According to the NHS Choices website flu is a highly infectious illness that spreads rapidly through the coughs and sneezes of people who are carrying the virus (1). It can be particularly severe in
- anyone over the age of 65
- pregnant women
- people with an underlying health condition (particularly long-term heart or respiratory disease)
- people with weakened immune systems.
Anyone in these groups is more likely to develop potentially serious complications such as pneumonia or bronchitis, which could result in hospitalization and is therefore especially recommended to request the vaccination which is free on the NHS. It is stated that serious side effects of the flu vaccine are very rare although there may be a slight temperature and aching muscles for a couple of days after having the vaccination and some soreness at the point of the injection.
From September 1 2013, a new annual nasal spray flu vaccine, which is squirted up each nostril will be offered to all children aged two and three years. In some parts of the country, pre-school and primary school children between the ages of four and 10 will also be offered the vaccine. Eventually it is planned for all children between the ages of two and 16 will be vaccinated against flu each year with the nasal spray (2).
This all sounds perfectly sensible and logical. However when attempts have been made to substantiate the rationale which underpins the policy, serious doubts emerge. The Cochrane Collaboration which is widely recognized as an organization which consistently produces objective evaluations of important medical/health issues has considered the safety and efficacy of the flu vaccine on a number of occasions. The most recent one is based on the relevant research up to June 2010 (3).
The specific objectives were:
To identify, retrieve and assess all studies evaluating the effects (efficacy, effectiveness and harm) of vaccines against influenza in healthy adults. It was concluded that over 200 viruses cause influenza and influenza-like illness which produce the same symptoms (fever, headache, aches and pains, cough and runny noses). Without laboratory tests, doctors cannot tell the two illnesses apart. Both last for days and rarely lead to death or serious illness. At best, vaccines might be effective against only influenza A and B, which represent about 10% of all circulating viruses. Each year, the World Health Organization recommends which viral strains should be included in vaccinations for the forthcoming season.
The researchers assessed all relevant trials which compared those who had been vaccinated with controls which had not been vaccinated. It was found that under ideal conditions in which the vaccine was totally matched to the virus causing the flu 33 healthy adults need to be vaccinated to avoid one set of influenza symptoms. In average conditions (partially matching vaccine) 100 people need to be vaccinated to avoid one set of influenza symptoms. Vaccine use did not affect the number of people hospitalised or working days lost but caused one case of Guillian-Barré syndrome (a major neurological condition leading to paralysis) for every one million vaccinations. Fifteen of the 36 trials were funded by vaccine companies and four had no funding declaration. It was suggested that the results may be an optimistic estimate because company-sponsored influenza vaccines trials tend to produce results favorable to their products and some of the evidence comes from trials carried out in ideal viral circulation and matching conditions and because the harms evidence base is limited.
With respect to aerosol vaccines which the NHS will be using for children the Cochrane report concluded that:
“It is not possible to give a definite indication on the practical use of live aerosol vaccines, because the assessment of their effectiveness is based on a limited number of studies presenting conflicting results. The effectiveness, according to WHO criteria, appears relatively low. Results regarding inactivated aerosol vaccine are based on the analysis of a few trials reporting only clinical outcomes not directly comparable, owing to non-homogeneous definitions. It does not seem wise to draw conclusions from these data. Rates of complications caused by influenza in these trials were very low and analysis of the few trials which contained this outcome, did not reveal a significant reduction with the influenza vaccine. This result appears to contrast with assertions of policy makers and may be due to the general rarity of complications caused by respiratory infection in healthy adults.”
The authors were particularly concerned that previous versions of the review had been extensively misquoted, especially in public policy documents. Common types of misquotes were the generalisation of evidence from this review to all age and risk groups and the generalisation of estimates of effect to all outcomes (especially complications and deaths). Furthermore it is then assumed that the performance of vaccines is uniform across all age groups and from symptom prevention to all outcomes. A specific example is given in which the Centers for Disease Control in the USA failed to evaluate the quality of the evidence and only quoted anything supported its own policy (4).
Although it is 7 years since a retired physician wrote to the British Medical Journal the points made are just as relevant to-day as they were then. Here is an extract:
“5 years ago I asked my GP what the facts were about the pros and cons of ‘flu vaccination, and I was referred to the propaganda hand outs from the Department of Health. These were long on assertion and short on facts. Perhaps unwisely I embarked on a literature search and running correspondence with various civil service mandarins (including Sir Liam Donaldson) with the limited ambition of getting data on what actual tests-of efficacy and safety- were done on current vaccines and with what results. After much evasive action and stalling I was informed that such information was confidential. The Lancet ……… published my scepticism about the extra ordinary claims being made for the ability of ‘flu vaccine to prevent not only the ‘flu but death as well, whatever the cause. Since then there have been a few papers expressing concern about the inconclusive nature of the evidence for its efficacy ……. On the other hand, there have been repeated exhortations to the public to “protect themselves.” The enormous expense of this futile exercise doesn’t seem to register- partly, I fear, because of payment inducements offered to GPs. They, perhaps, may claim they believed the recommendations of the DH and carried out the vaccination programs in good faith. This “only carrying out orders” excuse is of doubtful validity. There can be no excuse for the harmful public health decisions and refusal to come clean about what precisely were the reasons for them. It is too much to hope for repentance and reversal, however”(5).
There can be little doubt that the justification for the current policy on flu vaccination in the UK or anywhere else simply does not exist. It is probably much more effective to ensure you and your family all have an adequate level of Vitamin D (See Blog 48) rather than accept the advice of the NHS on the flu vaccines. So get out there into the sunshine while it lasts!
- 4. Centers for Disease Control and Prevention (2009) Prevention and control of seasonal influenza with vaccines. Recommendations of the Advisory Committee on Immunization Practices (ACIP). Recommendations and Reports: Morbidity and Mortality Weekly Report 2009;58 (RR-8):2.