Vaccination has greatly diminished death, illness and suffering in the world. But no other medical technology has been so dogged with controversy. The book chronicles the development of the key lifesaving vaccines since the 18th century. It tells the stories of great scientists and their discoveries, of the protests and pain along the stumbling path of progress. This is the first book to tell the whole story of vaccination for a general audience. In light of controversies about flu vaccine and autism, it will be of particular interest to parents, pediatricians, public health workers and anyone fascinated by medical history. Read More>>

Also Available: Table of Contents and Index

Arthur Allen is a Washington DC-based journalist who has written on vaccine issues in The New York Times Magazine, the Washington Post Magazine, The New Republic, Atlantic Monthly, Salon and Slate.

CONTACT

Flu Vaccination--why bother?

Not always for the reasons you'd think

Welcome, vaccination freaks, to my blog. As the author of a new history of vaccines and the controversies they provoke, I thought it would be worthwhile to have a forum for honest and at least partially well-informed discussion of the problems and successes of vaccine production and policy. I intend to comment on issues that appear in the news, the medical journals and elsewhere. I welcome posts from anyone with knowledge or informed opinion on vaccines, especially professional vacmcinologists. I’m the publisher here, and I reserve the right to reject material or send it back for editing. Keep it short, folks. And if you’re going to be nasty, at least be funny.

As consumer products that fight disease, vaccines are unique. Unlike therapeutic drugs, which an individual takes for an individual fix, vaccines require community buy in. Why? Because no vaccine works 100 percent of the time, and because not everyone who requires protection from a disease can be vaccinated. So, vaccination campaigns work indirectly, in part. Take the campaign against measles. The measles virus is incredibly contagious; it has a way of finding people who aren’t immunologically protected against it. As late as the early 1960s, 3 million American kids got measles every year. Measles hasn’t freely circulated in the United States since 2002. When cases are imported–often by unvaccinated travelers, especially members of religious groups, from countries like India--the disease does serious damage. It infects people who were vaccinated as kids, either because the vaccines in those days weren’t always effective, or because immunity has waned. It also infects adults who were not vaccinated, but never got measles as children and thus lack natural immunity. Thus, when we vaccinate our babies against measles, we are also protecting a lot of other people.

Because vaccination against diseases like measles, whooping cough and polio requires a community response, there is always an element of coercion in the vaccine enterprise. In the United States, school entry is denied to those who refuse to vaccinate, unless they get special exemptions. In Europe, doctors are given extra pay for vaccinating their patients. Why the coercion/bribes? We vaccinate babies because many of these diseases are deadliest in babies. We also vaccinate babies because it’s easiest to fully immunize them, during routine visits to the pediatrician. As the diseases disappear, they don’t seem like immediate threats to your average parent. However, they can return in the absence of vaccination. So continued protection from these diseases requires the gentle persuasion of a wise, omnipotent (tongue only partially in cheek) state or the public health authority.

These babies aren’t sick when we vaccinate them. Some will become sick some time after vaccination–given that they receive shots at birth and two, four, six months of age, and again at 1 year and 18 months, the timing is inevitable. And, occasionally, vaccines cause actual harm. For example, something like 1 in 30,000 children vaccinated against measles develops a (usually transient) blood clotting disorder. Hence, vaccines are always controversial in a way that the latest antibiotic or heart medicine is not.

So, what about flu vaccination? The cultural tradition in the United States is to vaccinate old people against flu. This is because old people are most likely to die of the disease; according to a CDC study, something like 36,000 of them die of it every year (This is an estimate, because old and feeble people who are carried off by upper respiratory ailments are rarely cultured to determine the culprit with certainty). My parents, and all their friends, have gotten vaccinated religiously each year for the past 20 years. This probably has done them some good, over all. But research in recent years has shown that vaccination of old people often doesn’t protect them very well against flu. Their thymuses have dried up; vaccination no longer stimulates the creation of memory cells that generate robust protection against influenza. To protect old people, the best groups to vaccinate are their nurses and nursing home guardians, and the children and grandchildren who visit them–even if these younger people aren’t usually killed by flu. This is a major explanation for why, over the past decade, the CDC and other public health groups have gradually expanded the number of people whom they recommend for flu vaccination.

Another reason to push flu vaccination is the likelihood that we’ll be visited soon by a pandemic influenza, one that’s radically different and more deadly than the annual type. It may not be the avian flu currently popping up here and there in Asia, but it could be something just as bad. Annual vaccination campaigns against more humdrum varieties of the virus may be making two contributions to fighting pandemic flu. First, the generation of immune cells and antibodies to currently circulating flu varieties may provide some protection against the bad flu coming down the road. And second, vaccinating against everyday flu is also providing a "shot in the arm" to the flu vaccine industry.

Until recently, this was more crucial than it may be today. Two years ago, there were only three U.S.-licensed vaccine makers–Aventis-Pasteur (now Sanofi), Medimmune and Chiron. When Chiron’s British production line was contaminated with bacteria, we were suddenly down to two providers, and one of them, Medimmune, made only a few million doses. All vaccines are difficult to make and flu vaccine has been an especially dicey proposition. From one year to the next, the number of people seeking flu vaccination might range from 20 million to 80 million. Extra vaccine was thrown away, with the manufacturer eating the loss. Over the past two decades, big flu vaccine manufacturers like Wyeth, Merck and Parke-Davis left the market.

But that’s changed now. After Hurricane Katrina, the Bush administration realized that natural disasters could also be politically costly. So it promised $7 billion to fight avian flu, and about a billion of that has been spent to promote flu vaccine production. Six different companies – Sanofi, GlaxoSmithKline, Medimmune, Solvay, Baxter and Chiron – are promising to build new flu vaccine plants in the United States. Our current vaccine-production facilities can now handle surge capacity. So, it’s no longer necessary to get vaccinated to support your local vaccine maker. The government is doing the supporting – as it should have done a long time ago.

TrackBack

TrackBack URL for this entry:
https://www.typepad.com/services/trackback/6a00d83453213869e200d834cf66e453ef

Listed below are links to weblogs that reference Flu Vaccination--why bother?:

Comments

TheProbe

Welcome to the blogosphere! Another voice of rationality who also writes books!

The Gr8ful Med

Dear Mr. Allen

As a Chiropractor and a Medical doctor I have both sides of the vaccine debate. Im looking forward to your side. Thanks for taking the time to write the book and the blog.

Gr8ful Med

The comments to this entry are closed.