Flu vaccine ethics

2009-10-27

in Canada, Politics, Science

Electrical meters

An article in today’s Globe and Mail argues that it is selfish for people to refuse the H1N1 flu vaccine, given the risks it creates for other people. The argument is a pretty strong one. The chances of suffering serious side effects from the vaccine are very low, the illness is a serious one, and people who could get vaccinated choosing not to do so does very plausibly cause harm to others.

Firstly, people hospitalized with preventable swine flu will occupy beds and the attention of medical staff, to the detriment of other patients. There is also a chance they will make medical personnel sick. Refusing to get vaccinated also threatens those who are immunosuppressed.

Medical ethics is often a challenging field in which to reach conclusions about what behaviours are admirable, which are dubious, and which should be prohibited. There is often a trade-off between individual autonomy, individual risk and reward, and collective risk and reward. In this case, I think those who choose not to get the vaccine as mis-applying their autonomy. That is on account of a faulty perception about the risks and rewards they face. That said, I am wary of saying that people other than primary care providers should be mandated to take the vaccine. If anything, that might produce a more harmful backlash in the long term. That said, I think it is fair to say that people who choose not to get the vaccine probably aren’t acting very intelligently or empathetically.

[Update: 18 November 2009] I got the vaccine tonight – the first evening when it was available for non-priority groups in Ottawa.

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{ 95 comments… read them below or add one }

. October 27, 2009 at 10:30 am
XUP October 27, 2009 at 11:15 am

If you’re a healthy person, taking the usual precautions against viruses. I’m not sure it’s intelligent to rush out and have an untested vaccine injected into your system. No one has been able to explain link between the 1976 swine flu vaccine and the increased incidence of Guillain-Barré syndrome, for instance. There has also been no evidence that the H1N1 vaccine is going to provide you with any meaningful protection from getting the flu. Ethically, I have a greater responsibility and obligation for the health of my child than I do for the larger community. That’s a little like asking me if I’m driving a car and it careens out of control and I have a choice between running into my child, injuring and perhaps even killing her and running into a large group of strangers, injuring and perhaps even killing some of them, I’m never going to pick running into my child. You’ve downplayed the risks of this vaccine and you may very well be correct, but there is too much information out there to the contrary which makes me uncomfortable about this vaccine.

Milan October 27, 2009 at 11:21 am

This vaccine is made using the same process as the ordinary seasonal flu vaccine, which I think means it is justed as ‘tested’ as the mix of strains they cook up every year.

. October 27, 2009 at 11:22 am

In 1976, vaccination with the swine flu vaccine was associated with getting [Guillain-Barré syndrome]. Several studies have been done to evaluate if other flu vaccines since 1976 were associated with GBS. Only one of the studies showed an association. That study suggested that one person out of 1 million vaccinated persons may be at risk of GBS associated with the vaccine.

. October 27, 2009 at 11:24 am

The H1N1 pandemic flu vaccine is made exactly the same way by the same manufacturers with the same processing, the same materials, as we make seasonal flu vaccine, which has an extraordinarily good safety record,” says Dr. Anthony Fauci, director of the National Institute of Allergies and Infectious Disease. He is more responsible than any other single person for the fast-track development of this new flu vaccine.

The new H1N1 vaccine has gotten more scientific scrutiny than seasonal flu vaccines do, he adds. “We don’t even do those [clinical trials] with the seasonal flu vaccine,” he says. But in this case the tests were needed so scientists and manufacturers could know how big a dose would be necessary to get a protective immune response.

At the same time, Fauci acknowledges that it’s just not possible — with any flu vaccine, and perhaps with any vaccine — to know in advance if it will cause rare side effects, such as the Guillain-Barre paralysis that a different, less purified swine flu vaccine may have touched off in 1976.

(Guillain-Barre syndrome normally strikes 1 person in every 100,000 in the population. The National Institute of Medicine says the 1976 swine flu vaccine was associated with a Guillain-Barre rate of 2 per 100,000.)

If such a rare reaction occurred once in every 100,000 vaccinated people, Fauci says, “you’d have to put millions of people on a clinical trial, and that’s not how clinical trials work.” Nor would there be enough time to do it.

The CDC is planning to watch more closely than ever for serious side effects among those who get the new vaccine, says Dr. Beth Bell of the agency. The CDC will use, among other things, its own Vaccine Adverse Events Reporting System. It will be augmented by surveillance in the military services, the Veterans Affairs system, and a new “real time” monitoring system that involves health plans covering 15 percent of the U.S. population.

. October 27, 2009 at 11:25 am

The first and most important step to prevent the flu is to get vaccinated. Vaccination stimulates an immune response using a killed or weakened virus that uses the body’s own defense mechanisms to prevent infection. CDC’s current recommendations to protect against 2009 H1N1 virus do not include natural remedies as a sole prevention method. If you want to use a natural remedy to reduce symptoms, CDC recommends that you talk to your healthcare provider about options.

. October 27, 2009 at 11:26 am

Indeed, there’s nothing more universal than fear of shots. “I just think there are people wired that way,” says Gregory Poland of the Mayo Clinic. “They operate on the basis of emotion and anecdote—what they read at the University of Google—rather than a fact-based or data-driven point of view.” In the 19th century, people thought the cowpox vaccine would cause pieces of cow to grow out of their arms. Canadian medical giant William Osler was widely mocked when he urged British troops at the beginning of World War I to get inoculated against typhoid fever. The French government stopped offering vaccinations for hepatitis B in schools in 1998 while it investigated the relationship between shots and multiple sclerosis. (Subsequent studies found no causation.)

Milan October 27, 2009 at 11:29 am

There has also been no evidence that the H1N1 vaccine is going to provide you with any meaningful protection from getting the flu.

Early Data Show H1N1 Vaccine Is Highly Effective

“A team of researchers led by Ira Longini, a biostatistician at Fred Hutchinson Cancer Research Center, used data from earlier H1N1 outbreaks this year in the U.S. and Mexico to model how the pandemic is likely to unfold this fall. The team found that by first vaccinating children, then adults, until 70% of the U.S. population is covered, officials would be able to all but stop the pandemic.”

That’s a little like asking me if I’m driving a car and it careens out of control and I have a choice between running into my child, injuring and perhaps even killing her and running into a large group of strangers, injuring and perhaps even killing some of them, I’m never going to pick running into my child.

It is better for your child and for everyone else if your child gets vaccinated. The risks associated with the vaccine are less than those associated with the illness, and the risks to society from unvaccinated people are non-trivial.

. October 27, 2009 at 11:41 am

General Questions and Answers on 2009 H1N1 Influenza Vaccine Safety

Will the 2009 H1N1 influenza vaccines be safe?

We expect the 2009 H1N1 influenza vaccine to have a similar safety profile as seasonal flu vaccines, which have a very good safety track record. Over the years, hundreds of millions of Americans have received seasonal flu vaccines. The most common side effects following flu vaccinations are mild, such as soreness, redness, tenderness or swelling where the shot was given.

Will the benefits of the 2009 H1N1 influenza vaccines outweigh the risks? Is this something I should talk to my healthcare provider about?

Currently the 2009 H1N1 influenza virus (sometimes called “swine flu”) seems to be causing serious health outcomes for:

1. healthy young people from birth through age 24;
2. pregnant women; and
3. adults 25 to 64 who have underlying medical conditions.

Seasonal influenza vaccines are highly effective in preventing influenza disease. The expectation is that a vaccine against 2009 H1N1 influenza would probably work in a similar fashion to the seasonal influenza vaccines. CDC and FDA believe that the benefits of vaccination with the 2009 H1N1 influenza vaccine will far outweigh the risks.

Vaccination is the best way to prevent influenza infection and its complications. This is the reason that CDC, national health organizations, and healthcare providers intensively promote vaccination for seasonal influenza, and the reason why so much work is being done to have a vaccine available in the fall for the 2009 H1N1 influenza virus.

Will there be a possibility of Guillain-Barré Syndrome (GBS) cases following the 2009 H1N1 vaccine?

In 1976, there was a small risk of GBS following influenza (swine flu) vaccination (approximately 1 additional case per 100,000 people who received the swine flu vaccine). That number of GBS cases was slightly higher than what is normally seen in the population, whether or not people were vaccinated. Since then, numerous studies have been done to evaluate if other flu vaccines were associated with GBS. In most studies, no association was found, but two studies suggested that approximately 1 additional person out of 1 million vaccinated people may be at risk for GBS associated with the seasonal influenza vaccine. FDA and CDC will be closely monitoring reports of serious problems following the 2009 H1N1 influenza vaccines, including GBS.

. October 27, 2009 at 11:43 am

“According to Jan Medlock of Clemson University in South Carolina, and Alison Galvani of Yale, however, vaccinating those most at risk of bad effects is not the right way to deal with the disease.

,,,

They argue that it would be better to concentrate on vaccinating those most likely to spread the virus—both schoolchildren and people between the ages of 30 and 40, who are likely to be the parents of those children, and who are, at the moment, at the bottom of the vaccination priority list.

Yet no matter which outcome was looked at, nor which pattern of epidemic was chosen, the result was the same. The best approach to influenza is to vaccinate young people and their parents, not infants and the elderly. Moreover, it is a cheaper and more efficient option.”

alena October 27, 2009 at 12:05 pm

I agree that taking the vaccine is probably the wisest thing to do. Many people who work in the school system have already been exposed to the virus and they were not able to get the shot before school started. Two of my students are currently ill with the H1N1 virus; one quite seriously. I spent much time with him and a week later, I am still alright. I am hoping that by exposure, I will develop an immunity. Only time will tell.

Milan October 27, 2009 at 12:11 pm

Getting the vaccine would be a safer way of developing immunity.

I am planning to do so as soon as the Ottawa clinics are done dealing with high risk individuals.

. October 27, 2009 at 12:21 pm

Backgrounder: Vaccine Myths

The most effective way to protect yourself and your loved ones from flu viruses, including the H1N1 flu virus, is to get immunized.

It is important to know what is myth and what is fact. The following are among the more common myths surrounding flu vaccines, including both the seasonal and the H1N1 flu vaccines.

Myth 1: Vaccines don’t work.

Myth 2: There are many serious side effects from vaccines.

Myth 3: Because the H1N1 flu vaccine is new, it is untested and unsafe.

Myth 4: Taking the regular flu shot puts me at risk of becoming very ill with H1N1

Myth 5: The influenza vaccine can give you influenza.

XUP October 27, 2009 at 1:18 pm

First of all, “Just Some News” I have read all these cut-and-pastes you’ve bombarded me with. I’ve also read a lot of stuff that doesn’t come from the official vaccine PR sources. And I’m sorry if I’m suspicious of something that seems to require such hysteria and scare tactics to persuade. Whenever someone tries to bully me into consuming pharmaceuticals I really want to know why. Why do I so desperately need these and why are you so desperate to force me to have them? While I’m sure our pharmaceutical companies and our government have only our best interests at heart and would never encourage the populace in something that might harm them down the road, I’m just don’t know enough to buy into this unequivocally. I wouldn’t dream of stopping anyone else of getting the vaccine and I’m willing to do whatever else is necessary to ensure I don’t get or pass on a virus. But, like a lot of the other new vaccines that have been flooding the market in the last 20 years, I’m not convinced this one is necessary.

. October 27, 2009 at 1:35 pm
Milan October 27, 2009 at 1:41 pm

I’ve also read a lot of stuff that doesn’t come from the official vaccine PR sources.

The CDC and World Health Organization are about as credible as they come. Canada’s public health agency also says that it is a myth that vaccines are not proven to be effective, and that they have serious side effects – both things you initially claimed.

Whenever someone tries to bully me into consuming pharmaceuticals I really want to know why.

The original article is pretty clear: they want to avoid people getting sick and gumming up the health system. Also, there are immunocompromised people and others who cannot take the vaccine who are endangered by those who choose not to.

There are lots of conspiracy theories about pharmaceutical companies, but I don’t think the idea that they have a nefarious plot to push ineffective vaccines is credible. If anything, it is the anti-vaccine movement that is causing harm, as herd immunity is lost and people start dying of measles and diptheria again.

Milan October 27, 2009 at 1:45 pm

Oddly enough, the case for vaccines is well made in an open letter to Oprah:

We have come close to eradicating life-threatening and crippling illnesses because of vaccines, but are now struggling to prevent outbreaks because of parents’ philosophical beliefs that vaccines are harmful. Realize this: when someone chooses not to vaccinate their child, they aren’t just putting their own child at risk, they are putting everyone else around them at risk. Diseases with vaccines should normally be of little concern even to unprotected individuals due to herd immunity – with the majority of the population immune, unprotected individuals are less likely to come into contact with the pathogen. Unfortunately, herd immunity disintegrates as fewer people are vaccinated, putting everyone who hasn’t yet been vaccinated at greater risk for infection. Now, the rates of infection by diseases for which we have safe and effective vaccines are climbing, thanks to anti-vaccination activists like Jenny McCarthy.

The fact that human health outcomes are being worsened because people are finding untrustworthy information credible (and simultaneously doubting credible sources) is rather sad.

Sarah October 27, 2009 at 3:28 pm

Speaking as one of the people classified as at high risk, I have to say that I resent the healthy people who refuse vaccinations based on irrational fears that are are peddled by quacks and conspiracy theorists. I will be getting the vaccine, just as I usually get a seasonal flu shot, but the vaccine is not 100% effective, so it is much safer for those at high risk – and as Milan says, for everybody else – if there is herd immunity. I understand the concerns that people raise about big corporations trying to push unnecessary products – pharmaceutical companies are no different to any other corporation in this respect, even those that brand themselves as green or independent – but it is bizarre to use that as an excuse to dismiss all scientific evidence, regardless of the source and the degree of scrutiny that has been applied.

Milan October 27, 2009 at 4:15 pm

Also, vaccines are not historically money-makers for drug companies.

Indeed, the whole reason why there has been consideration of creating prizes for vaccines for new illnesses is to try to create more motivation.

If you really do see drug companies are 100% profit motivated with no ethical qualms whatsoever, you would expect them to want to sell treatments (especially for chronic conditions) rather than one-off vaccines. Vaccines that prevented chronic diseases would be the last thing they would want to see invented.

oleh October 28, 2009 at 1:19 am

Milan, thanks for providing me with this information which encourages me to get the vaccine at the earliest opportunity for my own selfish reasons but also for the greater good. After all, I drive a car on the right side of the road, as opposed to the left, for my own selfish and also the collective good.

Peach F. October 28, 2009 at 8:43 am

It will be interesting to see if this parallels the refusals of the pertussis vaccine and the subsequent outbreaks of whooping cough. That particular vaccine *does* have serious, if very rare, risks–hence the refusals–but so does the disease.

Peach F. October 28, 2009 at 8:43 am

“Pertussis is most dangerous for infants younger than 6 months, too young to be vaccinated. They usually contract the infection from caretakers whose immunity has waned.”

This would seem to be in line with what you’re saying about swine flu. In that particular case, the health care worker had allegedly been immunized, but that does not diminish the risk presented by unimmunized and subsequently infected workers…. Read more

All that having been said, my little Shirley Temple is running a fever of 38.4C (101F) and I have no idea why. I am concerned, and I am grateful that I have the capability to be home with her.

Rachel E. October 28, 2009 at 8:45 am

I read all the comments on your blog, but I’m replying here… if someone thinks that I should get vaccinated against H1N1, does that not also mean that they believe I should get the seasonal flu shot every year, seeing as the seasonal flu also kills many people with compromised immune systems? Vaccinating the entire country every single fall for the seasonal flu would be quite an undertaking and the general population would never go along with it.

Milan October 28, 2009 at 8:46 am

Rachel,

One difference that may be important is that it seems like vaccination has the prospect of stopping H1N1 in its tracks, if widely deployed.

That being said, perhaps you could argue that it is also selfish for people to avoid getting the seasonal flu vaccine yearly.

Tristan October 28, 2009 at 11:11 am

“I should get the seasonal flu shot every year, seeing as the seasonal flu also kills many people with compromised immune systems?”

What I’ve heard over and over again, is that H1N1 kills people who do not have compromised immune systems. So, I think one would be justified in getting this vaccine even if one does not get the normal flue shot.

Tristan October 28, 2009 at 11:14 am

“perhaps you could argue that it is also selfish for people to avoid getting the seasonal flu vaccine yearly.”

There are two lines of argument here. Either yes, it is selfish, because if everyone got the normal flu vaccine yearly less people would catch it, less deaths, less productivity loss. Or no, because not enough is produced to have not-at-risk people getting the vaccine. But, I don’t think the “no” is very serious both because your actions don’t make everyone else do what you’ve done, and because if everyone did start getting the seasonal flue vaccine, production could probably be ramped up.

Milan October 28, 2009 at 11:21 am

Production could certainly be ramped up.

Flu vaccines are made using chicken eggs as primary cells. Expanding production would just be a matter of more eggs and vessels, generating more antigen. After that, adjuvant, stabilizers, and preservatives are sometimes added.

. October 28, 2009 at 11:29 am

Internet Probably Couldn’t Handle a Flu Pandemic

Several readers including mikael and gclef noted a report from the General Accountability Office suggesting that it should be Homeland Security’s job to make sure the nation’s business can flow during a pandemic. In particular, if H1N1 sends workers and schoolchildren home in large numbers, GAO thinks it might be a good idea for ISPs to prioritize traffic (favoring commerce over games, say), to reduce network speeds, and possibly to shut down high-traffic Web sites. DHS retorts that not only isn’t it their job to control the Internet in this way, but the GAO is naive to believe it’s even possible: “An expectation of unlimited Internet access during a pandemic is not realistic.

Milan October 28, 2009 at 11:45 am

The city of Ottawa has a website which includes wait times at flu vaccine clinics.

They are still restricted to ‘priority’ populations:
* People 6 months old to 65-years-old with chronic medical conditions
* Healthy children between 6 months and five years of age
* Health care workers
* Household contacts and care providers of infants younger than six months and people with compromised immune systems
* Pregnant women

You can speed things up a bit by bringing a completed consent form with you.

Sarah October 28, 2009 at 12:58 pm

Part of the difference with seasonal flu vaccines is that they’re just guessing which strains will be dominant each year, so the vaccine is less effective insofar as the guesses can be wrong (e.g. they might vaccinate for 3 strains, but the strain which makes the largest number of people in your area ill might be something else). Nobody expects to eradicate seasonal flu, so it’s just a matter of trying to prevent the most vulnerable people becoming ill each year, whereas as Milan says we might be able to more or less stop the transmission of H1N1 as a strain. Another difference is that H1N1 seems to be more liable than seasonal flu to produce serious respiratory infections like pneumonia (which can be fatal and requires substantial healthcare resources to treat).

Anon October 28, 2009 at 2:01 pm

this is an issue that will take a lot of consideration for me, because i have an immune system disorder AND a history of sensitivity to both eggs and surface needles. working as a music teacher, i invite coughing children into my home, so on the surface it makes sense that i get the vaccine. BUT because of my multiple sclerosis and sensitivities… Read more / wacky immune system, the chances of me having a very adverse reaction to the shot are high. should or shouldn’t i?

in the meantime, i do think that children, teachers, health care professionals, and front line public workers without immune system disorders should get the shot, i was convinced by the globe and mail article that to not do it is selfish… if you had the choice of not killing yourself or someone else, even if that chance was remote, wouldn’t you take it?

. October 28, 2009 at 2:18 pm

Why I’m getting the H1N1 vaccine

Once the city gives the okay for the general population to get the H1N1 vaccine, I’ll be lining up to get the shot. I’ve done lots of reading up on it and for me the benefits of getting vaccinated greatly outweigh the infinitesimal risk. Here’s why I’m getting vaccinated:

I’m a woman in my 30s and H1N1 is disproportionately affecting young women. Of the people admitted to a Canadian intensive care unit between April and August, the mean age was 32. 17% of them died and almost two-thirds of those who died were female.

R.K. October 28, 2009 at 3:48 pm

While it is sensible to get the vaccine, people are making too much of a fuss about H1N1. This year really isn’t so different from an ordinary flu season.

R.K. October 28, 2009 at 3:50 pm

The Abstract Random post linked above does make a good point about hospital bed availability:

“There are only 110 intensive care beds in Eastern Ontario and intensive care wards routinely run at or near capacity. In the past two months over a quarter (27%) of the people in Ottawa who have caught H1N1 have ended up in the hospital. If that trend continues, there will be bed and equipment and staff shortages in no time and the consequences will be tragic. ”

The biggest danger associated with H1N1 might not be dying from it yourself, but rather hurting someone else’s chances of recovering from something deadly, by overwhelming the medical system.

. October 28, 2009 at 5:11 pm

Fighting Flu and Falsehoods

To combat both H1N1 and the lies and misperceptions about the disease, the government is going on an unprecedented multimedia information campaign.

Sarah October 29, 2009 at 3:55 am

I got my H1N1 and season flu shots today at a public clinic in Vancouver, which had a sizeable lineup but was well organized. They were conscientious in asking people about their relevant medical history, allergies and any reactions previous flu shots, and in informing us about the (very small) potential risks.

. October 29, 2009 at 10:01 am

Ottawa schoolchildren can get H1N1 shot
7,500 Ottawa residents vaccinated Wednesday
Last Updated: Thursday, October 29, 2009 | 9:45 AM ET

Healthy school-age children who show up at Ottawa’s swine flu vaccine clinics will not be turned away even though they are not on the city’s original list of priority groups.

Dr. Isra Levy, Ottawa’s medical officer of health, told reporters on Wednesday afternoon that medical officials think the decision not to include healthy children over the age of five in the first round of vaccinations is a “sound one.”

“But we do understand and recognize the interest of our parents in our community and I can confirm that we will not refuse any school-age child who wants the vaccine,” Levy said.

Levy urged parents of children between the ages of six and 18 years to voluntarily let members of priority groups — including children between six months and five years old and people under 65 with chronic medical conditions — go to the front of the clinic lines, which were still three hours long on Wednesday.

. October 29, 2009 at 11:22 am

Flu-shot skeptics weave a Web of lies

Don’t believe everything you read online – especially when it tells you the swine-flu vaccine will paralyze you, can ‘facilitate mind control at a distance’ or just isn’t worth taking

. October 29, 2009 at 5:27 pm

An Epidemic of Fear: How Panicked Parents Skipping Shots Endangers Us All

To hear his enemies talk, you might think Paul Offit is the most hated man in America. A pediatrician in Philadelphia, he is the coinventor of a rotavirus vaccine that could save tens of thousands of lives every year. Yet environmental activist Robert F. Kennedy Jr. slams Offit as a “biostitute” who whores for the pharmaceutical industry. Actor Jim Carrey calls him a profiteer and distills the doctor’s attitude toward childhood vaccination down to this chilling mantra: “Grab ‘em and stab ‘em.” Recently, Carrey and his girlfriend, Jenny McCarthy, went on CNN’s Larry King Live and singled out Offit’s vaccine, RotaTeq, as one of many unnecessary vaccines, all administered, they said, for just one reason: “Greed.”

Thousands of people revile Offit publicly at rallies, on Web sites, and in books. Type pauloffit.com into your browser and you’ll find not Offit’s official site but an anti-Offit screed “dedicated to exposing the truth about the vaccine industry’s most well-paid spokesperson.” Go to Wikipedia to read his bio and, as often as not, someone will have tampered with the page. The section on Offit’s education was once altered to say that he’d studied on a pig farm in Toad Suck, Arkansas. (He’s a graduate of Tufts University and the University of Maryland School of Medicine).

Then there are the threats. Offit once got an email from a Seattle man that read, “I will hang you by your neck until you are dead!” Other bracing messages include “You have blood on your hands” and “Your day of reckoning will come.” A few years ago, a man on the phone ominously told Offit he knew where the doctor’s two children went to school. At a meeting of the Centers for Disease Control and Prevention, an anti-vaccine protester emerged from a crowd of people holding signs that featured Offit’s face emblazoned with the word terrorist and grabbed the unsuspecting, 6-foot-tall physician by the jacket.

“An Epidemic of Fear.” Wired takes on the anti-vax movement

. October 30, 2009 at 10:46 am

Key Flu Indicators
October 23, 2009, 11:30

* Visits to doctors for influenza-like illness (ILI) increased steeply since last week in the United States, and overall, are much higher than what is expected for this time of the year. ILI activity now is higher than what is seen during the peak of many regular flu seasons.

* Total influenza hospitalization rates for laboratory-confirmed flu are climbing and are higher than expected for this time of year.

* The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report has increased and has been higher than what is expected at this time of year for two weeks. In addition, 11 flu-related pediatric deaths were reported this week; 9 of these deaths were confirmed 2009 H1N1, and two were influenza A viruses, but were not subtyped. Since April 2009, CDC has received reports of 95 laboratory-confirmed pediatric 2009 H1N1 deaths and another 7 pediatric deaths that were laboratory confirmed as influenza, but where the flu virus subtype was not determined.

* Almost all of the influenza viruses identified so far are 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception.

Milan October 30, 2009 at 10:47 am

All that seems like good reason to get the vaccine. H1N1 is the dominant flu elsewhere, and the seriousness of the pandemic seems to be greater than that of ordinary seasonal flu.

. October 30, 2009 at 11:48 am

Authorization of the H1N1 flu vaccine is the result of an extensive review process. Public health officials and experts have reviewed the best available science, information and evidence on the H1N1 virus and vaccines from Canada and from around the world.

The Government’s decision to proceed with H1N1 immunization and its choices on who to target, when and with what vaccine, reflect:

* guidance from the World Health Organization;
* an assessment of international practices;
* an exhaustive review of available vaccine safety and clinical trials data;
* input from a network of some 135 Canadian non-governmental organizations and a consultation with Canadians; and
* counsel by a number of expert advisory groups, including the expert Federal, Provincial and Territorial Pandemic Vaccine Task Group.

Canada’s thirteen provincial and territorial Chief Medical Officers of Health have also been involved in shaping the decision to approve the vaccine and support its direction.

. October 30, 2009 at 3:32 pm

Ontario to suspend rollout of H1N1 vaccine

Due to shortage, only those at higher risk of developing complications will be able to get immunized next week

. October 30, 2009 at 3:45 pm

Adjuvant worries dispelled by MDs

Ruth MacNeur, left, 44, a consultant with Mount Sinai Hospital receives her H1N1 flu vaccine by occupational health nurse Darlene Roland, right, on Monday, Oct. 26, 2009 in Toronto. Nathan Denette/The Canadian Press

Amid confusion over the safety of adjuvants, the Canadian Paediatric Society has restated that vaccines with the immune-boosting substance don’t pose any risks

Edward October 31, 2009 at 2:31 pm

I liked your article, Milan, because I think it is important to dispel some of the myths out there, but I think it is going a little too far to say that the principle of patient autonomy is being misapplied if we allow people to choose not to receive the H1N1 vaccine. I’ve gotten the vaccine already (as a healthcare worker), so obviously I don’t believe the misinformation out there about it being unsafe or anything like that. But while I think that people should be encouraged to get the vaccine, I don’t think that they should be forced to do so (or be labelled as selfish if they don’t). Yes, you are correct that there are probably going to be more cases of H1N1 if people don’t get vaccinated – that’s why authorities are urging people to get it. But good behaviours should be encouraged rather than forced in a free society (as opposed to decidedly bad behaviours). Eating three meals a day with lots of leafy greens is good for you and good for the health care system because you’re less likely to get sick, but it isn’t necessarily selfish not to do so. In something as private as one’s personal health and well-being, people should have a right to make up their own minds – even if it isn’t based on the best medical evidence out there.

R.K. October 31, 2009 at 4:55 pm

Forcing people to get vaccinated is impractical, and would probably contribute to the growing strength of the rising ‘anti-vax’ movement.

At the same time, I think it is perfectly fair to say that people who refuse to get the vaccine are often being irrational and selfish.

Tris November 1, 2009 at 4:36 am

I think not eating healthy is selfish – you are setting yourself to overconsume healthcare resources. I think it’s morally suspect to eat junk food, smoke, not be active ect…

Of course, we are permitted to and actually value being selfish. For instance, I have more than enough wealth and yet others have far less than enough.

alena November 1, 2009 at 1:33 pm

Many people do not eat healthy food because they cannot afford it or they do not have the proper knowledge from their family or other care providers. You also cannot blame people solely for poor eating habits when the food industry has directly contributed to polluting the food that we eat. Take a look at the people at Whole Foods and you will see who can afford upscale and perhaps a more healthy goods.

Tristan November 1, 2009 at 9:13 pm

“You also cannot blame people solely for poor eating habits when the food industry has directly contributed to polluting the food that we eat.”

On the one hand, there is a duty to learn – it’s true that the food industry has been able to lobby states into telling their populations that meat and dairy are essential parts of a healthy diet, when in fact they are superfluous. It is not ethical to wait for the corperations to be honest about what we should eat (this would eliminate soft drinks for one, which are hugely profitable). On the other hand, I said that “we are permitted to and actually value being selfish” – and this includes me. I also value acting selfishly, immorally – live without any kind of disregard for others would probably not be worth living. This is just obvious – a total concern for the needs of others would mean an elimination not only of strong property rights, but even of ties we have to objects by convention – I would need to give up any thing I have to another if it would benefit them more than I. This is of course, absurd – a certain amount of disregard for the needs of others is required to have a society of individuals.

. November 1, 2009 at 11:03 pm

Is the fear about the H1N1 vaccine unreasonable?

Yes – 74% – 9451 votes
No – 26% – 3274 votes

oleh November 2, 2009 at 3:05 am

I understand there is such a strong medical concensus in favour of widespread vaccination for H1N1. It will be an interesting exercise in public health education to see what percentage of the Canadian population does not get it and why. I have certainly heard much more discussion about it than taking the regular flu shot. I also take the regular flu shot as it is conveniently provided at my place of work . I take it because it is convenient and presumably reduces (but not eliminating) the risk of contracting the flu.

I would be pleased if the widespread vaccination of H1N1 this year led to increased vaccination for seasonal flu in the future. Being sick is no fun, hampers productivity and burdens family, friends and co-workers.

. November 3, 2009 at 11:25 am

Going forward, the first step is to re-educate the public about which flu to be concerned about before more people die or are hospitalized unnecessarily. More than 20,000 have been hospitalized so far from H1N1, with close to 4,000 unconfirmed deaths. We must realize that the seasonal flu vaccine is currently useless or, worse, a diversion in the way of getting the H1N1 vaccine. When a 40-year-old asthmatic smoker came to me for the yearly flu shot this week as a result of seeing ads for it, he was upset to find out that I had run out of it. It was hard for me to convince him that he was lucky—I had just received the H1N1 shot. He was worried about its safety, despite my assurances that it was made the same way as all flu shots.

R.K. November 3, 2009 at 12:33 pm

The broader problem here seems to be that people cannot identify which information is credible.

In that, they aren’t helped by a media that is always happy to pitch someone convincing sounding – but with bad information – against those who have good information.

. November 3, 2009 at 5:39 pm

City to open six flu-treatment centres
The Ottawa CitizenNovember 3, 2009 4:30 PM

OTTAWA — Starting Wednesday, Ottawans suffering flu-like symptoms who can’t see doctors of their own will be able to be treated at special clinics run by the public-health department, Dr. Isra Levy said Tuesday afternoon.

The health unit is opening dedicated treatment centres at six community-health centres, aimed at taking some of the load off Ottawa’s emergency rooms. The Children’s Hospital of Eastern Ontario and the Queensway Carleton Hospital have had to divert staff and convert space to increase their ERs’ capacity in the past week, heavily burdened by people who fear they have H1N1 influenza.

Tris November 4, 2009 at 11:15 am

Robert Kennedy Junior seems pretty worried about Vaccines. It’s worth pointing out that the vaccines he’s critical of are almost all vaccines that we – as people born before 1989, never got.

http://www.youtube.com/watch?v=UQG5Q4GWw2o&feature=related
http://www.youtube.com/watch?v=DjPox5xBOLI&NR=1
http://content.nejm.org/cgi/content/full/357/13/1278
http://en.wikipedia.org/wiki/Robert_F._Kennedy,_Jr.

His allegations of agency cover-ups and the production of bogus studies to dismiss inconvenient ones are not immediately dismissable. However, what he implies about the Amish is:

http://whale.to/vaccine/olmsted.html
http://autism.about.com/b/2008/04/23/do-the-amish-vaccinate-indeed-they-do-and-their-autism-rates-may-be-lower.htm

http://whale.to/vaccine/olmsted.html

Milan November 4, 2009 at 11:57 am

Can we please, please not go down the road of examining the views various celebrities hold on the safety and efficacy of vaccines? The last thing I want to spend my time doing is responding to idiots like Jenny McCarthy and Tom Cruise.

It pains me to see a heap of links to dubious information being posted on a site that tries to provide people with access to reputable sources.

If you insist on discussing the matter, the thread on MMR vaccines and autism is more related to vaccines in general, as opposed to the H1N1 vaccine specifically.

Milan November 4, 2009 at 12:02 pm

If we must mention celebrities, the aforementioned open letter to Oprah is a good example of someone pleading with celebrities to not use their popularity to confuse and mislead the public.

. November 6, 2009 at 2:21 pm

Take, for example, the turn toward unproven “alternative” medical remedies or the closely related retreat from vaccination, both of which you discuss at chapter-length. Yes, the folks who follow these fads aren’t listening to accurate science; often, they are in utter denial about it. And yes, they are wasting their money, possibly placing themselves at risk, and, in the case of vaccination skeptics, posing a threat to all of us. Yet I can’t help wondering if deep down, the real source of this irrational behavior lies not in public ignorance but rather in an understandable reaction against the problems with our health care system and the documented abuses and profiteering of some pharmaceutical companies.

Your thoughtful and nuanced exposition does not neglect these underlying factors. But I wonder whether their existence might point to something more radical. Perhaps the cure for denialism is not a greater infusion of scientific thinking or rationality but rather a solution to the underlying issues that drive people toward homeopathic placebos or worse. Would people flee so readily into the arms of Andrew Weil if they had more time with caring doctors whose services they could actually afford and if they didn’t hear so many horror stories about medical errors committed at hospitals?”

. November 6, 2009 at 5:50 pm

H1N1 is now world’s dominant flu virus, World Health Organization says

(CNN) — The H1N1 virus has now become the dominant influenza virus around the globe, with high levels and an increase of activity in many regions, the World Health Organization said Thursday.

In a weekly update, the WHO’s point person on the H1N1 virus, Dr. Keiji Fukuda, also warned the public not to treat the virus like just another flu.

Like seasonal flu, H1N1 is more active in the winter than in the summer, and a majority of infected people get better on their own, Fukuda said. H1N1 also is as transmissible and infectious as seasonal flu, he said.

oleh November 7, 2009 at 2:09 am

Is there still a debate about the efficacy of having the vaccine over not doing so? it seems to me that the public debate, with the concensus of public health authorities advocating the vaccine , that the debate is largely stilled.

oleh November 11, 2009 at 3:53 pm

As deaths from H1N1 are now mounting (8 in British Columbia in the last week), I have heard no more a debate as to whether or not to take the vaccine.

I am also comforted by the relative absence of rancour or individualism as the supply of vaccine is not as was ordered. It seems the public is still quite accepting that we should provide the vaccine to those who are most vulnerable and adopt an orderly approach to its distribution.

. November 12, 2009 at 8:23 am

Swine flu skepticism demands deft response
Thu Nov 12, 2009 7:19am EST

By Kate Kelland – Analysis

LONDON (Reuters) – European scientists and health authorities are facing angry questions about why H1N1 flu has not caused death and destruction on the scale first feared, and they need to respond deftly to ensure public support.

Accusations are flying in British and French media that the pandemic has been “hyped” by medical researchers to further their own cause, boost research grants and line the pockets of drug companies.

Britain’s Independent newspaper this week asked “Pandemic? What Pandemic?.”

In their response, scientists are walking a fine line.

They say that although the virus is mild, it can still kill, and that the relatively low fatalities in Europe are in part the result of official response to their advice.

On suggestions of “hyping” the threat to boost research funding, they point out that while we know enough to start to protect the vulnerable, we need to know a lot more to conquer the virus, and funding for new research and drugs is vital to be equipped for future pandemics.

. November 12, 2009 at 9:32 am

November 12th, 2009

At this time, Ottawa Public Health is providing the vaccine to the following high priority groups

As of the end of day on Thursday, November 12, all vaccination clinics will be temporarily closed until further notice due to an inadequate supply of the H1N1 vaccine.

. November 12, 2009 at 10:06 am

Finding flu vaccine information in one easy place
By Jamie Yood

This year, it’s especially important to have clear information on what you can do to prepare for the flu season. With this in mind, we are happy to share a new feature for the U.S. which allows you to more easily find locations near you for getting both the seasonal and H1N1 flu vaccine. After expandingGoogle Flu Trends to a total of 20 countries and 38 languages, allowing more people to see near real-time estimates of flu activity, we began brainstorming with the U.S. Department for Health and Human Services (HHS), their flu.gov collaborators and the American Lung Association on the flu shot finder and other ways Google can be helpful to people this flu season.

You can check out the flu shot finder at http://www.google.com/flushot. The same tool will also be available shortly on http://www.flu.gov and the American Lung Association websites. It’s important to note that this project is just beginning and we have not yet received information about flu shot clinics for many locations. In addition, many locations that are shown are currently out of stock. We launched this service now in order to help disseminate information about locations where vaccines are available, and also to make more vaccine providers aware of the project so that they can contribute.

. November 12, 2009 at 11:07 am

Does the Vaccine Matter?
by Shannon Brownlee and Jeanne Lenzer

Public-health officials consider vaccine their most formidable defense against the pandemic—indeed, against any flu—and on the surface, their faith seems justified. Vaccines developed over the course of the 20th century slashed the death rates of nearly a dozen infectious diseases, such as smallpox and polio, and vaccination became one of medicine’s most potent weapons. Influenza virus was first identified in the 1930s, and by the mid-1940s, researchers had produced a vaccine that was given to soldiers in World WarII. The U.S. government got serious about promoting flu vaccine after the 1957 flu pandemic brought home influenza’s continuing potential to cause widespread illness and death. Today, flu vaccine is a staple of public-health policy; in a normal year, some 100 million Americans get vaccinated.

But while vaccines for, say, whooping cough and polio clearly and dramatically reduced death rates from those diseases, the impact of flu vaccine has been harder to determine. Flu comes and goes with the seasons, and often it does not kill people directly, but rather contributes to death by making the body more susceptible to secondary infections like pneumonia or bronchitis. For this reason, researchers studying the impact of flu vaccination typically look at deaths from all causes during flu season, and compare the vaccinated and unvaccinated populations.

Such comparisons have shown a dramatic difference in mortality between these two groups: study after study has found that people who get a flu shot in the fall are about half as likely to die that winter—from any cause—as people who do not. Get your flu shot each year, the literature suggests, and you will dramatically reduce your chance of dying during flu season.

Yet in the view of several vaccine skeptics, this claim is suspicious on its face. Influenza causes only a small minority of all deaths in the U.S., even among senior citizens, and even after adding in the deaths to which flu might have contributed indirectly. When researchers from the National Institute of Allergy and Infectious Diseases included all deaths from illnesses that flu aggravates, like lung disease or chronic heart failure, they found that flu accounts for, at most, 10 percent of winter deaths among the elderly. So how could flu vaccine possibly reduce total deaths by half? Tom Jefferson, a physician based in Rome and the head of the Vaccines Field at the Cochrane Collaboration, a highly respected international network of researchers who appraise medical evidence, says: “For a vaccine to reduce mortality by 50 percent and up to 90 percent in some studies means it has to prevent deaths not just from influenza, but also from falls, fires, heart disease, strokes, and car accidents. That’s not a vaccine, that’s a miracle.”

The estimate of 50 percent mortality reduction is based on “cohort studies,” which compare death rates in large groups, or cohorts, of people who choose to be vaccinated, against death rates in groups who don’t. But people who choose to be vaccinated may differ in many important respects from people who go unvaccinated—and those differences can influence the chance of death during flu season. Education, lifestyle, income, and many other “confounding” factors can come into play, and as a result, cohort studies are notoriously prone to bias. When researchers crunch the numbers, they typically try to factor out variables that could bias the results, but, as Jefferson remarks, “you can adjust for the confounders you know about, not for the ones you don’t,” and researchers can’t always anticipate what factors are likely to be important to whether a patient dies from flu. There is always the chance that they might miss some critical confounder that renders their results entirely wrong.

. November 12, 2009 at 1:25 pm

WHO updates H1N1 antiviral guidelines

The consensus that emerged from a meeting is that the drugs work and starting them sooner rather than later has an impact in severe cases

Helen Branswell

Toronto — Canadian Press Published on Thursday, Nov. 12, 2009 11:33AM EST Last updated on Thursday, Nov. 12, 2009 11:57AM EST

People at high-risk from H1N1 infection or those who start to progress from normal flu to more severe illness need rapid treatment with antiviral drugs, the World Health Organization said today as it updated its guidelines on how to use the medications.

The revised guidance is based on a WHO meeting last month that brought together doctors who have treated a lot of severe cases. The consensus that emerged: antiviral drugs work and starting them sooner rather than later has an impact on survival.

“We have heard that doctors involved in caring for very sick patients in intensive care units regretted that the patients arrived too late and even the most sophisticated medical procedures could not save their lives,” Dr. Nikki Shindo, an influenza expert with the Geneva-based global health agency, said in a teleconference briefing. “We asked what could have been done differently to avoid the tragic outcomes. All of them answered, without exception, that things may have been very different if they had been treated with an antiviral drug earlier.”

. November 13, 2009 at 7:13 pm

How the Swine Flu Has Spread

Yesterday, I had the opportunity to speak with a couple of engineers from Google who are working on a product known as Google Flu Trends”. This is a very simple, yet elegant and important application of what might be termed predictive analytics; if there were awards given out for such things (the Jameys?), it would be a good candidate to win one.

The product, which launched last year, works by analyzing searches that have correlated strongly in the past with flu statistics as put out by the CDC and other governmental agencies; a fuller write-up of the technology can be found in this article in Nature. The advantage of this is that whereas the CDC typically works on a 10 to 14 day lag before new flu statistics are published, the Flu Trends numbers can be turned around literally overnight. Flu Trends does not predict the future per se, so much as it “predicts the present”, as the engineers describe it.

The other nice thing about the Flu Trends data is that it is all publicly available. Here, for instance, is when the Flu Trends index hit 5,000 in each U.S. State, a level that would correspond to the peak of a fairly bad annual flu outbreak in the January or February.

. November 16, 2009 at 11:24 am

Quebec solves H1N1 vaccination queues with Disneyland Fastpasses

By Cory Doctorow on health

Quebec has streamlined its H1N1 vaccination system by borrowing a trick from Disneyland’s “Fastpass” queueing system. At Disneyland (and other Disney parks), busy rides have Fastpass ATMs at their queue-heads. Would-be riders insert their park-tickets and get a reservation stub in return, advising them to return later in the day in a one hour window (say, 1:15-2:15) (pro tip: Disney doesn’t enforce the “expiry” time, only the “ripening” time, so you can go any time after 1:15, which means that you can collect Fastpasses all morning when the lines are short and use them all afternoon when the lines are long).

. November 16, 2009 at 4:25 pm

Nearly a quarter of Canadians vaccinated against H1N1: chief health officer

WINNIPEG — The Canadian Press Published on Monday, Nov. 16, 2009 12:49PM EST

The country’s chief public health officer says almost one-quarter of Canadians have been immunized against swine flu.

Dr. David Butler-Jones says Canada is leading the world when it comes to the percentage of the population vaccinated.

He says that’s why Canada has had so few deaths and serious cases of the virus so far.

Dr. Butler-Jones also says that despite initial shortages, vaccine shipments are now flowing well.

He says there will be several million doses available this week and plans are to ship another three million doses next week.

. November 17, 2009 at 4:23 pm

Adverse reactions seen in 36 Canadians after H1N1 shot: official

Caroline Alphonso

Globe and Mail Update Published on Tuesday, Nov. 17, 2009 12:51PM EST Last updated on Tuesday, Nov. 17, 2009 2:18PM EST

The country’s chief public health officer says 36 Canadians have suffered serious adverse reactions after getting the H1N1 vaccine.

David Butler-Jones said today that the cases are being investigated to see if they are related to the vaccine. One elderly person has died, but the death hasn’t been conclusively linked to the H1N1 shot.

Dr. Butler-Jones stressed that the serious reactions to the H1N1 shot are much fewer than those caused by the seasonal flu shot. No figures were immediately available on the seasonal flu vaccine. But out of 6.6-million H1N1 doses distributed, there were only 36 reports of serious adverse reactions.

Serious adverse events are reactions that cause life-threatening illness, hospitalizations and deaths.

“Canadians can be assured that to date the frequency of serious reactions is less than 1 per 100,000 doses distributed, which is what we’ve seen with other vaccines,” Dr. Butler-Jones said. “The benefit of immunization, the prevention of serious illness and death far outweigh any theoretical risk associated with being immunized.”

. November 18, 2009 at 1:27 pm

Ontario makes vaccine available to all

General public will be able to get the H1N1 shot by the end of this week, Premier Dalton McGuinty announces

Karen Howlett

Toronto — Globe and Mail Update Published on Wednesday, Nov. 18, 2009 10:50AM EST Last updated on Wednesday, Nov. 18, 2009 10:51AM EST

Ontario will make the H1N1 vaccine available for the general public by the end of this week, Premier Dalton McGuinty announced this morning.

In a tacit acknowledgment that the rollout of the vaccination program got off to a bumpy start, with many residents facing long lineups at public clinics, he thanked Ontarians for being patient and for waiting their turn while those most at risk of developing complications got their flu shots first.

“I also want to thank everybody involved in our public health delivery system,” Mr. McGuinty told reporters. “This presented them with a huge challenge, the biggest vaccination program of its kind anywhere in our history. I think they performed remarkably well under the circumstances.”

Toronto and surrounding regions made the vaccine available to all comers earlier this week. Mr. McGuinty said he hopes to get the flu shot this week.

. November 18, 2009 at 5:58 pm

City offers H1N1 vaccine to general public
Wednesday, 18 November 2009
By Jessica Sims

Ottawa has enough supply to begin releasing the H1N1 vaccine to the general public, according to a press release from Ottawa Public Health today.

Healthy people from 10- to 64-years-old and pregnant women will be offered the unadjuvanted vaccine.

Those with chronic medical conditions and younger children will be given the adjuvanted version, which boosts the immune system’s response to the vaccine.

The supply of the unadjuvanted type is still limited.

Health care workers, pregnant women, people with physical disabilities, and children coming for their second dose are still asked to notify city staff when they arrive at vaccination clinics.

Milan November 18, 2009 at 9:06 pm

I got the vaccine tonight – the first evening when it was available for non-priority groups in Ottawa.

It was all quite efficient. I got a bracelet around 6:30, got the shot around 8:00, and was back home by 8:30.

. November 21, 2009 at 6:53 pm

WHO Says Swine Flu May Have Peaked In the US

“The World Health Organization says that there were ‘early signs of a peak’ in swine flu activity in parts of the Northern Hemisphere, including the US. The American College Health Association, which surveys more than 250 colleges with more than three million students, said new flu cases had dropped 27 percent in the week ending on November 13th from the week before, the first drop since school resumed in the fall. Nonetheless, Dr. Anne Schuchat, the director of vaccination and respiratory disease at the CDC, chose her words carefully. ‘We are in better shape today than we were a couple of weeks ago,’ she says. ‘I wish I knew if we had hit the peak. Even if a peak has occurred, half the people who are going to get sick haven’t gotten sick yet.’ Privately, federal health officials say they fear that if they concede the flu has peaked, Americans will become complacent and lose interest in getting vaccinated, increasing the chances of another wave. However, Dr. Lone Simonsen, a former CDC epidemiologist, says she expects a third wave in December or January, possibly beginning in the South again. Based on death rates in New York City and in Scandinavia, Simonsen argues that both 1918 and 1957 had mild spring waves followed by two stronger waves, one in fall and one in midwinter, adding that in the pandemic of 1889, the bulk of the deaths occurred in the third wave. ‘If people think it’s going away, they can think again.'”

. December 8, 2009 at 3:38 pm

The Long-Term Evidence for Vaccines

Vaccination does more than protect against flu. Study after study shows that keeping children safe from viruses has long-lasting, positive health benefits.

With some reports saying that the worst of the H1N1 outbreak may have already come and gone this flu season in North America but not worldwide, parents who decided to sit out vaccinations for their children may feel validated. But not only is that strategy risky, it’s uninformed, and ignores a larger truth about the benefit of vaccines. Throughout North America and Europe, an anti-vaccination movement has steadily grown over the past two decades, and was recently jet-propelled amid anxiety over immunizing pregnant women and children against the H1N1 “swine flu.” The greatest fall-off in child vaccination, and the strongest proponents of various theoretical dangers associated with vaccines, are all rooted in wealthy, mostly Caucasian communities, located in the rich world. At a time when billions of people living in poorer countries are clamoring for equitable access to life-sparing drugs and vaccines for their families, the college-educated classes of the United States and other rich countries are saying “no thanks,” even accusing their governments of “forcing” them to give “poison” to their children.

Will the children of these naysaying parents of the rich world turn to Mom and Dad 30 years from now and say, “Thanks for not getting me immunized. Thanks especially for saying no to the flu vaccine?”

Probably not.

If a woman is exposed to influenza while pregnant, or if an unvaccinated child gets the flu in his or her first year of life, the baby’s developing brain may be severely damaged by the virus. Analysis of medical records of Americans who were born in the late ’50s and early ’60s shows that having the mother catch the flu while pregnant increased the chance her child would later develop schizophrenia. It’s not a trivial difference: the children of moms who had flu midway during their pregnancies were as much as eight times more likely to become schizophrenic.

. December 8, 2009 at 3:40 pm

“Other vaccine-preventable diseases—measles, rubella, mumps, chickenpox, and whooping cough—can damage the optic nerves and hearing of fetuses and newborns. The effect in these cases is immediate and obvious. In the pre-vaccine era in the United States, a thousand kids lost their hearing every year due to measles infection, five out of every 10,000 children who contracted mumps suffered permanent deafness, and 10 percent of child deafness was due to rubella (a.k.a. German measles).

And today, in countries with spotty child-immunization achievements—including the United Kingdom—viral infection in utero or in infancy accounts for 10 to 25 percent of child deafness.

Influenza in utero or in the first year of a child’s life is a major cause of adult cardiovascular disease—heart attacks and strokes. People who suffered influenza during the Great Pandemic of 1918–19 were 20 percent more likely to develop heart disease as adults. To put that in perspective, having a “bad cholesterol count” of more than 240mg confers a 20 percent elevated risk of heart attacks, according to the American Heart Association.”

. December 18, 2009 at 8:45 pm

The extraordinary power of vaccines

By Elizabeth Payne, The Ottawa Citizen
December 17, 2009

You might be forgiven for thinking the vaccine was a new invention after witnessing the fuss over the pandemic H1N1 immunization campaign this fall.

People agonized over whether or not to get it, consulted friends, neighbours and the Internet, and talked about it endlessly. In the end, close to 47 per cent of Ottawa residents lined up to get jabbed, which is significantly more than get an annual flu shot. Fussing aside, the H1N1 vaccine campaign has been, and continues to be, a success.

That is good. What is better is the campaign might have reminded those of us lucky enough to be able to take vaccines for granted what modern miracles they are. Vaccines have changed the world. And they continue to do so.

Vaccines are so much a part of the way we do things in Canada that most of us give them very little thought once our children are beyond the childhood immunization stage — which might explain the out-of-proportion concerns about the H1N1 vaccine.

The H1N1 vaccine campaign is not over yet, and Chief Public Health Officer Dr. David Butler-Jones is warning Canadians who are not yet immunized not to get complacent. But all our recent focus on this particular vaccine may give Canadians a renewed appreciation for what vaccines have done for us and can do for us in the future. And, more importantly, what they can do for people in parts of the world who don’t have the luxury of being complacent about public health.

Matt January 12, 2010 at 3:34 pm
Milan January 12, 2010 at 3:42 pm

To what extent do you think that judgment can only be made with the benefit of hindsight?

During the period of initial concern about this flu, it seemed like the mortality rate in Mexico was quite high. The question, then, is how precautionary an approach we should take, in the face of a pandemic that could be (but also may not be) serious in terms of its human health impacts?

Matt January 12, 2010 at 4:23 pm

I don’t think with the knowledge available to me that I’m in a position to really know whether or not the seriousness of swine flu was over embellished for the benefit of pharmaceutical companies or not.

If it’s true that bioreactors used to grow cancer cells were also used to manufacture swine flu vaccine, that sounds concerning. The average person does not have the ability to ensure proper quality control of the products they are injecting into their body, and thus the trust they place in the companies making the vaccine must not be violated.

Milan January 14, 2010 at 5:27 pm

Here is one response to the claims that the risk of H1N1 was exaggerated:

WHO official: H1N1 threat not exaggerated

By Rob SteinWashington Post Staff Writer
Thursday, January 14, 2010; 10:25 AM

A top World Health Organization official Thursday dismissed charges that the agency exaggerated the threat posed by the H1N1 virus and that it had been unduly influenced by the pharmaceutical industry to issue dire warnings about the swine flu pandemic.

“The world is going through a real pandemic. The description of it as a fake is both wrong and irresponsible,” Keiji Fukuda, the special adviser to the WHO director-general on pandemic influenza, told reporters during a briefing. “WHO has been balanced and truthful in the information it has provided to the public. It has not underplayed and not overplayed the risk it poses to the public.

“We did take very great care that the advice it received is not unduly influenced.”

Milan January 14, 2010 at 5:28 pm

I agree with Matt that quality control is very important, and not something that individual patients can manage for themselves.

oleh January 15, 2010 at 8:36 am

I attribute the panic as arising from the media. There was the catchy description of “swine flu”. The exotic indication that it started in Mexico, The concern that it would spread.

It is an easy story for the media to carry, sensationalize and spread.

Much harder and sensational than reporting on obesity which cause hundreds of thousands of deaths in Canada per year rather than hundreds.

oleh January 15, 2010 at 8:38 am

Milan,

Congratulations on now exceeding a quarter of a million visitors.

I notice that this discussions has generated 83 comments.

Do you know which of your entries have generated the most comments?

Milan February 1, 2010 at 9:44 am

Regarding H1N1, people may be interested in knowing that 425 people have died from it so far, across Canada.

In addition, between 38% and 45% of Canadians opted to be vaccinated.

Milan February 1, 2010 at 9:45 am

Also, the rate of adverse reactions to the H1N1 vaccine doesn’t seem to be any higher than for the annual seasonal flu vaccines.

. February 12, 2010 at 11:54 am

H1N1 patients were younger and needed more care, study says

Canadians who died of H1N1 were, on average, 30 years younger than those who typically die of seasonal flu, newly-released data show.

Infection with the pandemic strain of influenza also resulted in markedly more cases that required treatment in intensive-care units and resulted in patients requiring mechanical ventilation to breath. But, paradoxically, there were fewer deaths than a run-of-the-mill flu, according to an analysis by the Canadian Institute for Health Information.

“We’ve had good data collection throughout the pandemic and this helps put it into context,” said Kathleen Morris, head of emerging issues at CIHI, said in an interview.

“We hope this information will serve as a springboard for understanding influenza – pandemic and seasonal – and the impact it has,” she said.

The study consists of a comparison of hospitalizations and deaths related to H1N1 in 2009-10 and a seasonal flu in 2007-08.

. April 14, 2010 at 12:16 pm

Incidence of Guillain-Barré Syndrome was low with H1N1 vaccine, researchers report

The Public Health Agency of Canada said there were 26 cases of GBS reported after the H1N1 campaign, which equals about one case for every million doses

Carly Weeks

Globe and Mail Update Published on Tuesday, Apr. 13, 2010 7:33PM EDT Last updated on Tuesday, Apr. 13, 2010 7:55PM EDT

For every 10 million H1N1 vaccinations administered in the U.S. last year, officials received about six reports of people developing Guillain-Barré Syndrome, a rare neurological disorder.

It’s a low number, and one that officials had predicted they would see, considering the fact researchers know the risk of developing the syndrome following vaccination is quite low.

But memories of problems during a 1976 immunization campaign and public anxiety during last year’s H1N1 pandemic stoked fears that mass inoculation using a new vaccine would result in a rash of serious side effects, health problems and even deaths. As a result, public health officials in Canada and around the world have been closely monitoring reports of medical problems or other adverse events associated with those who were vaccinated.

Now that the peak of the pandemic has passed and researchers are looking back at the response, signs indicate many of those public fears were exaggerated, or even unfounded.

. June 13, 2010 at 10:12 pm

Living in denial: Why sensible people reject the truth

HEARD the latest? The swine flu pandemic was a hoax: scientists, governments and the World Health Organization cooked it up in a vast conspiracy so that vaccine companies could make money.

Never mind that the flu fulfilled every scientific condition for a pandemic, that thousands died, or that declaring a pandemic didn’t provide huge scope for profiteering. A group of obscure European politicians concocted this conspiracy theory, and it is now doing the rounds even in educated circles.

This depressing tale is the latest incarnation of denialism, the systematic rejection of a body of science in favour of make-believe. There’s a lot of it about, attacking evolution, global warming, tobacco research, HIV, vaccines – and now, it seems, flu. But why does it happen? What motivates people to retreat from the real world into denial?

Here’s a hypothesis: denial is largely a product of the way normal people think. Most denialists are simply ordinary people doing what they believe is right. If this seems discouraging, take heart. There are good reasons for thinking that denialism can be tackled by condemning it a little less and understanding it a little more.

Whatever they are denying, denial movements have much in common with one another, not least the use of similar tactics (see “How to be a denialist”). All set themselves up as courageous underdogs fighting a corrupt elite engaged in a conspiracy to suppress the truth or foist a malicious lie on ordinary people. This conspiracy is usually claimed to be promoting a sinister agenda: the nanny state, takeover of the world economy, government power over individuals, financial gain, atheism.

. July 19, 2010 at 10:20 am

H1N1 vaccine averted nearly 1 million cases: study

Toronto — The Canadian Press Published on Monday, Jul. 19, 2010 9:58AM EDT Last updated on Monday, Jul. 19, 2010 10:14AM EDT

A new study says Ontario’s H1N1 vaccination program averted nearly one million cases and as many as 50 deaths.

The study says Ontario could have seen an additional 420 hospitalizations, 28,000 visits to hospital emergency departments and 100,000 visits to doctors’ offices if it hadn’t offered the flu shot program

The study was done by Beate Sanders, a health economist with the Ontario Agency of Health Protection and Promotion and was published in the journal Vaccine.

Sanders says that while the $180-million vaccination program was expensive, it was cost-effective.

GHMMS October 6, 2011 at 9:13 am

If you don’t want the flu, get vaccinated. Stop worrying about other people who choose not to. They are risking getting the flu, if it is even a genuine risk (which it isn’t). As long as you and all your loved ones are innoculated with neurotoxins and carcinogens, that is all you have to worry about. Get over it.

Matt November 4, 2011 at 4:53 pm

I’ve gotten a flu shot every year for the past few years, and this year I tried Intanza which I’ve seen described as “The Pain Free Flu Shot” (it uses a smaller needle injected intradermally).

In my opinion, it actually caused slightly more soreness than a regular shot, although not significantly different. I think “pain free” is a bit misleading, though, because it is still somewhat uncomfortable as are most injections.

In the future, I still am inclined to use Intanza as it doesn’t contain Thimerosal like a regular intramuscular vaccine.

Matt November 4, 2011 at 4:56 pm

And to GHMMS, you claim getting the flu isn’t a “genuine risk.” I don’t see how you can support this claim, though, as obviously the flu exists and thus there is a measurable probability of getting it (thus there is a risk). Getting vaccinated, statistically speaking, lowers that risk.

Matt November 20, 2015 at 9:57 pm

I was thinking of this thread the other day when I got this year’s shot. I’m less and less convinced it’s worthwhile. I didn’t get it last year, which turned out to be okay because it was a dud.

Also the “Canadian Problem” troubles me.

Milan November 23, 2015 at 2:46 pm

The effectiveness of the vaccine certainly seems to be a morally relevant consideration when it comes to who, if anyone, should be required to take it, as well as who it might simply be desirable to have vaccinated.

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