Six Reason to Question Vaccinations

[Skeptic Ginger]

I value truth over policy.

Shouldn't the American public be told that one of the reasons for the strong-arm approach to child vaccination is to head-off the risk of shifting up the age of infection with chickenpox, where it is likely to cause far more serious complications and deaths?

http://www.who.int/vaccines/en/varicella.shtml



Has there ever been a vaccination programme which needed such high, consistent coverage to avoid killing more people than it saved?

So the fact we shouldn't use the vaccine in Sub Saharan Africa means we also shouldn't use it in the US or Europe?

 

[Beth]

The editors on Dr (if he even is one, I wonder if his computer science PhD is from a diploma mill) Goldman's organization, Medical Veritas International Inc. reads like a who's who in anti-vaxer mythology.

Let's take the first editor listed after Dr G, Dr. Bonnie S. Dunbar has a letter to Dr. Joyce C. Lashof, M.D.; Committee Chair; Presidential Advisory Committee on Gulf War Veterans Illness with the usual unscientific babble. Ms Dunbar seeks a grant not to study the possible connection but rather the letter states the claim as a foregone conclusion asking to therefore study, She goes on and on about all the research and proof about the risks of hep B vaccine. By her measures we should have expected an epidemic of autoimmune diseases among school children and health care workers around the country. There is no such epidemic.

That letter is dated Jan 3, 1997. That's over 10 years ago, from back when when I was looking into such research. Was such a study performed and if so, what were the results? Is the vaccine used now identical to the one used in 1995 and 1996? I thought changes had been made and that the risk of adverse reactions dropped as a result.

 

[Skeptic Ginger]

More on the fake Dr Goldman.

From his bio at "novaccine.com":

Gary S. Goldman holds a Ph.D. in Computer Science from Pacific Western University in Los Angeles and graduated with honors in 1977 from California State University, Fullerton (CSUF) with a double major: B.S. Engineering (Electronic emphasis) and B.S. Computer Science. His biography is included in Marquis’ 8th Edition 2005-2006 Who’s Who in Science and Engineering and 23rd Edition (2006) of Who’s Who in the World.

Re the Who's who, that's just a list of engineering grads. They have the same marketing scheme as in other fields, they put your name in, make it sound official and important, then sell you a copy along with selling the names to every advertiser who wants a list of that target market.

Wiki says "Pacific Western University operated in the Brentwood, California suburb of Los Angeles for its first twenty years, and then moved to Westwood" where it is now called California Miramar University^WP. They don't even offer PhDs and they are not accredited. Wiki notes, "California Miramar University (CMU) is a distance learning private university located in San Diego, California" and that some info on the page is disputed. Like the fact it is a diploma mill.

As such, its degrees may not be acceptable to employers or other institutions. In some jurisdictions the use of degree titles from the university may be restricted or illegal. [1][10] Jurisdictions that have restricted or made illegal the use of credentials from unaccredited schools include Oregon [2][11], Michigan[12], Maine[13], North Dakota[11]New Jersey[11], Washington[2][14], Nevada[2], Illinois[2], Indiana[2], and Texas.[1]. Many other states are also considering restrictions on unaccredited degree use in order to help prevent fraud. [15]

This Dr G is either really lying about a lot of his supposed accomplishments or whoever hired him never checked his resume.

 

[Ivor the Engineer]

So the fact we shouldn't use the vaccine in Sub Saharan Africa means we also shouldn't use it in the US or Europe?

The WHO document:

Case-fatality ratios (deaths per 100 000 cases) in healthy adults are 30–40 times higher than among children five to nine years of age. Hence, if a vaccination programme is undertaken, it is important to ensure high vaccination coverage [Ivor: document quotes 85-90% in previous section] in order that prevention programmes do not cause changes in the epidemiology of varicella resulting in higher incidence rates in adults.

I'll ask again:

Has there ever been a vaccination programme which required such high, consistent coverage to avoid killing more people than it saved?

And add:

If it was know before the routine mass Varicella vaccination programme was started that 2 doses (and possibly more) would be required, do you think it would have been introduced?

 

[Skeptic Ginger]

That letter is dated Jan 3, 1997. That's over 10 years ago, from back when when I was looking into such research. Was such a study performed and if so, what were the results? Is the vaccine used now identical to the one used in 1995 and 1996? I thought changes had been made and that the risk of adverse reactions dropped as a result.

The hepatitis B vaccine was made from a blood derivative until 1986. After that it was changed to the recombinant vaccine that is the same one in use today. Another company had a similar vaccine licensed in 1989. The two differ in mcg per dose with one being double the other but both are considered to be equally effective. I use the higher concentration exclusively because they are not really equal though both work. I found a higher failure rate early on with the lower dose since I do a lot of post vaccination testing.

I give literally thousands of doses of hep B vaccine every year and have done so for 18 years. I know of not one single serious adverse reaction. I also network with all the hospital employee health nurses in this area. Two people who were not in those I vaccinate but were employees in two local hospitals had hair loss after the vaccinations. Both were diagnosed as hypothyroid and both had normal regrowth of hair after treatment. As far as I know hypothyroidism has not been connected to hepatitis B vaccinations. I typically see the employees I vaccinate every year, either in classes or getting annual TB skin tests. Had there been adverse reactions occurring, especially frequently, I have a large enough population that I would have been made aware of the problems.

Edited to add, with the exception of no longer using Recombivax, I have used the same vaccine, Engerix B, with no changes to the formula since I began working in the occupational infectious disease field 1989.

 

[Skeptic Ginger]

The WHO document:



I'll ask again:

Has there ever been a vaccination programme which required such high, consistent coverage to avoid killing more people than it saved?

And add:

If it was know before the routine mass Varicella vaccination programme was started that 2 doses (and possibly more) would be required, do you think it would have been introduced?

Another example of you knowing a lot but not quite enough. The WHO reference is evaluating the risk of vaccinating people in poverty stricken countries which may or may not be able to give boosters if needed. In those countries, trading some deaths in childhood in order to prevent more deaths in adults is a reasonable trade off.

In countries with the ability to give boosters to adults, trading booster doses for childhood deaths is a reasonable trade off.

 

[Ivor the Engineer]

Another example of you knowing a lot but not quite enough. The WHO reference is evaluating the risk of vaccinating people in poverty stricken countries which may or may not be able to give boosters if needed. In those countries, trading some deaths in childhood in order to prevent more deaths in adults is a reasonable trade off.

Is this part of your "framing" science idea? The document states that unless 85-90% coverage rate is maintained, the age of infection could increase, leading to more serious illness and deaths in any country, irrespective of its state of development. The fact that developing countries have bigger public health problems to deal with and could probably not maintain 85-90% coverage is immaterial.

I'll ask again:

Has there ever been a vaccination programme which required such high, consistent coverage to avoid killing more people than it saved?

In countries with the ability to give boosters to adults, trading booster doses for childhood deaths is a reasonable trade off.

Really? The varicella vaccination campaign was justified on the socioeconomic benefit, assuming only one dose of vaccine was required. Now we know at least two are needed, doubling the cost.

(again: )

If it was know before the routine mass Varicella vaccination programme was started that 2 doses (and possibly more) would be required, do you think it would have been introduced?

 

[Skeptic Ginger]

I'm not going to argue values with you, Ivor. I don't hold your values.

There is a point about interrupting the natural epidemic cycle leading to unvaccinated kids not getting chicken pox as children and being susceptible as adults. They can get vaccinated as adults or take their chances. Why should I risk my child's life (regardless of the numbers, the vaccine is safer than the disease) to save your unvaccinated child later in life?

 

[robinson]

Evidence based medicine

Postgrad Med J. 2006 May;82(967):351-2.

Chickenpox, chickenpox vaccination, and shingles.
Welsby PD.

Infectious Diseases Unit, Western General Hospital, Edinburgh EH4 2XU, UK. \

Chickenpox in the United Kingdom, where vaccination is not undertaken, has had a stable epidemiology for decades and is a routine childhood illness. Because of vaccination, chickenpox is now a rarity in the USA. In the UK vaccination is not done because introduction of a routine childhood vaccination might drive up the age at which those who are non-immune get the illness (chickenpox tends to be more severe the older you are), and the incidence of shingles may increase. The United Kingdom is waiting to see what happens in countries where vaccination is routine.

 

[Ivor the Engineer]

I'm not going to argue values with you, Ivor. I don't hold your values.

My questions have nothing to do with your or my values. The first one is asking about a fact (if you don't know the answer, that's fine; I'll try to find out for myself. I will not think any less of you for not knowing). The second is just asking for your judgment based on your greater exposure than mine. Again, if you don't think you are able to answer, just say so. I'm not trying to make you look ignorant, because I know you are not.

1) Has there ever been a vaccination programme which required such high, consistent coverage to avoid killing more people than it saved?

2) If it was know before the routine mass Varicella vaccination programme was started that 2 doses (and possibly more) would be required, do you think it would have been introduced?

There is a point about interrupting the natural epidemic cycle leading to unvaccinated kids not getting chicken pox as children and being susceptible as adults. They can get vaccinated as adults or take their chances. Why should I risk my child's life (regardless of the numbers, the vaccine is safer than the disease) to save your unvaccinated child later in life?

Because your child's life is at a far, far higher risk every single day, vaccinated against chickenpox or not. The grim reaper is very rarely hiding in Varicella. Much more often he's driving a car, or behind a bullet.

I have no problem with any parent choosing to have their child vaccinated, if they think it is worth it. What I object to is forcing vaccination for such a low-risk disease. If you don't want your children to get chickenpox, give them the vaccine. If I think it is better for mine to have chickenpox, why should they be barred from school?

As for my values (which I'm perfectly happy for you not to agree with): Why should millions be spent on each child who would have died from chickenpox, rather than treating some other condition?

I still think the best use of the varicella vaccine is for adolescents and adults who have not had chickenpox as a child.

 

[Skeptic Ginger]

.....
I still think the best use of the varicella vaccine is for adolescents and adults who have not had chickenpox as a child.

Round and round the mulberry bush...


You just got done saying it wasn't values then you argued your values.

I recommend parents consider the chicken pox vaccine because it prevents rare but not zero fatalities and other serious complications from childhood chicken pox. You prefer to lose a few kids or their limbs or face to flesh eating bacteria because you don't want to pay for that particular hazard reduction.

 

[Skeptic Ginger]

Postgrad Med J. 2006 May;82(967):351-2.

Chickenpox, chickenpox vaccination, and shingles.
Welsby PD.

Infectious Diseases Unit, Western General Hospital, Edinburgh EH4 2XU, UK. \

So your point is this general comment means exactly what? It certainly doesn't vindicate the fraudulent Dr Goldberg with his phony PhD credential and his anti-vax woo web site and all his false claims of fatalities being greater with shingles than chicken pox.

I don't have an issue with the two countries' different approaches. I have an issue with the statement chicken pox is "a routine childhood illness". It ignores the times it isn't so routine.

 

[Ivor the Engineer]

Round and round the mulberry bush...

Yes, I'm having a Jeremy Paxman / Michael Howard moment too.

You just got done saying it wasn't values then you argued your values.

Feel free to ignore any questions of mine which have a personal value component to them. Let's just stick to these two:

1) Has there ever been a vaccination programme which required such high, consistent coverage (85-90%) to avoid killing more people than it saved?

2) If it was know before the routine mass Varicella vaccination programme was started that 2 doses (and possibly more) would be required, do you think it would have been introduced?

I recommend parents consider the chicken pox vaccine because it prevents rare but not zero fatalities and other serious complications from childhood chicken pox.

Ok, I'm fine with that.

You prefer to lose a few kids or their limbs or face to flesh eating bacteria because you don't want to pay for that particular hazard reduction.

I could come back with a list of causes of death you "don't want to pay for", which kill far more people than chickenpox.

Check out Table C on page 8 from this report by the CDC.

I have a hard time believing spending $450 million+ on those causes of death could not save many more lives than mass varicella vaccination (100-150)each year.

 

[Deetee]

Ivor, I am still interested in your answer the the question below. It would go some way towards revealing what things you would want your money spent on.

Ivor, it might help if you gave us an actual figure in terms of $$cost per QALY that you would find acceptable as an expenditure.
Then we can see for ourselves which interventions you would regard as having merit.

 

[Ivor the Engineer]

Ivor, I am still interested in your answer the the question below. It would go some way towards revealing what things you would want your money spent on.

Ivor, it might help if you gave us an actual figure in terms of $$cost per QALY that you would find acceptable as an expenditure.
Then we can see for ourselves which interventions you would regard as having merit.

No problem. I started the other day, but got distracted and forgot about it.

The answer to your question is that I don't have an absolute threshold. I tend to think treatment should be rationed by need as well as efficiency. I.e. those with greater need should get more treatment than those with lesser need, especially when treatment can make a significant difference.

 

[Skeptic Guy]

Yes, I'm having a Jeremy Paxman / Michael Howard moment too.



Feel free to ignore any questions of mine which have a personal value component to them. Let's just stick to these two:

1) Has there ever been a vaccination programme which required such high, consistent coverage (85-90%) to avoid killing more people than it saved?

2) If it was know before the routine mass Varicella vaccination programme was started that 2 doses (and possibly more) would be required, do you think it would have been introduced?



Ok, I'm fine with that.



I could come back with a list of causes of death you "don't want to pay for", which kill far more people than chickenpox.

Check out Table C on page 8 from this report by the CDC.

I have a hard time believing spending $450 million+ on those causes of death could not save many more lives than mass varicella vaccination (100-150)each year.

Do you think that there is no money being spent on those ten causes of death? Or throwing an additional $450m, if spent on those causes and not on vaccinations, would result in fewer deaths?

 

[robinson]

Until this topic, I never considered money and how many lives could be saved for the same amount, in regards to vaccination programs.

It is indeed a reason to question vaccinations.

 

[Deetee]

Can you be a bit clearer on your statement on vaccination?

The expenditure in order to save one life is one method of assessing the suitability for a medical intervention. For vaccinations in general, the benefits are usually unquestioned, and certainly a no-brainer for diseases like diphtheria, pertussis, measles, Hib, meningococcus and so on. Vaccines such as Gardasil may save lives, but there is a higher cost involved. Some vaccines may not particularly "save lives", but may avert illness that is rarely fatal but can be unpleasant (hepatitis A, chickenpox). For these interventions, one needs to consider indirect costs and benefits carefully. Not all vaccines are equal, medico-economically speaking, so it doesn't make sense to put them all in the same category.

Vaccines are a simple and generally safe method of saving lives. Contrast this with the costs of (say) statins or coronary bypass to prevent a death from myocardial infarction, liver transplants for hepatitis C, or vioxx to make someon'e arthritis better. I think if you wish to question the benefits of medical interventions, there are plenty more battlefields that would be suitable for your fight than the vaccine one.

No doubt when you have angina, you will be happy that your doctors limit your treatment to GTN spray, on the basis that investigation and interventions like angiography are not really cost effective when considering the general health economy and that the money could be more fruitfully spent elsewhere.

 

[Chris Haynes]

...For these interventions, one needs to consider indirect costs and benefits carefully. Not all vaccines are equal, medico-economically speaking, so it doesn't make sense to put them all in the same category.....

That is kind of what it says here: Economic Benefits and Costs Associated With Target Vaccinations

 

[Ivor the Engineer]

Let's have a look at the study which estimated Varicella vaccination was cost-effective before it was introduced in the US in 1995:

http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Cost-effectiveness of a routine varicella vaccination program for US children.

OBJECTIVE--To evaluate the economic consequences of a routine varicella vaccination program that targets healthy children. METHODS--Decision analysis was used to compare the costs, outcomes, and cost-effectiveness of a routine vaccination program with no intervention. Clinical outcomes were based on a mathematical model of vaccine efficacy that relied on published and unpublished data and on expert opinion. Medical utilization rates and costs were collected from multiple sources, including the Kaiser Permanente Medical Care Program and the California Hospital Discharge Database. RESULTS--A routine varicella vaccination program for healthy children would prevent 94% of all potential cases of chickenpox, provided the vaccination coverage rate is 97% at school entry. It would cost approximately $162 million annually if one dose of vaccine per child were recommended at a cost of $35 per dose. From the societal perspective, which includes work-loss costs as well as medical costs, the program would save more than $5 for every dollar invested in vaccination. However, from the health care payer's perspective (medical costs only), the program would cost approximately $2 per chickenpox case prevented, or $2500 per life-year saved. The medical cost of disease prevention was sensitive to the vaccination coverage rate and vaccine price but was relatively insensitive to assumptions about vaccine efficacy within plausible ranges. An additional program for catch-up vaccination of 12-year-olds would have high incremental costs if the vaccination coverage rate of children of preschool age were 97%, but would result in net savings at a coverage rate of 50%. CONCLUSIONS--A routine varicella vaccination program for healthy children would result in net savings from the societal perspective, which includes work-loss costs as well as medical costs. Compared with other prevention programs, it would also be relatively cost-effective from the health care payer's perspective.

The Varicella vaccine costs $59 per dose and 2 doses are required, so rather than $35, $118 per child is being spent. Taking into account inflation from 1994 (~2.9%/year), that still makes the vaccination programme cost about 2.4 times more than they estimated it would. I don't see any mention of the likely increase in cases of Zoster being taken into account.

Ignoring Zoster for the moment and just taking into account the increased cost of vaccination, from the societal-perspective the $5 saved for every $1 spent has been reduced to $2.6/$1, whilst the cost per life-year saved has increased from $2500 to $8700 (including 2.9%/year inflation). Add on an significant increase in cases of Zoster (or vaccination against it), and Varicella vaccination will end up costing society, rather than saving money.

What's good from Merck's point of view is now that so many American children have been given the Varicella vaccination and its efficacy appears to wane over time (especially with ever-decreasing exposure to the wild-type virus), the only strategies the ACIP can consider are continuing vaccination and giving boosters as and when required (including vaccination against Zoster for those people who have already had Chickenpox), or face large numbers of adults getting Chickenpox and Shingles. It would seem Merck has the ACIP (and the American public in general) by the balls as far as Varicella and Zoster vaccinations go.