Flu vaccination is largely ineffective, despite what your Government may have you believe

A couple of weeks ago I had my lovely elderly parents around for lunch. The subject of flu vaccination came up. My father is dead against this practice, and views flu as a largely self-limiting illness that rarely leads to significant complication (he’s right). My mother, on the other hand, has dutifully attended her doctor’s surgery for the last few years for her flu ‘shot’. Vaccination is, by her own admission, always followed by a persistent cough. This may be coincidence of course, or perhaps a ‘nocebo’ response (like a placebo response, only negative).

Anyway, I ended up suggesting she might rethink her views on the vaccination, especially in light of evidence which suggests that it does not particularly help the elderly (as it’s so often said to do). See here and here for more on this. The upshot is my mum skipped her flu shot this year.

Another reason why I’m not particularly enthusiastic about flu vaccination is that the ‘evidence base’ for it appears pretty flimsy. Last year, the British Medical Journal published a review of the literature which I wrote about here. Read this blog post and/or the original BMJ article and you may come to the conclusion that flu vaccination policy is based on misreporting and misrepresentation of the actual evidence.

I started to think about this topic again on receipt of an email yesterday from an US-based doctor who alerted me to this document. It is written by Dr Eric Kasowski, a doctor the US Center for Disease Control’s (CDC’s) Influenza Division. It urges healthcare workers to get their flu shots. Oddly, for something aimed at health professionals, it cites no studies. I don’t want to be overly suspicious, but this is usually not a good sign.

While we health professionals like to think of ourselves as independently-minded people, the fact is we are as subject to ‘group-think’ as anyone else, in my opinion. Do doctors really have time to go back to the original research, read it and assess it? Not usually. Normally, we doctors will accept what our Government’s tell us quite uncritically.

By way of example, let me relate an experience from a month or so ago. I was listening to the radio and the subject of flu vaccination was being discussed. The issue of the evidence for this practice came up. The doctor in the radio studio giving comment was not only unable to cite any evidence, he also stated that there MUST be evidence, otherwise our Government would not be advising that we have these shots. I’d like to say that such naivety was a rare thing in medicine, but my experience tells me that it is not.

Anyway, after talking with my parents I thought I’d take a look for any more recent evidence relevant to flu vaccination, and came across a review published earlier this year by the Cochrane Collaboration (a collective of international doctors and scientists supposedly dedicated to objective assessments of treatments by proper review of the evidence) [1]. The authors of this review highlight the fact that industry-funded studies were more likely to report positive findings and be published in prestigious journals and be cited more frequently. Here’s the exact wording of the warning:

WARNING:
This review includes 15 out of 36 trials funded by industry (four had no funding declaration). An earlier systematic review of 274 influenza vaccine studies published up to 2007 found industry funded studies were published in more prestigious journals and cited more than other studies independently from methodological quality and size. Studies funded from public sources were significantly less likely to report conclusions favorable to the vaccines. The review showed that reliable evidence on influenza vaccines is thin but there is evidence of widespread manipulation of conclusions and spurious notoriety of the studies. The content and conclusions of this review should be interpreted in light of this finding.

One of the problems with flu vaccination is that it tends not to work at all well if the strains of flu in the vaccine do not match the strains of flu in the environment. Even when the match is perfect, 1 per cent of flu vaccinated individuals ends up with a infection, compared to 4 per cent of unvaccinated individuals. However, in partial matching of vaccine/infecting strains (which is usually how things are), these figures are 1 per cent and 2 per cent respectively. In other words, the true reduction in flu risk in the population is a mere 1 per cent.

Here’s some more findings from this study:

Influenzea vaccines have a modest effect in reducing influenza symptoms and working days lost

There is no evidence that they affect complications, such as pneumonia, or transmission.

Here’s a plain language summary of the study in the authors’ own words:

Over 200 viruses cause influenza and influenza-like illness which produce the same symptoms (fever, headache, aches and pains, cough and runny noses). Without laboratory tests, doctors cannot tell the two illnesses apart. Both last for days and rarely lead to death or serious illness. At best, vaccines might be effective against only influenza A and B, which represent about 10% of all circulating viruses. Each year, the World Health Organization recommends which viral strains should be included in vaccinations for the forthcoming season.

Authors of this review assessed all trials that compared vaccinated people with unvaccinated people. The combined results of these trials showed that under ideal conditions (vaccine completely matching circulating viral configuration) 33 healthy adults need to be vaccinated to avoid one set of influenza symptoms. In average conditions (partially matching vaccine) 100 people need to be vaccinated to avoid one set of influenza symptoms. Vaccine use did not affect the number of people hospitalised or working days lost but caused one case of Guillian-Barré syndrome (a major neurological condition leading to paralysis) for every one million vaccinations. Fifteen of the 36 trials were funded by vaccine companies and four had no funding declaration. Our results may be an optimistic estimate because company-sponsored influenza vaccines trials tend to produce results favorable to their products and some of the evidence comes from trials carried out in ideal viral circulation and matching conditions and because the harms evidence base is limited.

When Governments and the doctors and scientists paid by them urge us to do things but do not cite appropriate evidence (as is the case with the recent missive from Dr Kosowski) I say beware. These folks may put a case that makes their case seem like a no-brainer. In reality, though, what is often going on here is that their hoping that individuals will not look at the evidence base, engage their brains and think for themselves.

References:

1. Jefferson T, et al. Vaccines for preventing influenza in healthy adults (Review). Cochrane Database Syst Rev. 2010 Jul 7;(7):CD001269.

20 Responses to Flu vaccination is largely ineffective, despite what your Government may have you believe

  1. John Duggan 26 November 2010 at 3:01 pm #

    None of what you state is a surprise
    However, one aspect that should at least be considered is whether a small change in the infection rate may have a much more significant effect on the overall spread of an epidemic. I remember looking at simulations of this sort of thing when I was at university and, depending on the parameters, a small change in the rate of contagion can stop an epidemic dead in its tracks or spin it out of control.
    I am not saying this is the case here and it doesn’t excuse the other sort of spin but, as Dr Briffa knows, things are not always as simple as they seem

  2. audrey wickham 26 November 2010 at 4:35 pm #

    On the other hand . . . my experience of flu vacinations has been exceptionally good. I have had an annual flue jab for years but in 1991 too much was happening in my life and I forgot to have my jab. I had one cold after another for months on end – no ‘flu but lots of debilitating colds. Since then I have had a head cold for about two hours from the time I got up in the morning and then it cleared up – I haven’t had a full blown cold for any year except 1991 in the last say 20 years. Haven’t had ‘flu in forty years.

  3. Elenor 26 November 2010 at 8:56 pm #

    Audrey? Do you realize that “colds” and influenza are IN NO WAY related? Having or not having a flu vaccine will not affect whether or not you get a cold, anymore than putting gas in your car affects whether or not your transmission works! The (various) ‘bugs’ that cause colds are not similar to or related to the bug that causes influenza. You’re drawing a (faulty) conclusion on the basis of things that have nothing to do with each other.

  4. Joseph Putnoki 27 November 2010 at 3:44 am #

    About 10 months ago her in Australia visiting a friend who just being visited by another friend of same age and ethnicity ( Greek) we chatted. Next week they told me the friend without any health complaints after getting his flu shot was fond dead in his bed next morning. I did not have the heart to comment. Angry and worried for them I am educating myself about health matters and try to be up to date without lapsing into uncritical acceptance of complementary medicine nor into hypercriticism without evidence of the allopathic camp. Big Pharma became feral and predatory in latest decade and more and more people are at risk and die due to unacceptable manufacturing practices, doctored trials and corrupting of regulatory authorities. The men in question while I can not prove it, likely to have died as result of the flu shot. This is no idle speculation. Looking deeper into the practices of manufacture is alarming!

  5. helen 27 November 2010 at 9:47 am #

    I have only ever had the flu once in my life and that was after buckling under one year to my boss’s assertions that we all had to have a flu injection!!!! – I worked in public transport at that time.
    I haven’t had a cold for over 20 years because I take a stack of vitamin C every day so I can only go by what works for me but hey while everyone else in my work place has at least a week off every year for one cold/flu thing or another. I don’t even get a sniffle. But then what would I know I don’t have a bit of paper saying I passed an exam in the things I study!!!

  6. Ivan Scott 27 November 2010 at 4:56 pm #

    I take issue with your presentation of the data in the line: However…these figures are 1 per cent and 2 per cent respectively. In other words, the true reduction in flu risk in the population is a mere 1 per cent.
    The actual reduction of risk is 50%, from 2 cases (n=100) to 1 case (n=100). This is substantial.

  7. John Briffa 27 November 2010 at 7:03 pm #

    Ivan

    You’re focusing on the (in my opinion) generally irrelevant ‘relative risk’ reduction. I was referring to the much more important (again, in my opinion) ‘absolute risk’ reduction.

    Let’s say flu vaccination reduced the risk of illness by 2 in a million to 1 in a million (relative risk reduction is 50 per cent). Would you describe the effect here as ‘substantial’? And if so, do you think this treatment should be widely advocated?

  8. donna 27 November 2010 at 7:34 pm #

    Try Viralox, clinically proven to be 3 times more effective than flu vaccine, all natural with no side effects. made from colostrum

  9. Andrea Galindo 30 November 2010 at 3:31 am #

    I am from Mexico, where we do not usually have flu shots; now I live in the US where EVERYBODY wants to give you a flu shot.. I am very against the flu shots, but my husband is pro shots. I have a 6 month old baby and don’t want to give her a flu shot, I would prefer for her immune system to naturally develop. Can you recommend me articles or do you have data to convince him not to give that flu shot to our baby? THANKS!
    A.

  10. Dan 12 December 2010 at 4:49 am #

    John,

    The example you used to argue for absolute risk is misleading. Try applying the same population size (one million) with the percentages used by Ivan (one and two percent) and you get a difference of ten thousand.

  11. Susan 17 December 2010 at 11:05 pm #

    when you say the jab isn’t effective do you mean- a) it might protect you against some viruses but not a whole load of others that are around. or b) you can still get the flu you have actually been vaccinated against or)c) you’re not that likely to catch flu anyway (if you’re over 60?) and the flu jab reduces the risk negligeably?

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