In this week’s eSkeptic, Dr Harriet Hall, MD, (aka the Skepdoc) explains why fearmongering about the swine flu vaccine is both wrong and dangerous.
Dr Harriet Hall, MD is a retired family physician and Air Force Colonel living in Puyallup, Washington. She writes about alternative medicine, pseudoscience, quackery, and critical thinking. She is a contributing editor to both Skeptic and Skeptical Inquirer, an advisor to the Quackwatch website, and an editor of ScienceBasedMedicine.org, where she writes an article every Tuesday. She recently published Women Aren’t Supposed to Fly: The Memoirs of a Female Flight Surgeon. Her website is www.skepdoc.info.
Swine Flu Vaccine Fearmongering
by Dr Harriet Hall, MD
Fear is a curious thing. It often bears no relation to the actual risk of what we fear. When swine flu first broke out in Mexico, people were understandably afraid. Travel was restricted, schools were closed, and so many people stayed home that the streets of Mexico City were empty. As the disease spread around the world, Egypt developed a paranoid fear of pigs and committed national pigicide. They ordered the slaughter of all 300,000 of their country’s innocent little porkers, ignoring the fact that the flu is spread person-to-person, not pig-to-person. Now that the disease has officially been labeled a pandemic, fears have switched from the real threat of the disease to an imagined danger from the vaccine.
Some people just plain hate the idea of vaccines — to the point that they are willing to spread old falsehoods, make up new lies, distort the results of studies, misrepresent statistics, and endanger our public health. There are websites like “Operation Fax to Stop the Vax” and even anti-swine-flu-vaccine rap videos. Press releases, e-mail campaigns, talk shows, and blogs are being used to stir up irrational fears. These people are irresponsible fearmongers. They are wrong, and they are dangerous.
The 1918 flu. The flu epidemic of 1918 started as a mild disease in the spring, called the “3-day fever.” Most victims recovered in a few days; there were few deaths. Then in the fall, it turned into something far more severe. It was the same flu strain, but it had become more virulent. Some victims died within hours. Healthy young adults were as susceptible as children and the elderly. It affected remote villages as well as urban areas. It attacked 1/5 of the world’s population and killed 50 million people.
Wartime conditions may have favored the evolution of a more virulent strain. In peacetime, the sicker stay put and the mildly affected move around. In the trenches, the mildly affected stayed on duty and the sicker were sent on crowded trains to crowded field hospitals. Today, places with social upheaval might have similar effects favoring a virulent strain.
The 1976 swine flu. In February, 1976 a strain of H1N1 influenza similar to the 1918 strain killed a soldier at Fort Dix. Officials feared a pandemic and over-reacted. In actuality, the H1N1 strain was limited to the Fort Dix area and quickly died out, and another related strain only persisted until March. Nevertheless, a swine flu vaccine was developed and was given to 48,000,000 Americans, 22 percent of the population. The vaccination program was stopped in December after 532 cases of paralysis from Guillain-Barré syndrome were linked to the vaccine and 25 people died. It had been a false alarm, and more people died of the vaccine than of the disease. The risk of getting Guillain-Barré from the vaccine was approximately 1 in 100,000.
The 2009 swine flu. Between April 15 and July 24, 2009, there were 43,771 confirmed and probable cases of H1N1 influenza (“swine flu”) in the U.S. There were 5,011 hospitalizations and 302 deaths, 39 percent among those aged 25 to 49, in contrast to the usual flu where 90 percent of the deaths are in people over age 65. For comparison, the more common strains of flu have been killing around 36,000 people a year in the U.S. Swine flu has been declared a phase 6 pandemic by the World Health Organization: that is a measure of its spread, not of its severity.
What are the chances that the new swine flu will follow the course of the 1918 flu? We have no way of knowing. All we can do is hope for the best and prepare for the worst. In addition to the annual flu vaccine for the usual common strains, a specific vaccine for the H1N1 strain is being prepared and tested to see whether one or two shots will be needed to produce a satisfactory immune response. So we may be offered as many as three shots this year. Supplies will be limited, at least in the short run, so the CDC has announced these priorities:
- Pregnant women
- Household contacts and caregivers for children younger than 6 months of age
- Healthcare and emergency medical services personnel
- All people from 6 months through 24 years of age
- Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.
What if it fizzles out like the swine flu of 1976? That’s already ruled out: the 1976 flu had fizzled by March; the new swine flu hasn’t shown any signs of fizzling yet. We will be monitoring numbers of cases and vaccine complications very carefully, assessing the risk/benefit ratio, and we’re not likely to repeat the mistakes of 1976.
The Lies and Distortions vs. the Facts
I can’t hope to address all the misinformation that is circulating, and even if I could, more new lies would come out by the time I finished writing. Here are some of the ones I have heard. A correspondent in the Netherlands forwarded me an alarmist e-mail that is circulating in Europe.
Claim: It alleges that only one person has died of swine flu in the UK, and it questions whether he really had flu. It tells us “you are slated for vaccination against a disease which poses no credible threat whatsoever.”
Fact: As of August 27, the death toll in the UK was 66. As of Sept. 1, 2009, 2184 deaths had been reported worldwide. Most rational people would call that a credible threat.
Claim: Guillian-Barré Syndrome is a newly concocted name for a much more familiar condition: Polio.
Fact: Ridiculous! Polio is a distinct disease and its symptoms are very different from those of Guillain-Barré syndrome. A diagnosis of polio can be confirmed by finding the actual poliovirus particles in body secretions or cerebrospinal fluid. The last case of “wild polio” in the U.S. occurred in 1979. Polio has been eradicated in most countries; Guillain-Barré still occurs regularly in every country.
Claim: Guillain-Barré is still being caused by flu vaccines. A study based on the Vaccine Adverse Event Reporting System (VAERS) found 54 cases of GBS reported after vaccination in the U.S. in 2004; 57 percent of these followed flu vaccines and the rest followed other vaccines.
Fact: The VAERS is a voluntary reporting system that accepts all reports of symptoms or illnesses that occurred after vaccination. It even accepted a fraudulent report claiming that a man had been turned into The Hulk by his influenza vaccine. To find out whether the VAERS reports mean anything, it is necessary to compare the incidence of the condition in those vaccinated to the incidence in the unvaccinated. Guillain-Barré syndrome affects 1 to 4 of every 100,000 people around the world every year, and the increased risk from vaccines is currently estimated at no more than one in a million.
Claim: It usually takes several years to test a drug and show that it is safe, but the swine flu vaccine is going to be fast-tracked for quick approval.
Fact: A new flu vaccine has to be developed every year to respond to the new strains that are constantly evolving. Time does not allow for the same kind of testing we require for approval of a new pharmaceutical. Time is even shorter for the swine flu this year. We have a lot of experience in producing new flu vaccines every year, and there is no reason to suspect that this year’s batches will be any more dangerous than usual. Because of fast-tracking, we will be monitoring very closely for side effects. We have a choice between fast-tracking and being prepared for a serious outbreak, or being slow and cautious and totally unprepared.
Claim: 4,000 people were afflicted with Guillain-Barré Syndrome in 1976.
Fact: At least 1 in 100,000 people would have gotten Guillain-Barré syndrome anyway. The excess cases attributed to the vaccine were estimated at 532 (some sources say half of that number), and most of them recovered fully; 25 deaths were attributed to the vaccine.
There are several websites where writers with a bad track record for scientific credibility (like Joseph Mercola and Gary Null) advocate vaccine refusal. The Health Freedom movement wants the government to forget about trying to protect the public and give us the freedom to harm ourselves by using untested, disproven, useless, or even dangerous treatments.
Claim: Legislation allows for you to be isolated or quarantined or “incarcerated in relocation centers” if you refuse vaccination during a declared Pandemic Emergency. This is a violation of human rights and of the Constitution.
Fact: If you have active TB, the government has not only the power but the responsibility to require treatment or quarantine so you don’t sit next to me on the bus and cough in my face. If you contract Ebola virus, I sure hope you will be quarantined to reduce the death toll. Quarantine is legal, is mandated by legislation, and is accepted by international law. Sometimes the duty to protect most of the people in a society temporarily trumps a few individual human rights. The government is not going to require quarantine unless there is a serious threat that demands action.
Claim: People should be allowed to “self-shield.” For self-shielding you go home lock the doors and stay there. Then you can try to further protect yourself with nano-silver, homeopathic remedies, cold packs, vitamins, flavonoids, zinc, astaxanthin, magnesium, and other stuff.
Fact: A self-imposed quarantine is better than nothing, but I question whether it would be effective in practice. The suggested (untested) remedies might conceivably keep people entertained so they are more willing to stay home.
Claim: The CDC and the American Academy of Neurologists have asked neurologists to be vigilant in looking for cases of Guillain-Barré syndrome in people who have been vaccinated. This is an admission that they know the vaccine will be dangerous.
Fact: They clearly said1 “they do not expect the 2009 H1N1 vaccine to increase the risk for the autoimmune disease” but since this is a concern with any pandemic vaccine, they will be on the alert. This is a good thing. If the incidence starts rising, they will know it earlier and be able to react more quickly than they did in 1976.
Claim: The threat of Guillain-Barré is a reason to reject vaccines.
Fact: No one understands what causes Guillain-Barré syndrome, but it can develop after an infection, surgery or vaccination. It is possible that people who develop GBS after vaccination might also have developed GBS after natural exposure to the disease. One expert said2,
From both the societal and individual perspectives, the risk of GBS after a flu shot pales in comparison to the risk of serious adverse events if infected with the influenza virus: 60 to 70 cases of GBS vs. 20,000 deaths from influenza. Keeping things on the same scale, people over 65 years of age can choose from a risk of one case of GBS per million people or 10,000 cases of hospitalization and 1500 deaths due to influenza.
Claim: Joseph Mercola writes about “Squalene: The Swine Flu Vaccine’s Dirty Little Secret.” He has claimed that the vaccine adjuvant squalene is dangerous, that the Gulf War Syndrome was caused by the squalene in anthrax vaccines, that squalene is “good” or “bad depending on how it gets into your body: “Injection is an abnormal route of entry which incites your immune system to attack all the squalene in your body, not just the vaccine adjuvant.” And the only reason they put adjuvants in vaccines is to save money.
Fact: Squalene is found naturally in the human body. It is a precursor of cholesterol and other compounds necessary to human health. Squalene antibodies were found in Gulf War veterans; but the rate turned out to be no higher in those who had Gulf War Syndrome than in those who didn’t. Squalene antibodies were found at similar rates in people who had never been exposed to squalene in vaccines. The anthrax vaccine has been ruled out as a possible cause of Gulf War Syndrome. Anyway, it turns out there was no squalene in the anthrax vaccine!
American flu vaccines do not contain adjuvants, but maybe they should. Adjuvants enhance the body’s innate immune response to the antigens in vaccines, making vaccines more effective. And they allow for broader cross-reactivity against viral strains not included in the vaccine3. Mercola says adjuvants are added just to increase profits, but the pharmaceutical and health industries could make far more money treating patients in an epidemic than they could ever make trying to prevent one.
There is a large body of data demonstrating the safety of squalene. Flu vaccines containing MF59, a squalene-based adjuvant, have been used in Europe for 10 years, with 22,000,000 doses given; and no serious adverse events have occurred, only mild local reactions. The vaccine does not raise the incidence or titers of anti-squalene antibodies. The World Health Organization (WHO) considers it safe4.
items of interest…
Claim: Flu vaccines are not very effective and don’t protect everyone. The effectiveness is particularly low in the elderly.
Fact: This claim is true, but… In recent years, flu vaccines have been 75 percent effective in preventing hospitalizations for flu, and 75 percent is way better than nothing. No vaccine is 100 percent effective. Flu vaccine is particularly problematic because of the constantly mutating strains of the virus. Nevertheless, the benefits of vaccines are clear. It is true that the elderly are not as well protected by the vaccine (efficacy rates have been estimated at 50 percent or less): that’s why it’s so important for younger people to be vaccinated, reducing the prevalence of the disease in the population and thereby reducing the likelihood of the elderly being exposed. In other words, don’t just get the flu shot for yourself, get it for Grandma.
Claim: Mercola says “Injecting organisms into your body to provoke immunity is contrary to nature.”
Fact: Nature kills people. Doing something contrary to nature is what medicine is all about. It’s a good thing.
Claim: “The potential for a weaponized vaccine to be the vector for a weaponized flu cannot be discounted.”
Fact: Most far-fetched conspiracy theories are wrong. I have no trouble discounting this one. The potential may be there, but the likelihood is homeopathic.
Claim: People should make their own decisions about their health care.
Fact: One of the basic principles of medical ethics is autonomy: patients have the right to accept or reject any treatment. Modern doctors try to involve the patient in the decision-making process, but most people are ill-equipped to make health decisions on their own without getting information and guidance from a health care professional. In a recent survey5, 30 percent of Americans believed that there had been a case of smallpox in the United States in the past five years, and 63 percent thought there had been a case somewhere in the world in the past five years. They didn’t know that the last case in the U.S. occurred in 1949 and the last case in the world occurred in 1977 in Somalia; 25 percent thought it was likely that they would die if they got the smallpox vaccine (the actual risk of death from the vaccine is one per million). People who are uninformed and scientifically illiterate are not capable of making rational decisions about health matters.
Mercola’s advice for preventing flu: Eliminate sugar and processed foods from your diet, take a high quality source of animal-based omega 3 fats like Krill Oil, exercise, optimize your vitamin D levels, get plenty of sleep, deal with stress, and wash your hands.
Fact: Washing your hands is a good idea.
Mercola claims: “Vitamin D deficiency is the likely cause of seasonal flu viruses.”
Fact: Now really! Vitamin D deficiency in a human body can no more “cause a virus” than it could “cause a cat.” Perhaps he meant vitamin D deficiency could predispose a body to infection, and there is some research to suggest that it might. Some have claimed that taking vitamin D supplements will prevent the flu, but there is no evidence to support that.
Mercola’s claims and arguments were decisively eviscerated on Science-Based Medicine by Dr. Joseph Albietz6. Not only are Mercola’s assertions demonstrably false, but they reveal a profound misunderstanding of immunology. Unfortunately, he reaches a large audience of scientifically naïve people who believe his every word.
In response to Dr. Albietz’s article, there were some interesting comments from readers that further demonstrate the anti-vaccine mindset and the ability to distort information to promote a cause.
Claim: The government is going to mandate that everyone get the swine flu vaccine.
Fact: No such proposal has been made. The government couldn’t do it even if it tried, because there won’t be enough doses to go around. That’s why they’ve issued recommendations prioritizing who should get the vaccine first.
Claim: George Bush signed an agreement that if a pandemic emergency arose and the President declared a national state of emergency, control of the government would be passed to the United Nations. Blue-helmeted UN soldiers would run our country and the Constitution would be suspended.
Fact: It was simply an agreement to facilitate international cooperation, to share information and enhance collaboration in the event of an emergency. It says nothing about the UN at all, much less about relinquishing sovereignty to the UN or any other organization. The actual agreement can be read online at www.spp.gov/pdf/nap_flu07.pdf
The same person pointed out that shots hurt and that alone should tell you something. “Yet you are willing to trust these people with your lives to make a vaccine that the Creator never intended the human body should need, and let them inject it into your body? You people are scary or insane!”
No, it is the anti-vaccine zealots who are scary. They are not insane, just self-deluded and misguided. I hope the swine flu won’t develop into a reprise of 1918; but if it does, the false information these people are spreading could be responsible for a great deal of death and suffering. Freedom of speech is a good thing, but this kind of fear-mongering is almost as bad as shouting “Fire!” in a crowded theater.
- ^ Press release from the American Academy of Neurology, August 31, 2009. Available online at: www.aan.com/press/?fuseaction=release.view&release=757
- ^ Grabenstein, J.D. 2000. “Guillain-Barre Syndrome and Vaccination: Usually Unrelated.” Hospital Pharmacy 36:2, 199–207. Available online at: www.factsandcomparisons.com/assets/hospitalpharm/IMM1.pdf
- ^ O’Hagan D.T. 2007. “MF59 is a Safe and Potent Vaccine Adjuvant that Enhances Protection Against Influenza Virus Infection.” Expert Rev Vaccines 6(5):699–710.
- ^ Global Advisory Committee on Vaccine Safety, World Health Organization. 2006. http://tinyurl.com/squalene-adjuvant
- ^ Blendon, R.J., et al. “The Public and the Smallpox Threat,” NEJM 348(5):p. 426–432. 2003. http://content.nejm.org/cgi/content/full/348/5/426
- ^ Albietz, J. 2009. “A Defense of Childhood Influenza Vaccination and Squalene-Containing Adjuvants: Joseph Mercola’s ‘Dirty Little Secret’ Science-Based Medicine,” Aug 21. www.sciencebasedmedicine.org/?p=851
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