented from genetically drifting.
But you made it even better...can I use you analogy?
Therefore, when testing the vaccine in the laboratory, first 'accuractely adjust your gun sights on the fixed target, the frozen virus(the virus the vaccine was made out of)...and then test the vaccine against the moving target, a variety of 'field' viruses.
I'm glad you like the analogy, and, of course, you may use it with my compliments. It really holds up well both coming and going, doesn't it? Just because you have demonstrated that a rifle sight is accurately adjusted, it's no guarantee that you'll be able to hit a moving target. Too many other factors; how fast the target is moving, which way the wind is blowing, your rate of fire, etc. And then there's the question of whether the bullet hits hard enough to take the target down even if it finds it.
Hi All...
...I understand the point of TomDVM -- that proving the efficacy of a vaccine against the homologous lab strain it was designed from is only the first start. That being said, there are many studies out there, particularly for H5N1, that have demonstrated cross-clade protection in animal models.
Path Forward
I will let history be the judge...of course in the current era, history is a tool to be manipulated.
As John Prine said so well:
When the SARS outbreak broke...the WHO had 'her hair up in curlers and her pants to her knees'. By the time the WHO pulled its pants up and brushed itself off...the outbreak was over...
...The credit due and the credit owed is to the frontline healthcare workers who knowlingly risked their lives with no support from anyone. Neila Laroza was one of those nurses. She had a family but volunteered to nurse sick healthcare workers who had been isolated in one facility...her bravery cost her her life.
Of course that hasn't stopped the re-invention of history that has occurred in the past five years since. In my opinion...and it is only my opinion, if the World Health Organization spent half as much effort on doing their job and less money on hiring 'spinners' and reinventing history, we all would be a lot better off.
Now, with respect to your last post...other than passing a law forcing sovereign Governments to purchase large quanities of Tamiflu...that is about as strong an indorsement as one can get...I'm sure Roche was quite pleased...and if you notice the recomendation was made in March of this year...which indicates to me again, that the World Health Organization has never met a dead horse that it wasn't willing to 'flog'.
I also have a question for you...kind of in the vein of 'if a tree falls in a forest and no one is there, does it make a noise'...
...Do you think, the citizens of the world, have a right to know if the supervisors that were making these commendations and recomendations, had shares in Roche at the time or if they were receiving monies from Roche for other services provided on a part-time contract outside work hours...
...and do you think the citizens of the world have a right to know if the supervisors that were making the decisions, obiously to the benefit of one drug company, were hired by by the same drug company after they retired from the World Health Organization...
...and do you think the citizens of the world have a right to know what contact a supervisor hired by a drug company may currently have with other WHO supervisors that they might have hired or promoted.
Thanks