Some Thoughts on TEH SWINEY FLOO!! Policy, the Lesson of PCV7, and That Murderously Incompetent Atlantic Article

Before I get to the horrendous Atlantic article about vaccination, it’s worth reviewing the Mad Biologist’s Pentultimate Postulate of Vaccination (What? You don’t know it?):
Effective vaccination is not about protecting you, it’s about protecting other people from you.
To put it another way, the best way for you not to get influenza is to not come into contact with people who have it–and standing next to a vaccinated person dramatically decreases those odds.
So onto the PCV7 vaccine.

The PCV7 vaccine confers immunity to the seven most common types of Streptococcus pneumoniae, a bacterium that causes pneumonia (worldwide, S. pneumoniae is the leading killer of children under five, not the Big Three that the Gates Foundation focuses on. Just sayin’). In the U.S., starting in 2000, children under five were vaccinated against S. pneumoniae, which led to a 94% drop in cases of invasive pneumonia in young children three years after the introduction of the vaccination (my thanks to the Notorious K.A.T. for pointing me towards the reference).
But there was an unanticipated side effect of the PCV7 vaccine–and it was a good thing (sometimes the ‘law’ of unanticipated consequences works out well): invasive pneumonia dropped by two-thirds among the elderly during that same time.
Elderly people didn’t receive the vaccine. Only the young kids were vaccinated. And the pattern in the elderly was exactly as one would expect: the amount of invasive pneumonia caused by the S. pneumoniae that the vaccine protects against, dropped, while infections due to S. pneumoniae not found in the vaccine remained essentially constant.
This is why I’ve written before on this blog that the grandchildren are killing their grandparents (because they are). It’s also why I have, tongue-in-cheek, formulated the Mad Biologist’s Pentultimate Postulate of Vaccination.
So onto the issue of whether or not TEH SWINEY FLOO!! vaccination is ‘over-medication’ (short answer: NOES!). ScienceBloglings Revere (part II) and Orac have nice takedowns of that argument, so I won’t rehash it all here. But I do want to raise a couple issues here about swine and seasonal flu vaccination policy–or our non-policy, to be more accurate.
One of the issues regarding flu vaccination is the question of does it actually reduce the burden of influenza in terms of preventing sickness and death (particularly among the elderly)? Considering that we bias our efforts towards the at-risk populations, the effects appear to be modest. Among the elderly, my reading of the literature is that there is a significant, but modest decrease in hospitalization and mortality. This isn’t surprising, since vaccination basically ‘trains’ your immune system to rapidly recognize influenza. But if your immune system is relatively weak, there’s only so much that training will do (if you want a guard dog, would you rather have a trained bull mastiff or a trained Pomeranian?).
But we should learn a very important lesson from the PCV7 experience–the people we should be vaccinating are the people who are spreading the disease, not the ‘end users.’ Once we’ve reached the triage stage of vaccination–targeting the immunocompromised only–we’re in the pile-into-the-lifeboat stage (hell, given the grossly inadequate amounts of swine flu vaccine, we might be in the cannibalism-in-the-lifeboat phase).
In other words, the problem isn’t overmedication, it’s undermedication. Since I’ve started blogging, I’ve repeated voiced my frustration over our lack of an influenza vaccination policy. Right now, it’s basically a policy of ‘get it if you feel like it and can afford it.’ While that’s not quite as bad as an anti-smoking policy of “smoke ’em only if you got ’em”, it’s pretty close.
The PCV7 experience highlights two points. First, we need to plan to produce much more vaccine, seasonal and epidemic, than we currently do (something always goes wrong in production, so we should target the rapid production of 300 million doses)–and if that requires government price supports or guaranteed purchases, then we should do so. For those who think that’s too expensive, it’s not when you consider what is fiscally crowding out public health.
Second, while I oppose mandatory vaccination, we need to have a much more vigorous vaccination effort. We should have clinics in schools (with opt-out policies), voting precincts, and encourage, businesses to do vaccination drives. It goes without saying that emergency and medical personnel (especially those at nursing homes) should be targeted (again, with opt-out policies)–they are the definition of high-contact personnel.
What is so frustrating about our vaccination non-policy is that we know what to do (and our best estimate is that widespread flu vaccination of children could dramatically reduce influenza mortality and morbidity among the elderly), but we lack the political will to do it. And unfortunately, crap like that which The Atlantic published doesn’t help.
Cited article: Reingold, A. et al. 2005. Direct and Indirect Effects of Routine Vaccination of Children with 7-Valent Pneumococcal Conjugate Vaccine on Incidence of Invasive Pneumococcal Disease — United States, 1998–2003. MMWR 54(36): 893-897.

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3 Responses to Some Thoughts on TEH SWINEY FLOO!! Policy, the Lesson of PCV7, and That Murderously Incompetent Atlantic Article

  1. Marco says:

    Well said, I just had an argument with my parents on the merits of getting flu shots, my mother got none as a child and is opposed to getting any in the future. I tried to tell her that the shot benefited at risk populations but she remains unconvinced; maybe this will do the trick.

  2. moe says:

    This makes me think of washing your hands after using the bathroom. I mean, I don’t care if people want to eat poo, but putting your poo all over the place for other people to unknowingly eat is gross.

  3. JohnV says:

    We just had a fascinating seminar here yesterday by Dr. Klugman about the role of S. pneumo and flu deaths in 1918 and the vaccine and deaths now and all that good stuff. I can’t really go into specifics because he had disclaimers on his slides about unpublished data etc…
    It was really nice to see an infectious disease talk focusing on bacteria since we don’t get much of that at work (I know… I should be recruiting speakers…..).

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