Flu Shots

[JEROME DA GNOME]

So after the CDC decides they need their spokespeople in the media stating concern and alarm, and predicting dire outcomes...and they end up in the news doing just that, it's a process they have no control over?
You don't think the CDC ever contacts the media with good stories that need to be told in the interest of health communication?

Drug companies do not lobby the governmnet!

You are outrageous!

 

[Dymanic]

You don't think the CDC ever contacts the media with good stories that need to be told in the interest of health communication?

The CDC "serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and health education activities designed to improve the health of the people of the United States."

With that mission statement in mind, what would you consider the ideal approach to communicating a threat, when a consensus among experts indicates that a threat exists?

 

[JEROME DA GNOME]

The CDC "serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and health education activities designed to improve the health of the people of the United States."

With that mission statement in mind, what would you consider the ideal approach to communicating a threat, when a consensus among experts indicates that a threat exists?

Assuming that the CDC being a governmental organization is immune from the vast amounts of cash funneled into the governmnet by the manufacturers of the vaccine the implication of your question would be correct.

 

[kellyb]

With that mission statement in mind, what would you consider the ideal approach to communicating a threat, when a consensus among experts indicates that a threat exists?

Are you talking about birdflu here or seasonal flu?
I don't really see where you're going with this. Health marketing uses a variety of strategies.
Here are just a few:

(from their script suggestions page)
http://www.cdc.gov/healthmarketing/entertainment_education/tips/influenza.htm

Case Examples
1. A 70-year-old grandmother flies across the country to visit her family. After landing, she has a scratchy throat, coughs a little, and is tired and maybe even a little feverish, but she chalks it up to the long flight. At her daughter's house, she lies down. The daughter checks on her a bit later, and finds her burning with fever, with an intense headache and body aches. She is coughing and congested. The daughter calls a doctor who says the symptoms sound like influenza infection. Has the mother had a flu shot? No. The mother and daughter immediately go to the hospital emergency room where the diagnosis is acute bronchitis infection and pneumonia. The mother is hospitalized, antibiotics are administered, but her condition declines. She dies three days later.

http://www.cdc.gov/healthmarketing/basics.htm

A Health Marketing Example
The CDC develops a new rapid HIV testing kit that provides results in half the time of current tests. To efficiently market the new product, the testing kits are announced by the national media and medical journals. The CDC sends free samples of the new testing kits to each of the state health departments, who deliver them to local health departments, clinics and hospitals. Here is how the CDC used the marketing mix:
Product: new HIV testing kit; released by a credible research agency
Price: free for trial use
Place: widely and evenly distributed throughout states using state and local health departments
Promotion: national media publicizes to public; journals inform medical community

http://www.cdc.gov/healthmarketing/entertainment_education/index.htm

The media is a resource.
They also make little posters and stuff.


http://www.cdc.gov/flu/professionals/flugallery/2007-08/edumat_dad-baby.htm
http://www.cdc.gov/flu/professionals/flugallery/2007-08/edumat_mom-baby.htm
http://www.cdc.gov/flu/professionals/flugallery/2007-08/images/p_grandfather65_aa_180x240.gif
http://www.cdc.gov/flu/professionals/flugallery/2007-08/images/p_nurse_personal_5people_180x240.gif

 

[Ivor the Engineer]

Why don't they try honest(-ish) marketing?

Like saying:

"Guys, if we don't use enough flu vaccine the companies that make it for us are going to ramp down production and close their manufacturing plants. When pandemic flu arrives, a lot more people than usual will be at risk of serious or fatal illness and require a flu jab. Unless we have the capacity to treat them now, many more people will die in the future."

 

[kellyb]

I guess they think what they're doing now is more effective?
Plus, they do seem to really think that getting every man, woman and child (and infant now) to get a flu vaccine every year will save lots of lives from seasonal flu.
So since the "Do this or DIE" "message" is effective, why mess with perfection?
I also get the impression that there's a kind of almost religious-type "belief" in flu vaccines. People are slow to let go of old ideas about stuff. It's human nature.
Or something. I dunno.
Weird situation, for sure.

 

[Dymanic]

Are you talking about birdflu here or seasonal flu?

Let's say seasonal flu.

I don't really see where you're going with this.

You asked: "You don't think the CDC ever contacts the media with good stories that need to be told in the interest of health communication?" I'm asking whether you think it is proper for the CDC to do such a thing, or what sort of alternative you might propose.

Plus, they do seem to really think that getting every man, woman and child (and infant now) to get a flu vaccine every year will save lots of lives from seasonal flu.

I think that's an important point. The conspiracy theorist might argue that they (which includes most physicians as well as public health officials) really don't think flu vaccines are effective, but promote the practice because they are all in Big Pharma's pockets. I'm glad that we agree on this.

I also get the impression that there's a kind of almost religious-type "belief" in flu vaccines.

That sounds a lot like a familiar creationist argument. I think it's useful to make a distinction between subjective opinions and reasoned judgements. A frighteningly large number of people in Idiot America are unable to make this distinction. Since you aren't one of them, it's surprising to see you try to dismiss a consensus among public health care professionals as some mere quirk of human nature.

 

[Beth]

I guess they think what they're doing now is more effective?
Plus, they do seem to really think that getting every man, woman and child (and infant now) to get a flu vaccine every year will save lots of lives from seasonal flu.
So since the "Do this or DIE" "message" is effective, why mess with perfection?
I also get the impression that there's a kind of almost religious-type "belief" in flu vaccines. People are slow to let go of old ideas about stuff. It's human nature.
Or something. I dunno.
Weird situation, for sure.

The problem I see with this sort of marketing approach is that it degrades the credibility of the CDC. It's essentially crying wolf falsely and everyone knows the moral of that story. I have little respect for the CDC these days and almost all of their loss of crediblity in my eyes comes as a result of their public advisory messages and policy recommendations in regard to vaccinations.

 

[Segnosaur]

The article stated; according to the CDC, that flu deaths have increased fourfold since the introduction of the vaccine.

Fourfold is 4 times as many.

But the article already explained the problems:

- The total number of deaths may be higher, but then there are also more people alive, and they are living longer (and flu tends to affect older people more). For example, lets say you had a town of 100 people in the 70s. Lets say 10% of the people there MIGHT die from the flu, and a vaccine is brought in that will save half the deaths. As a result, 5 people die, 5 are saved. Twenty years later, the population of the town has doubled. 10% of the people might still die from the flu (total of 20 people)... Vaccines are still 50% effective. As a result, 10 people will die, 10 will be saved. The vaccine has saved people (in fact, more people than before), but because there are simply more people around more people die.

- the article you referred to also pointed out that many people in high risk groups simply aren't taking the vaccine. Can't blame the vaccine if you're not taking the shot.

 

[Segnosaur]

(bump)

Any significant downsides to getting a flu shot?

Don't think there's anything that significant. There is the cost (even if you get the shot for 'free', the government still charges you for it through your taxes). And, since most flu vaccines use eggs for incubation, people with an allergy to eggs might have a bad reaction to it.

 

[robinson]

Does anyone have any actual information about how Flu shots are made each year? Where do they get the "new" flu from to make the vaccines? How do they test them to make sure they are safe? That they actually work?

Solid scientific information about the manufacturing process. the safety and efficiency testing, would go a long way towards encouraging skeptical people to get the vaccines. It seems the problem is a lot of people are skeptical of the value of getting a shot.

If somebody is skeptical of a claim, evidence is one of the best ways to convince people to change their minds. Spurious claims and sketchy evidence, or worse, wild claims and fear mongering, don't do anything except further more skepticism about the validity of a claim.

How hard would it be to simply publish the scientific facts, along with the evidence for these facts, rather than keep claiming something is true?

So, does anyone actually have any facts about Flu vaccines? In regards to the main issues that are questioned by skeptics?

 

[fls]

I think I have less trouble trusting the ACIP because rather than picturing them as nameless corporate drones, some of them are people I worked with (my residency research was on vaccine policy) and whose opinions are highly respected for a reason. Plus I've served on various public health/advisory committees and so have first-hand experience with the kind of discussions that take place.

ETA: I've never seen anything remotely as 'calculating' as Kelly has proposed. The kind of people that are drawn to serve on these committees tend to be from the opposite end of the spectrum (usually at least a few raised as idealist hippie types (myself included ).

However, if the CDC is untrustworthy, what about policy from other countries?

Linda

 

[kellyb]

Hmm...I just jumped over to the WHO site, and it looks like it's a different branch of the CDC (not the ACIP) doing the brainstorming here...

http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2004_3.pdf

Vaccines for pandemic influenza
Informal meeting of WHO, influenza vaccine manufacturers,
national licensing agencies, and government representatives
on influenza pandemic vaccines
SUMMARY REPORT
11–12 November 2004
Geneva, Switzerland

The American representative is:

Members of the WHO Global Influenza Surveillance Network:
Dr Nancy Cox
Director, WHO Collaborating Centre for Surveillance, Epidemiology and Control of
Influenza; Chief, Influenza Branch, Viral Disease Division
Centers for Disease Control and Prevention
Atlanta, Georgia USA

So she's way up in the WHO and the CDC.

And some of the highlights of the meeting:

Increased vaccination coverage during seasonal epidemics should be
recognized as the best long-term strategy for ensuring an adequate
manufacturing base for pandemic vaccines; national policies should seek to
improve vaccination coverage of groups at high risk of complications during
seasonal epidemics

Roles and responsibilities. Concerning roles and responsibilities, governments
were urged to provide a better environment for the development of influenza
vaccines in general, most notably by increasing the uptake of seasonal vaccines,
when this conforms with national health priorities. It was up to countries with
resources and manufacturing capacity to prepare the stage for responding to what
would unquestionably be a global threat.

Health officials and industry executives were in full agreement that increased use
of vaccines for seasonal epidemics represents the best long-term strategy for
increasing manufacturing capacity for pandemic vaccines.


These efforts went hand-in-hand with campaigns to improve uptake of seasonal
vaccine; several countries (Canada, Switzerland, the UK, and the USA) reported
impressive progress in this regard.

Yeah...I bet they did.

At this point industry stepped up and got to make their requests:

Partnerships needed in specific areas. Industry identified five main areas in
which public-private partnerships were needed to move the process forward: (1)
development of the seed vaccine and registration of a mock-up product, (2)
expansion of production capacities, (3) assurance of adequate supplies and
equitable distribution, (4) acceleration of time to market, and (5) assurance of
liability protection.

(2) Expanded capacity. Vaccine formulation – antigen content, adjuvants,
immunogenicity, and dose schedule – would ultimately influence the number of
doses available. Furthermore, increased uptake of seasonal vaccines would
profoundly expand global manufacturing capacity. This could be achieved
through government policies aimed at meeting WHO recommendations and
targets for seasonal vaccine coverage in high risk groups in countries where
influenza vaccination is part of national priorities for combating infectious
diseases.

(3) Supplies and distribution. Industry was keenly aware of the problem of
inadequate supply and inequitable distribution. Again, increased uptake of
seasonal vaccines was the best long-term strategy for increasing overall capacity.

Here's another one



http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_05_8-EN.pdf

2. Increase the supply of influenza vaccines
– Find ways to bridge the gap between current vaccine production capacity and
the expected demand during a pandemic
Ways must be found to ensure that countries without domestic manufacturing
capacity will have access to affordable vaccines in adequate quantities. Several
approaches are being pursued, including antigen sparing strategies, technology
transfer, and cell-culture and recombinant vaccine development. Increasing the
demand for seasonal vaccines expands overall manufacturing capacity. The
comparative effectiveness and implementation costs for the various approaches
have not been reviewed. An action plan, with specific recommendations for
countries with and without vaccine production capacity, is urgently required.

Increasing demand for influenza vaccines????

How in the world do you do that, I wonder....

Enhance utilization of seasonal influenza vaccines in high risk groups, in line
with WHO targets (50% coverage in 2006 and 75% in 2010)
Achievement of this goal requires global leadership in assessing and
communicating progress in influenza coverage in countries having national policies
for influenza vaccination and, elsewhere, in vulnerable groups. Other activities
include the development of recommendations to augment vaccine coverage in
target groups, support for the implementation of national vaccination programmes,
and the acquisition of better epidemiological and economic data on the burden of
seasonal influenza in developing countries.

So...
They were shooting for 50% by 2006 (last year)...and 75% by 2010...so we've got a ways to go with this whole thing, still, I think...

 

[fls]

I guess what I don't understand is why it is unreasonable to improve vaccination coverage in high risk groups - so much so that suggesting it's a good idea for more elderly people be vaccinated than unvaccinated becomes evidence of conspiracy?

Linda

 

[kellyb]

Most of the US is targeted for flu vaccination now.


What do you thnk about the "7 step recipe"?
Do you agree with Dymanic; it's simply a description of something the CDC has no control over?

 

[Beth]

You know Kelly, your posts do show evidence of a conscious plan to increase vaccination coverage. But I'm not entirely sure it's a 'bad thing'. Basically, the risk of an new pandemic flu is strain in real enough. They've happened in the past, it's pretty much a sure thing that it will occur again, it's a matter of when, not if. It makes sense to figure out how to make sure the manufacting and distribution facilities are in place to respond quickly and effectively to such an event and doing it the way they are makes sense economically, not just for vaccine manufacturers, but also for the general public.

While I don't like the scare tactics, as long as the vaccines remain optional I don't have a problem with the strategy of increasing demand for seasonal vaccines, particularly when they are targeting those who are most at risk.

 

[fls]

Most of the US is targeted for flu vaccination now.

But the 'targeting' and goals are really just directed at the high risk groups - trying to improve coverage to greater than 50% in the elderly, for example, where it will provide the most benefit.

What do you thnk about the "7 step recipe"?
Do you agree with Dymanic; it's simply a description of something the CDC has no control over?

It was clearly descriptive. Some parts would make no sense if read as prescriptive.

Linda

 

[kellyb]

While I don't like the scare tactics, as long as the vaccines remain optional I don't have a problem with the strategy of increasing demand for seasonal vaccines, particularly when they are targeting those who are most at risk.

It's kind of a weird situation, though, in that those who are most at risk are also the same people the vaccine doesn't even work in. (the very young and the very old).
And really, it's everyone who's being targeted now.

Remember this part of the recipe?

2.Dominant strain and/or initial cases of disease are:
–Associated with severe illness and/or outcomes
–Occur among people for whom influenza is not generally perceived to cause serious complications (e.g., children, healthy adults, healthy seniors)

And then there's the CDC's version of the vaccine's effectiveness that they use to push it, which doesn't line up with reality.
And that's not cool, either.
And then there's the overblown figures on annual influenza deaths (36,000?)
http://www.bmj.com/cgi/content/full/331/7529/1412
And THAT's not cool, either.
So the whole shebang leaves a bad taste in my mouth.

Not that I have any better ideas myself on what to do about pandemic influenza, because you're right...eventually some new, bad flu virus will emerge, even though I personaly doubt it'll be H5N1. But eventually one will, and it'll be "a lot worse" than seasonal flu.
But still....

 

[kellyb]

But the 'targeting' and goals are really just directed at the high risk groups -

Almost everyone is part of the high risk group, though. Infants, children, parents, grandparents, etc, etc.

It was clearly descriptive. Some parts would make no sense if read as prescriptive.

Linda

Ok. Let's break this down to it's most basic form.

Does the CDC contact the media and provide them with information to raise awareness about health related issues and motivate health behavior?

 

[JEROME DA GNOME]

But the article already explained the problems:

- The total number of deaths may be higher, but then there are also more people alive, and they are living longer (and flu tends to affect older people more). For example, lets say you had a town of 100 people in the 70s. Lets say 10% of the people there MIGHT die from the flu, and a vaccine is brought in that will save half the deaths. As a result, 5 people die, 5 are saved. Twenty years later, the population of the town has doubled. 10% of the people might still die from the flu (total of 20 people)... Vaccines are still 50% effective. As a result, 10 people will die, 10 will be saved. The vaccine has saved people (in fact, more people than before), but because there are simply more people around more people die.

- the article you referred to also pointed out that many people in high risk groups simply aren't taking the vaccine. Can't blame the vaccine if you're not taking the shot.

Those are all speculative reasons. This is why I propose a moratorium to determine if the flu shot does or does not contribute to flu death.