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
Myth: No Rainbow, No Pot of Gold
Note: separate re-issue of part two of one of our myths blogs. We got a complaint that this one was too hard to find and link to. The easiest fix was to split it into a separate article. Thanks for your understanding.
Myth: Vaccines aren’t money makers for drug companies.
Reality: As spoken by Tom Broker about Gardasil and Merck (see page 19 of pdf)
“From a purely business point of view, they’ve been facing some real interesting challenges over the Vioxx issue and they are looking at this as the foundation and the savior of the company. Believe me, they have a huge stake in this, just as we all do.”
How profitable are vaccines? Prevnar did very well for Wyeth:
… Prevnar, which had $2.7 billion in sales last year. Prevnar is Wyeth’s No. 2 product by revenue, behind antidepressant Effexor.
Some business press projections on the potential in the vaccine market:
Gardasil sales totaled $365 million in the first quarter of 2007, helping Merck reach nearly $1 billion in total vaccine sales for the quarter, more than triple vaccine sales from a year earlier. Analyst projections have ranged up to $4 billion in annual sales for Gardasil, assuming the government mandates widespread vaccinations for girls.
Merck launched two other vaccines in 2006 – Zostavax, for the prevention of shingles, and Rotateq, for the prevention of a rotavirus that causes diarrhea in infants. Les Funtleyder, analyst for Miller Tabak, estimates that these vaccines could reach hundreds of millions of dollars in annual sales.
“Merck showed that you can make quite a bit of money with vaccines, and I think that got a lot of people’s attention,” said Funtleyder.
If vaccines have the potential to offer huge profits to pharmaceutical companies–just like other blockbuster drugs–Lipitor or Vioxx are good examples, I think we can reasonably assume that the temptation to publish ghostwritten studies, suppress unwelcome results and use Key Opinion Leaders to subtly sell product is there with vaccines, too. And vaccines offer two additional benefits, available for no other drugs: mandates and immunity from lawsuits (in the US). Who wouldn’t be tempted by a package involving a guaranteed market, and tort immunity?
There was a period, quite a long time ago now, when vaccines were not profitable. But time past is not time present. This myth is long past its sell-by date.
Medical Double Standards in the Third World
When it comes to third world medicine we almost invariably hear from the WHO about the successes of massive vaccination programs. If you look into the recent agenda for the World Health Assembly [1] you will find pandemic influenza vaccines at the top of the technical matters, and in the status section, the eradication of Poliomyelitis is at the top of that section. What is glaringly absent is a discussion of the pervasive double standards in research ethics, health-care safety and professional rigor that exist in the developing world. The WHO and its medical partners won’t talk about it publicly because when you look at the numbers, it is directly implicated in the suffering and ultimate death of millions of people in the developing world. That is what we’ll cover in this piece.
It is well known that needle re-use can be a major cause of virus transmission. In 2000, a WHO press release states:
Unsafe Injection practices have serious large-scale consequences…”unsafe injection practices throughout the world result in millions of infections which may lead to serious disease and death. Each year over-use of injections and re-use of dirty syringes and needles combine to cause an estimated 8 – 18 million hepatitis B virus infections, 2.3-4.7 million hepatitis C virus infections and 80,000 – 160,000 infections with HIV/AIDS worldwide. [2]
That same press release uses an epidemic of Hepatitis C that occurred from Schistosomiasis treatment in Egypt. Notably absent is any discussion of the massive immunization campaigns waged throughout the third world coincident with the massive epidemics of HIV and other infectious diseases. However, someone there must be aware of the potential problem because the press release states the following at the end:
In addition, to ensure the safety of immunization injections, WHO, the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), and the International Federation of the Red Cross and Red Crescent Societies (IFRC) have recently called for the exclusive use of auto-disable (AD) syringes for immunization by the end of 2003.[2]
We know quite reliably that the WHO knew years prior to this press release (2003) that medical practices in the developing world were problematic. As Gisselquist outlines in his 2009 article [3] the WHO was quietly giving UN employees the following advice in 1991.
take special precautions to avoid HIV transmission via blood . . . If you are not carrying your own needles and syringes, avoid having injections unless they are absolutely necessary . . . Avoid tattooing and ear-piercing. Avoid any procedures that pierce the skin, such as acupuncture and dental work, unless they are genuinely necessary. Before submitting to any treatment that may give an entry point to HIV, ask whether the instruments to be used have been properly sterilized.[3]
H1N1 Influenza in the U.S.
While it’s too soon to be sure, influenza numbers are dropping and the season may be coming to an early close. The CDC has these numbers:
During week 51 (December 20-26, 2009), influenza activity decreased slightly in the U.S.
154 (3.9%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza.
Translation: of thousands of tested cases of “might be flu”, 154 turned out to really be flu, only 3.9% of the total specimens tested. Lots of sneezing and coughing out there, and not an insubstantial number of hospitalizations and deaths for “influenza-like-illness and pneumonia” , but no influenza viruses are the main cause at this point.
2009 H1N1 virus did turn out to be more dangerous to children than the typical yearly influenza virus: the CDC received 225 reports of deaths this year, 130 last year, 88 in 2007 and 78 in 2006.
The breakdown by age:
Since August 30, 2009, CDC has received 225 reports of influenza-associated pediatric deaths that occurred during the current influenza season (42 deaths in children less than 2 years old, 25 deaths in children 2-4 years old, 83 deaths in children 5-11 years old, and 75 deaths in children 12-17 years old).
How likely was a child under 2 to die from H1N1 based on these numbers?
Live births in 2007: 4,317,000, minus 29,000 infant deaths, gives us a starting number of 4,288,000. The number of births has been going up every year for the last few years, so if we assume the same number in 2008 we are erring on the side of caution. We’ve got a total of roughly 8,576,000 children in the U.S. under the age of two. Forty-two of those children died this year as a result of H1N1, according to the CDC. This means that one child out of every 204,190 died from 2009 H1N1 according to the reported number of cases.
Are the reported number of cases reflective of the true burden of illness? Probably not entirely, but in November, CBS news reported that:
It’s a little counter intuitive,” Frieden said, “but the best way to estimate the total burden of illness is not to count the cases, but to estimate them based on the best available science.”
However, Ashton pointed out, things are very different when reporting pediatric flu deaths. She said states are required to document each case with the CDC, and every week the updated numbers are an accurate reflection of the entire country.
The numbers of pediatric deaths from 2009 H1N1 are based, therefore, on actual case counts in the U.S., during 2009.
Infants and toddlers were one of the groups recommended for the 2009 H1N1 vaccine. However, if saving the maximum number of lives is our goal, then there are several other causes of death in infants and toddlers which we feel should be addressed with a vigor to match the actual death and injury rates for each category.
Among 1- to 4-year-old children, injuries accounted for 42 percent of all deaths, followed by deaths due to congenital malformations (birth defects), malignant neoplasms (cancer), homicide, and diseases of the heart.
Or to give some comparative numbers:
More than 16,500 lives could be saved each year in the United States alone if our under-5 mortality rate was the same as Iceland. If the U.S. rate of under-5 mortality was similar to that of France, Germany and Italy (all 4 per 1,000 live births), over 12,000 child lives could be spared.
The causes of child deaths in the industrialized world differ dramatically from those in developing countries. In the developing world, over half of under-5 deaths are caused by pneumonia, diarrhea or newborn conditions. In the industrialized world, these problems rarely lead to death. Children’s deaths are most likely the result of injury suffered in traffic accidents, intentional harm, drowning, falling, fire and poisoning.
MRSA and Child Flu Deaths
Recent news stories about a link between MRSA and flu deaths in children raise some interesting questions in light of our Sisyphus series (Part I, Part II and Part III).
“Being a carrier of MRSA has increased a lot, especially among school-aged kids,” said Lyn Finelli, chief of influenza surveillance at the CDC. “And being colonized may put them at risk for a severe staph aureus infection when they get the flu.”
This particular news story blames the problem on antibiotic overuse, and, of course, recommends the flu vaccine to save children from this dangerous situation. Read more
The Situation has Changed–For the Better?
Insidevaccines will be posting occasional news stories related to vaccines with commentary by our team of editors. Here we go–
In 2002 Robert Goldberg wrote:
Despite significant activity in the area of vaccine design, vaccinology and immunology, vaccine development is on the verge of becoming a brackish backwater of other biotechnology and pharmaceutical enterprises. The market for vaccines is dominated by government purchasers that drive prices down to commodity levels, the regulations for the development and production of new vaccines are mired in the 1950s and sometimes cost more than producing vaccines themselves.
Public health officials and politicians are — depending on the day — either indifferent or outright hostile to the [sic] providing private companies with incentives for investing in new vaccines for a wide range of diseases. Indeed the solution de jour is to have the government — perhaps the Department of Defense (DOD) or some offshoot of the public health service — take over the development and production of vaccines, as if a U.S. government run National Vaccine Authority could magically and efficiently construct and operate billion dollar facilities without any glitches or major disruptions. Only scientists whose only brush with business is food shopping could concoct such an idiotic scheme.
Rotavirus: Death by Diarrhea?
Rotavirus is reported to be the leading cause of diarrhea among children, causing upwards of 55,000 hospitalizations per year in the US. Symptoms consist of vomiting and diarrhea, usually lasting between 3-8 days. Subsequent bouts of rotavirus are usually milder.
When this vaccine made its debute in 1998, I’ll admit to some skepticism. I laughed and said,“Really? Now it’s death by diarrhea!” When the first Rotavirus vaccine (RotaShield) was recalled in 1999, for causing intussusception, I felt justified in my stance. Especially when I found out that intussusception caused by this vaccine is a “compensable injury” and is paid for out of the National Vaccine Injury Compensation Program. (1) (Intussusception is a serious and potentially life-threatening condition that occurs when the intestine gets blocked or twisted. One portion of the intestine telescopes into a nearby portion, causing the intestinal obstruction. The most common site is where the small intestine joins the large intestine.)
In 2006, a new rotavirus vaccine (RotaTeq) was approved by the FDA. My family doctor and most of those around me were all strongly recommending the new vaccine, so I turned my attention towards some research.
Read more
Sisyphus and the Conjugate Vaccines
As a punishment from the gods, Sisyphus was compelled to roll a huge rock up a steep hill, but before he reached the top of the hill, the rock always escaped him and he had to begin again. The maddening nature of the punishment was reserved for Sisyphus due to the mortal’s hubristic belief that his cleverness surpassed that of Zeus.
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In September, the AP reported that Prevnar…
“A vaccine that has dramatically curbed pneumonia and other serious illnesses in children is having an unfortunate effect: promoting new superbugs that cause ear infections.”
http://www.msnbc.msn.com/id/20825107/
I always wonder who actually writes these science stories you see in the media.
Yes, the emerging serotypes cause ear infections and other mild illnesses, but they also cause various deadly forms of invasive disease. It’s a phenomenon called “serotype replacement” (or “replacement disease” in other circumstances) and so far all of the conjugate vaccines (Hib, Prevnar, Menactra) have done this in some form or fashion. The vaccines work extremely well against vaccine-included serotypes of streptococcus pneumoniae, but they work so well that they also prevent asymptomatic carriage of these normally commensal organisms.
And that is a problem.
For example, from The Lancet:
“FINDINGS: We noted no reduction of AOM episodes in the pneumococcal vaccine group compared with controls (intention-to-treat analysis: rate ratio 1.25, 95% CI 0.99-1.57). Although nasopharyngeal carriage of pneumococci of serotypes included in the conjugate-vaccine was greatly reduced after pneumococcal vaccinations, immediate and complete replacement by non-vaccine pneumococcal serotypes took place.”
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Parents: Does the CDC Think We are Stupid?
Why else would the CDC supply the parents of America with dumbed down information that contradicts their very own guidelines on how to distinguish trustworthy information from mere opinion? Here are the guidelines from the CDC on evaluating information found on the Internet.
The CDC on trustworthy information.
What is the scientific evidence for claims made? The original source of facts and figures should be shown. For example, the Web site should provide citations of medical articles or other sources of information. You should be able to distinguish facts from opinions. Also, facts are more reliable if they come from a published scientific study on humans rather than from unpublished accounts or from reports of a single person or of animal studies.
When it comes to information for parents, the CDC motto is clearly: “Do as I say, not as I do.”
Read more