A Pox on the Taxpayer
Filed under: CDC Watch, Opinion, Vaccine Science, Vaccine/Disease Analysis
A handful of countries recommend the chickenpox (varicella) vaccine for all children and an even smaller group have a chickenpox booster on the schedule. The US leads the pack of countries with a 2 shot schedule, and following along are Ecuador, Saudi Arabia, Germany, Greece, and part of Australia.
Some countries give the shot to adolescents, others offer it to members of “risk groups”… and a few have a one-shot schedule for toddlers: Canada, Costa Rica, Uruguay, Cyprus, Latvia, and Korea. A grand total of 26 countries offer the shot in one way or another. [1]
The US was the first country to recommend the shot for all toddlers, in 1996 :
…. empiric data on medical utilization and costs of work-loss resulting from varicella were used. The results of this study, which were determined using an estimated cost of $35 per dose of vaccine and $5 for vaccine administration, indicated a savings of $5.40 for each dollar spent on routine vaccination of preschool-age children when direct and indirect costs were considered. When only direct medical costs were considered, the benefit-cost ratio was 0.90:1. [2] (emphases added)
But it turned out that a single shot of varicella vaccine didn’t work to suppress chickenpox.
…varicella outbreaks have regularly been observed in populations with high vaccination coverage and are the cause of sizable disease and economic impact for public health departments and the US health system overall. To further reduce varicella disease burden, a routine 2-dose varicella vaccination recommendation was approved by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) in June 2006 (first dose for children 12–15 months of age, second dose for children 4–6 years of age) . [3]
The single-shot regimen showed a narrow margin of benefit only when placed alongside income lost by parents staying home to care for sick children.
But when the one-shot program failed, the ACIP came up with another cost/benefit justification for the second shot where the evidence….
….included ongoing disease burden and varicella-zoster virus transmission, including transmission from breakthrough cases to high-risk persons that may lead to severe disease and even death (CDC, unpublished data); partial or complete susceptibility in 1-dose vaccine recipients as they become adults; the burden on public health agencies due to varicella outbreaks in highly vaccinated school settings, which have proven disruptive to society and costly to control; and the increased immunity and disease protection from a second dose. Overall, the 2-dose strategy still provides very high cost savings (>$0.9 billion from societal perspective). [3] (emphases added)
So the ACIP justifications for adding a second dose, used the consequences of their decision to recommend the first dose of varicella vaccine. These ingenious calculations created a bigger cost savings than their first round! Read more
Indian Physicians slapped with anti-vaccine label!
Why? Because they questioned a WHO (World Health Organization) diktat in favor of universal Hib vaccination in India.
Sorry, but this is getting ridiculous. Anyone, at any time who raises any concern about the safety, efficacy, or appropriateness of any vaccine is now called anti-vaccine.
Here is a potted history of the recent outbreak of name-calling.
In the July 2010 issue of the Indian Journal of Medical Research this editorial appeared: Introducing pentavalent vaccine in the EPI in India: A counsel for caution.
The latest WHO position paper on Hib says ‘Hib vaccine should be included in all routine immunization programmes. This suggests that Hib vaccine should be included in the immunization programme universally, irrespective of an individual country’s disease burden, not withstanding of natural immunity attained within the country against the disease, and not taking into account the rights of sovereign States to decide how they use their limited resources. The mandate and wisdom of issuing such a directive, for a disease that has little potential of becoming a pandemic, needs to be questioned.
The editorial reviews the available data and on the basis of the science, questions the need for the Hib vaccine in India.
In response to this thoughtful challenge to the WHO policy on Hib, a news commentary was published in the BMJ (British Medical Journal) which called the concerned doctors an “anti-vaccine lobby.” This article, which is unreferenced, claims:
The Hib organism, which can cause severe bacterial meningitis and pneumonia, is estimated to kill more than 370 000 children worldwide each year, GAVI said. Nearly 20% of these deaths occur in India.
In response to the BMJ article, a rapid response was published in the online version of the BMJ by eight members of the supposed “lobby”
The doctors wrote:
The thrust for including Hib vaccine in India is based on 2 arguments. The first is that there is anecdotal evidence of the existence of Hib disease and Hib meningitis in India and that Hib meningitis may lead to long term morbidity. The second argument is that the well-to-do parents sometimes buy Hib vaccine in the open market to vaccinate their children. The Government of India must therefore provide it free for the poor, on the grounds of equity and fair play (2).
The problem with the anecdotal reports is that they do not specify the size of the universe from which the samples are drawn and public health policies cannot be based on these figures without a denominator. The many systematic surveys done to look at the magnitude of the problem of Hib disease in India have nearly always shown that the incidence of Hib disease is much lower than what was projected for India. Most of these studies have been funded by the WHO and these have been reviewed recently in an open access journal (3).
So, we have the BMJ calling names and publishing an unreferenced attack claiming high numbers of deaths from Hib, while the supposed anti-vaccine lobby provides carefully referenced information debunking the claims.
The pro-vaccine lobby has plumbed to new depths.
Polio and Sanitation
Filed under: CDC Watch, Parents' Pages, Vaccine Science, Vaccine/Disease Analysis, WHO Watch
KHAGARIA: On the sandy banks of Kosi river in north Bihar, a quiet crowd of several hundred people is waiting in the sizzling morning sun. A speck appears in the pale blue summer sky, rapidly growing in size — its a gleaming white helicopter. Within seconds it is hovering above the opposite bank, amidst the cornfields.
The crowd is awestruck at the monstrous machine as it settles down in billowing clouds of sand. Out comes the man everybody has been waiting to see — Bill Gates.
Bill Gates has come to find out why polio eradication is failing in Bihar. He asks questions about immunization strategies and tries to figure out what sort of technical problems are blocking universal vaccine delivery.
People complain of lack of basic health facilities…There are only 49 auxilliary nurse and midwives under the PHC, against a sanctioned strength of 76…So, the delivery of basic health services is itself a distant dream…The villagers hope against hope. Isn’t the spread of polio linked to lack of sanitation and basic health facilities? Gates acknowledges this fact but says that it is for the government to do the needful. “We are concentrating on the eradication of polio, which is achievable through vaccines,” he says. [1]
Polio epidemics first appeared in the mid-nineteenth century. Many doctors and scientists struggled with the mystery: why, as living conditions improved, did incidents of paralysis increase? Out of all the changes that came with modernity, improved sanitation was chosen as the change which caused polio to turn from a mild illness to one that left death and permanent damage in its wake. Here is an excellent example from a 2007 medical article which summarizes the concept:
Prior to the 20th century, virtually all children were infected with PV while still protected by maternal antibodies. In the 1900s, following the industrial revolution of the late 18th and early 19th centuries, improved sanitation practices led to an increase in the age at which children first encountered the virus, such that at exposure children were no longer protected by maternal antibodies. Consequently, epidemics of poliomyelitis surfaced . [2] Read more
Vaccine Myths, Round Two
Filed under: Parents' Pages, Vaccine Myths, Vaccine Science, Vaccine/Disease Analysis
Introduction: A while back, we explored some common anti-vax myths. Because in the great vaccine debates, the myths tend to outnumber the facts, we’ve decided to begin a multipart series dispelling some of the mythologies people argue over which preclude productive discussions over real issues. Below, you will find the facts behind two more common vaccine myths: herd immunity, and whether or not vaccines are profitable to pharmaceutical companies.
Myth: herd immunity isn’t real, and all the vaccine preventable diseases were declining in incidence prevaccine
Reality: vaccine induced herd immunity is a real phenomenon, and the incidences of the “diseases of childhood” (measles and mumps, for example) averaged out to be constant in the prevaccine era.
Here’s a chart showing the incidence of measles from 1912 till 1960.
Although the “death rate per cases” dropped an amazing amount, the same number of cases were happening per year on average. Read more
Prevnar IS Safe – Have a Look at the Studies!
In November of 2008, a report was published about a halted vaccine trial in India. Here is an excerpt which can be found on Livemint :
New Delhi: Patient trials of an advanced pneumonia vaccine by the domestic unit of US drug giant Wyeth Inc. have been suspended by India’s drug quality regulator after the death of an infant on whom the vaccine was tested in a trial in Bangalore.
The child had a pre-existing cardiac disorder. Indian drug rules prohibit testing on human subjects with such conditions without the prior approval of the drugs controller general of India (DCGI), the drugs quality regulator.
Indian authorities said that the trial was stopped because:
“The baby was suffering from a cardiac abnormality and should not have been included in the trial at all. It seems that the ‘inclusion-exclusion’ criteria protocol has not been adhered to by the investigator,” said Surinder Singh, drugs controller general. “We have suspended all further trials across the country.”
Does the Inactivated Influenza Vaccine Even Work In the Recommended Age Bracket?
Filed under: News, Parents' Pages, Vaccine Science, Vaccine/Disease Analysis, WHO Watch
It’s that time of year again! Having spent last summer consulting the avian set on what’s hot in influenza, the pharmaceutical company has whipped up a fresh batch of flu vaccine, and now they need to move the merchandise! Fortunately, the CDC is happy to help with sales, by expanding the recommendation to ever more age groups. The Advisory Committee on Immunization Policy currently recommends the vaccine for all children aged 6 months to eighteen years. There is just one slight issue that might concern some parents. Peer-reviewed research in The Archives of Pediatric and Adolescent Medicine, Vol. 162 No. 10, October 2008,1 demonstrates that the vaccine is not effective under age 5!
An inherent assumption of expanded vaccination recommendations is that the vaccine is efficacious in preventing clinical influenza disease. Although studies have documented immune responses following 2 doses of inactivated influenza vaccine as well as vaccine efficacy for culture-confirmed disease in randomized clinical trials, surprisingly little information exists regarding influenza vaccine effectiveness (VE) among young children receiving vaccine in routine health care settings.
Where Do They Find These Scary Statistics III – Let’s Make a Few Assumptions – Hepatitis B
Filed under: CDC Watch, Vaccine Science, Vaccine/Disease Analysis
Parents have questions about the risk-benefit equation of the Hepatitis B vaccine. It is possible for a parent to be quite certain that their infant is not at risk of prenatal or birth exposure to this disease. The risk factors for exposure during infancy, early childhood, and the elementary school years can be reasonably well assessed on an individual basis. Read more
Where Do They Find These Scary Statistics? Part II: Gross Estimation–Diphtheria Statistics Defy Reality
Filed under: CDC Watch, News, Vaccine Science, Vaccine/Disease Analysis
Top graph from page 423 of The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century.
Lower graph from page 208 of Trends in Diphtheria Mortality.
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Series Links: Part I, Part III Read more
New vaccine
Where Do They Find These Scary Statistics?
Filed under: CDC Watch, News, Vaccine Science, Vaccine/Disease Analysis
Dr. Gerberding of the CDC
[Series Links: Part II, Part III]
Remember Hannah Poling? The head of the CDC, dressed in a very nice pink suit, appeared on TV and discussed Hannah’s case. In one of her appearances she said something like this: “Vaccines prevent 33,000 deaths a year in the United States.” Just to make sure I had the statement right, I searched for the phrase and found it again, from CNN, this time in print.
Today, through immunizations given in the first two years of life, we can protect children from 16 diseases, preventing 33,000 deaths and 14 million illnesses per year.
A few searches made it clear that this is a very popular statistic. A variety of news stories included the information that vaccines prevent 33,000 deaths a year in the United States. This is an interesting number to anyone who knows a bit about the history of infectious diseases. I decided to dig deeper.
My next find was this chart, which is on a the web-site of an organization called Every Child by Two. The chart provides morbidity (incidence) and mortality (deaths) for each disease. How in the world would someone be able to calculate (for example) the exact number of cases of diphtheria which would occur and the exact number of deaths which would follow? Amazing! There must be some truly extraordinary scientific research underlying these numbers, don’t you think? Read more