One Flu Over the Piggies’ Nest: another vaccine melodrama?

Vaccination, media coverage and social and health consequences: here we go again?

This morning a paper was published which suggests there may be a link between one of the pandemic H1N1 swine flu vaccines and narcolepsy diagnosis in children; it’s covered by Channel Four News (more links as I get them).

Narcolepsy is probably best known from comedies in which the character falls asleep at a moments notice, but in reality, of course, it’s a distressing and debilitating condition.

Coverage I have seen so far says that the authors of the paper have been careful to identify the limitations of their research. The research demonstrates a correlation not a cause, it’s a small sample group (n = 75 with 11 having had the Pandremix vaccine), any mechanisms are not understood and it’s not known if the patients would have been diagnosed with narcolepsy regardless of the vaccine. In short: more research required.

They also clearly state that this research is into the vaccine produced for the swine flu pandemic in 2009, and does not pertain to the seasonal flu vaccine.

The problem is that these limitations won’t stop people who are opposed to vaccination from using this as evidence supporting their position.

So my predictions for this vaccine scare:

  • At least one organisation opposed to vaccines will put out press releases using this to support their position.
  • Press releases will misrepresent the nature of the study, the conclusions and the implications for vaccination programs. They will invoke the precautionary principle suggesting that anything more than zero guaranteed risk is too much risk.
  • The anti-vaccine organisations will use stories about harms to further sensationalise the story, making it highly attractive to media outlets.
  • The mainstream press outlets will frame these extreme and inaccurate readings as providing balance to their coverage. The tabloid end of the market will use it to generate scary headlines.
  • The people countering the anti-vaccine lobby will be ineffective and, by arguing details, look as if they are being petty and technical (despite the entire thing being a details-oriented and technical debate), further damaging their reputation.
  • The people responsible for the seasonal flu program will find that uptake this year is much lower than predicted. Research will show this is because people were concerned about flu vaccination in general.
  • When a dangerous pandemic flu does emerge, vaccination rates will be even lower.
  • More people – especially those who cannot have the jab or those in whom it is ineffective – will have flu, be affected by serious secondary infection such a pneumonia and will die.

How do we counter this?

  • There needs to be urgent, clear and sympathetic messaging from both experts and advocacy groups which state unequivocally that flu vaccination is very safe.
  • These stories need to be accompanied by stories about real people who might die if the people around them aren’t vaccinated. Think about people with primary immune deficiencies in whom the vaccine doesn’t work.
  • People talking to the media need to defend their position without repeating myths from the opposition; repeating myths simply reinforces them. Simply counter claims with clearly stated facts which are framed for non-experts: compare risks to every day activities rather than using numbers (eg. more likely to die in a car accident).
  • Media: don’t buy into this balance argument. It’s not balanced if it legitimises killing people.
  • Lay educators (by which I mean, people with knowledge who are in the community and talk to people issues, say in the pub or around water coolers): you are key. You also need to know the facts and help communicate them in ways which counter misinformation. Key examples: get jabbed yourself, laughingly compare risk ratios to what you’ve done on your way to work etc…

I hope that I am wrong in my cynical expectations, but unfortunately, this has more than a whiff of a Wakefield-class scandal about it.



About David Waldock

Open University graduate, health and life science at undergraduate level, science and society at post-graduate. Interested in how the Internet is transforming the ways in which the public(s) engage with science(s). Also interested in "the skeptical movement" as a form of science activism and it's effectiveness in achieving its goals. Interested in the representation of LGB types in science and in the periscience communities. Work for a well known and loved public institution. Views are mine and not necessarily my employers.

2 responses to “One Flu Over the Piggies’ Nest: another vaccine melodrama?”

  1. Sarah Waldock says :

    And there also need to be more studies into vaccinations, the study of whether giving small children multiple vaccines do indeed overload their bodies or not, whether those people contra-indicated to take vaccine are more at risk from avoiding it than taking it [I’m talking people with compromised immunity who can react badly to a vaccine] because of the risk of catching the particular flu which the government hopes is the one to vaccinate against. It should also be considered that older people tend to be less at risk of things like bird flu, having built up a natural immunity to it for having survived the epidemics that are related to that, and perhaps they might provide a key to more effective vaccines to be developed. The problem is that the few cases which have had problems as a result of vaccination are generally emotive issues, and instead of addressing them, the government is inclined to first deny and cover up and then issue minimal to misleading facts and a soothing message, proving once again that they despise the electorate and do not trust them with a reasoned debate and risk assessment.

    • davidwaldock says :

      Obviously, as you say, this is an emotive subject. I’d like to reply to your second point first.

      You question whether people who are (for example) immunocompromised are at more risk from the vaccine or the disease. I think it’s a bit more complicated than that.

      There are broadly two types of vaccines: live vaccines, which contain a very weak form of the target pathogen, and non-live vaccines, which contain dead fragments of the target pathogen. Examples of live vaccines include MMR, FluMist (nasal) and the old oral polio vaccine. Most other vaccines are non-live.

      Patients can have compromised immune systems as a result of genetic conditions (eg. primary immune deficiencies such as neutropenia, common variable immune deficiency, severe combined immune deficiency and more), as a symptom of another condition (eg. HIV, radiation poisoning, some forms of leukaemia) or as a side-effect from another therapy (eg. in response to many forms of cancer therapy which kill off fast-growing cells such as those found in the immune system.).

      Patients with a compromised immune system absolutely should not have a live vaccine. This is because there is a risk that such patients will develop the actual disease; there are documented cases of this, including an outbreak of oral polio in a secluded religious community in which a large number of children had a primary immune problem.

      Another reason not to give people a particular vaccine is that they have an established allergic response to an ingredient; a common example I hens eggs.

      Non-live vaccines can (normally) be given to immune deficient patients. In some this will confer protection, in others it will not. Regardless, it’s a passive injection unlikely to cause harm. For example, I (who have common variable immunodeficiency) always have the seasonal flu jab, but we don’t know if it confers any protection.

      It’s also worth noting that immune systems are so genetically variable that even healthy people with “normal” immune systems may not develop immunity in response to a particular vaccine.

      However, for a vaccination program to be effective, not every individual in a community needs to be effectively immunised against a particular pathogen, regardless of the reason. If a person who is unprotected is surrounded by people who are immune, then the pathogen cannot be passed on to them. This is herd immunity, and it can be thought of as a biological insulation of vulnerable individuals.

      For herd immunity to be effective, however, a very high percentage of the population must be inoculated. The more infectious and virulent the disease the greater the percentage required for effective protection. Whooping cough requires more than 90% coverage; mumps around 75-86%.

      So in response to your second point: the issue from my perspective isn’t whether or not we should put immune deficient people at risk through giving them live vaccines, but whether we should allow them to be put at risk by people not vaccinating their children. From my perspective, it’s immoral to decide not to vaccinate children when it put me at greater risk than the child.

      In response to your first point, vaccination monitoring is a key task in public health, and statutory agencies (HPA in the UK at the moment, shortly to become local authority public health teams; CDC in the USA) use various intelligence systems to identify when there is an association between a vaccine and a syndrome or a particular disease.

      Unfortunately, these monitoring systems can be subject to false positives and are often indeterminate. For example, there was a question as to whether Guillaine-Barré disease (a neurological condition) was associated with a vaccination program in the USA in the mid twentieth-century. Although there was a correlation, evidence of a definitive cause was lacking.

      If the immune system was “overloaded”, this would definitely be picked up on by these monitoring systems. The sample sizes (>60 million people in the UK alone over the last 50 or so years) would result in a strong signal being identified.

      It’s also worth noting that “overload” is a fairly emotive term that has no real meaning in immunology: we get exposed to thousands of bacteria and viruses every day from the day we’re born. It’s difficult to see how vaccines would result in a different effect.

      Finally, government have certainly handled vaccine problems badly in the past; it handled pertussis vaccination so badly in the UK that rates dropped to ~30% in the 1970s, resulting in three whooping cough epidemics in the year I was born (1977).

      However, monitoring is now handled by independent professionals (in the UK), and vaccine companies are much more accountable and visible than they used to be. Whilst government sets policy, it’s professionals who determine which strains are likely to be high risk.

      Unless you are willing to suggest a massive conspiracy involving thousands of people – in which case there is little or no point trying to debate the issue – it’s very unlikely that such a case would remain secret. That’s not to say that government responses to public health problems couldn’t improve (see the horse meat kerfuffle!), but that keeping it a secret would be a challenge.

      However one looks at it, immunisation is an emotive issue. For vulnerable people (and their parents) there’s the concern that someone at work or in their class might be putting them at risks; for parents deciding whether or not to vaccinate, there’s the concern that regardless of statements of safety by experts whether one’s child might be one who is affected. Where does the balance lie?

      The balance lies in seeking to protect the interests of both. There is no such thing as a zero-risk vaccine any more than there is a zero-risk form of transport. We can’t invoke the precautionary principle because the consequences of not vaccinating (millions of unnecessary deaths) overwhelm any potential objections. Ultimately, it is a decision that has to be made as an informed, conscientious individual. For me, the danger lies in the sheer volume of misinformation which is promulgated by some very unsavoury characters who, far from fighting massive corporate interests to protect the defenceless citizen, are often empowering a different and less accountable and regulated set of big companies. At least if you decide not to vaccinate, ensure the decision isn’t based on known untruths.

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