More on Vaccines and Hype

October 30th, 2009 by Potato

There is a device that the government has tried to put around the neck of every person in the country. It looks innocuous, but it can cause bruising, interfere with napping, and while it may have been a handy tool in the 60s, there’s insufficient proof that they’re so needed in modern life that the government should be forcing their universal use. On top of that, adjuvant devices have been mandated recently as well, and these can cause really nasty burns, fractures, and other miscellaneous injuries, even if the person wasn’t at serious risk of the thing they were designed to protect against! In fact, they can make things exponentially more hazardous for first responders trying to help you!

Do you want the government forcing these devices into your life? Into the faces of your children?

I am, of course, talking about seatbelts and air bags, something you’d never consider buying a car without. But if you pitch the rhetoric the right way, look at the side effect risks without considering the benefits, and throw in a touch of paranoia about the government, then suddenly you’re not so sure you want those things in your life.

And so it is with vaccines: they’re not perfect, there is a side-effect spectrum. Unfortunately just due to the nature of the beast, any vaccine for the flu strain threatening us with a pandemic, H1N1 this time around, has been rushed to market. If it wasn’t rushed to market, it wouldn’t be specific to the strain that most recently evolved. We’re not going to have perfect information about the safety profile. We’re not going to have perfect information about the effectiveness since, after all, if we waited for that it would be too late for a vaccination program to work. That’s not to say that this is a shot in the dark — we know in general that vaccines are quite effective, and we know that in some large trials the antibodies against H1N1 were successfully produced by the people vaccinated. It’s just that it’s nearly impossible to meet the standard of evidence that some of the people standing up against vaccination are demanding. In this case you should not take the absence of definitive evidence as evidence of an absence of effect.

Fortunately, vaccines really aren’t that different from one another in their general side-effect profile. What will vary will be how many people get the specific illness from the vaccine (i.e.: if any live viruses get through and actually infect people), and how effective the vaccine will be. Which, as I said, probably will never be known until long after the window for vaccinations has ended.

It’s a gritty, uncomfortable situation to have to make potentially life-or-death risk-benefit decisions on such very imperfect information, and not what we generally expect from our doctors. But that’s all we’ve got.

And there is a lot of hype going on about the flu, and the vaccines, and it’s all a little much to take in.

For the H1N1 pandemic fears itself, I think that the coverage is a little over the top, but just a little. This is a fairly nasty strain of flu that kills young, healthy people — not just asthmatics and the elderly like most flu strains. There is something different about this strain than the regular seasonal flu. It’s deadlier and more contagious than is typical. On the other hand, it’s not turning out to be as deadly as it looked from the first cluster in Mexico (it’s not SARS-bad).

Some of the groaning about overhyping comes from the fact that Avian flu (H5N1) was over-hyped so much just a few years ago, but no pandemic came of that! Things are a little different this time around: Avian flu had the potential to cross the species barrier into humans, and was highly contagious… but was mostly contained to birds. Swine flu though is spreading person-to-person, and it’s in Canada (with nearly 100 deaths already). It’s still early and we don’t have a good idea of the total number infected, but the death rate appears to be about 10 times higher than a typical seasonal flu. People are stupid, and forget basic things like handwashing and not coughing on people on the bus, so I figured that a little bit of hype isn’t a bad thing from that perspective.

Hype can be damaging — people have very little patience, so if a pandemic doesn’t materialize in their community soon, they’ll start tuning out the message. On the other side of the spectrum, pandemic hype can lead to people not travelling, not eating out, etc., which can be costly to an economy already on the edge.

I’m not an epidemiologist, but looking at the data that’s out there now and doing a back of the envelope calculation, it looks like we’re on track to have 50,000 deaths in Canada as a result of H1N1 by the end of 2010, unless something changes (such as the vaccination program — all the deaths so far have of course occurred before the vaccines were available). So you tell me, is that potential worth the hype?

Thanks to our near-miss with SARS, hospitals in Ontario are well equipped to handle infectious diseases. Proper respirators are well-stocked, training courses have been given and repeated, and patients are screened for fever as a matter of course. The first few days of the vaccination clinics here have had very large response rates, with people lining up for hours to get the shot early. I believe that thanks to the hype (& vaccines) Canada will probably be looking at around 10,000 deaths by the end of this — about twice as bad as a typical flu season. Some will of course look back and wonder what all the fuss was about, and others will be glad we’re not in the parallel universe that did have to find out the hard way how bad things can get.

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