Our six year old came home from school with a request for parental consent to a flu vaccination for him. I wondered if it was needed or useful, and I wondered out loud on facebook. Several friends offered their thoughts in posts and private messages. (These replies came from researchers in immunology, public health, and policy-making as well as practising doctors and nurses.) The upshot of this quick survey was that flu viruses are constantly evolving, so the generic ‘flu’ is a moving target, and vaccines aimed at a selection of strains have a limited hit-rate. They can have some side effects. There is also some uncertainty about long-term effects.
Promoters of the vaccination programme offer speculation about how attacking the virus in kids – the most liberal spreaders-around of the disease – can have wider social benefits, especially over time. But the evidence to date on this is thin.[1]
Interestingly, the only consistent definite finding from the academic research on this subject is that we need more research. That conclusion obviously suits the researchers, but it is also used as a basis upon which to propose ever wider and more extensive trials and roll-outs. In one academic paper we can read ‘it could conceivably prove that viral vaccines are as useful in the prevention of bacterial otitis, pneumonia, sepsis and even meningitis as bacterial vaccines are—but if we do not look, we will not find out.’[2]
So at present it is unproven and uncertain. Meanwhile ‘looking in order to find out’ involves mass experimentation on our children. Research to date is interpreted as suggesting that pressing ahead will probably do little harm and could on balance do a little good across society as a whole. But it is not known for sure, and it does not have the degree of assurance associated with vaccinations of proven usefulness. Vaccines against meningitis and other series diseases were developed in response to a clear and pressing clinical need. But while the early use of flu vaccines itself was directed to protecting groups at clear clinical risks to themselves of morbidity and mortality,[3] the subsequent roll out to groups at minimal individual risk appears to have a different sort of rationale.
Given the pressures on resources both for schools and the health service, why is such priority accorded to this programme? The clinical case does not seem particularly powerful; and such public concern as may have started to arise in recent years seems to have been manufactured by communications from the parties involved in promoting the vaccines.
Here in Scotland, the supplier of the vaccine[4] appears to be the large pharmaceutical company Sanofi, a company that pools early stage research with Astrazenica. These are massive companies with a shared business interest in expanding their joint market area. In this business environment, it would not be any surprise to find that their strenuous promotion efforts have leached through into an increasingly business-driven health service and been abetted by lobby-able politicians.
Clearly, if you have a product that has to be purchased year on year for huge numbers across a population, then you have a good opportunity for making profits, and if you plough some of these back into further research and development you can probably make the case for extending your roll-out still further. The entire 18-65 age group is there awaiting the picking.
Meanwhile, what should we parents think? The accompanying leaflet my child brought home is called ‘Child flu immunization – what you need to know’. To be told by a faceless authority ‘what you need to know’ is to be subject to an assertion of unaccountable power. What I need to know is for me to decide! For starters, I’d like to know who exactly is promoting this programme within NHS Scotland and Scottish Government, who decided to award Sanofi this contract, and on what basis. Then we’d know who to expect authoritative answers from. I guess I’ll send these questions on to my MSPs.
[1] Osterholm, M.T., Kelley, N.S., Sommer, A., Belongia, E.A., 2012. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. The Lancet Infectious Diseases 12, 36–44.
[2] Thors, V., Smith, C., Finn, A., 2013. Should all children be immunised against influenza? Arch Dis Child 98, 846–849: p.848. [The article comes with this declaration of interests: ‘VT is an ESPID Research Fellow and is currently undertaking research partially funded by a grant to the University of Bristol from Astra-Zeneca. AF undertakes consultancy and clinical research for all the main vaccine companies including most of those manufacturing flu vaccines. All funding related to these activities is paid to his employers, the University of Bristol and University Hospitals Bristol NHS Foundation Trust. He receives no personal remuneration related to these activities and has no other financial interest in these companies or any related intellectual property.’]
[3] The National Flu Immunisation Programme 2016/17 UK Gov.
[4] NSS National Procurement, Flu Vaccine Distribution Arrangements 2016/17: Overview of Order Arrangements and Frequently Asked Questions (Updated: 11 July 2016)
Tim Hayward 