Flu Vaccines

[Mark]

Before vaccines people died as a matter of course. Dying from infectious disease is a very natural thing, it doesn't raise a lot of eyebrows when it happens... but, when it is preventable that tends to be viewed a massive government and public health failure.

The shortages are even more severe in some places than the reports suggest. In Massachusetts, where I am now, Chiron provided roughly 73% of the vaccine. This has forced public health officials to issue guidelines even further limiting who among the previously eligible groups should receive treatment. So, even at risk populations (to say nothing of the general public) will not be covered in this state nearly as well as they have been in the past. There will, without any doubt, be more deaths this year as a result. What the attributable risk will be we will have wait and see. A frequently cited figure from a conference which I just (as in, an hour ago) attended was about 30,000 excess deaths this year nationally as a result of the shortage if not immediate remedy appears. Ten 9/11's. Imagine if terrorists were to cause that much destruction.

Now, again, that is the answer to your question "what did we do before we had vaccines?" We watched vulnerable people die because we lacked the resources and technology to stop it. The situation is different now, we lack not the resources or technology, but the political will to ensure complete and effective production and distribution methods. Please note, that is not an indictment of this administration, it would likely be no better under any other. Hopefully this will raise awarness to the vulnerability of the U.S. population to infectious disease and the U.S. will redouble its efforts to ensure capacity for prevention measures.... especially with a developing bird flu situation abroad. We should remember that the flu of 1918 killed more people in the U.S. than the foreign wars of this century combined - roughly 600,000. Our public health infrastructure is light years better, of course, but the bugs are "better" too.

[Karen]

Mark,

A very informative reply. My initial thoughts to Kelly's post were very similar but without the facts and figures you provided. I worked in the medical field for many years and the hospital I worked for was just slammed every flu season. I personally dreaded that time of year. For the elderly, the very young, those with chronic medical conditions, and those with a compromised immune systems, the flu can be deadly. For us healthy folks it's hard to imagine how deadly it can be.

Karen

[kellyc]

Sorry I accidentally deleted my post above, I meant to edit the spelling. But I was asking what we did before flu vaccines? Has it been that long since they came out? It seems that making sure kids and elderly get flu shots are ok. But think the news should be ashamed of themselves for creating this panic.

[dhyatt]

Sorry I accidentally deleted my post above, I meant to edit the spelling. But I was asking what we did before flu vaccines? Has it been that long since they came out? It seems that making sure kids and elderly get flu shots are ok. But think the news should be ashamed of themselves for creating this panic.

Kelly,
Don't blame the news media, blame the trial lawyers. What do you think is likely to happen to Chiron beyond the fact they won't be paid for the vaccine they can't deliver? If a U.S. company failed to deliver like this, they'd probably have to pre-emtively declare bankruptcy due to being sued by every family that lost a loved one due to the flu. I'm willing to bet trial lawyers would actively seek out such cases with childish glee.

BTW - Since Chiron is a French company, why were we relying on them for vaccine in the first place? and what makes us so sure this wasn't intentional?

[Wuptdo]

Kelly wrote:

But think the news should be ashamed of themselves for creating this panic.


Ditto! A perfect example of the "media" machine rolling all over itself to get a "story" or our attention.

This warrant further study, but what I saw last night on the news shocked me. "Same techniques (eqqs) for the last 70 years" and "no incentives (i.e. money) to make better or increase production" and "low-profit margin." Mark is right, we have a healthcare system that is light years ahead of the rest of the World, but the profit/health care cost formula really $ucks.

Wuptdo B-)

Oh Mark - BZ on the 1918-1919 flu thing. It is amazing what is left out of most U.S. History books.

[Karen]

Honestly Kelly, I don't know how long flu shots have been around. But before they did come out more people died, bottom line. Although this probably isn't the best example, think of the polio vaccine. Pre vaccine folks contracted polio. Post vaccine folks did not. (with exceptions of course). Pre flu vaccine more people died from it, post vaccine less people are dying from it.

In my opinion the media is trying to emphasize to the generally healthy population to forgo the shot so that the high risk population is covered because of the shortage. I think this is a very important message. And I think it is important for people to understand how devestating contracting the flu can be for these folks. Yes, the media can go overboard but my feeling is they are just trying to get an important message out. My son is high risk and I had his shot schedualled already before the news came out of the shortage. So this personally affects the way I think about this issue... As well as having worked in a hospital full of flu patients literally on their last leg.

Karen

[Mark]

I'll agree the that media response has been too sensational for the matter. There is, howver, a serious risk now despite the fact that the level of infection is similar to that which was exhibited in the past.

Consider this analogy. Oil prices in the 70's, adjusted for real dollars, were higher than they are even now. In the interim oil prices generally, and gas prices in the U.S. specifically, had been relatively low. We enjoyed that, and it became the norm. Now, bouyed by crises abroad we see a rise in price exceeding, in absolute terms, that of the past and approaching it on an order of magnitude in adjusted terms. Despite the fact that the situation today is only a repeat of the past, it still feels like someone pulled the rug out from under us because we thought, or at least hoped, we had it figured out and could control the extremes of the cycle. That it mirrors historic events doesn't do much to alleviate the problems it's actually causing on the ground now - indeed, high oil prices are being blamed for the loss of billions of dollars (maybe daily) of slowed economic growth.

It is essentially the same for flu or any other serious infectious disease. You think you've got a handle on it only to have your weaknesses, false assumptions, and failures exposed. This is moving away from our topic a bit, but the same is true for bioterrorism in the U.S. today too.

Anyway, the media would do well to tone down the hysterics. One good thing might come out of the present panic, however, and that is that if we're fortunate that the shortage results in fewer deaths than expected, it might have been because renewed emphasis was placed on basic prevention measures. It's amazing how effective simple hand washing, limiting enivronmental exposures, and sanitation can be at reducing likelyhood of infection.

One final note of interest. The Mass. dept. of Health sent around in the past week to field offices and other public health professionals an updated memo regarding the law and proceedures for forced containment and isolation. This was mostly in response to developments in avain flu transmission in China but, it signals the mentality of a community beginning to fear epidemic incidence of infection.

[Anonymous]

Don your fact checking skills are not improving.

Chiron Corporation, which produced the contaminated flue vaccine is a US company with Corporate Headquarters in Emeryville, California. Its vaccine unit has major facilities in Liverpool, England. This is from the most recent annual report:

“Flu vaccines will be an important driver of growth for Chiron in the near-term to midterm. Outside the United States, Chiron markets Agrippal® S1, Begrivac™ and Fluad® flu vaccines. In total for the 2003-2004 flu season, Chiron produced 75 million doses of its four brands of flu vaccines for the global market. In order to fulfill the growing demand for flu vaccines, Chiron has committed approximately $100 million to further develop and expand our Liverpool, England, manufacturing facility.”

The only remaining supplier of vaccine in the United States, Aventis Pasteur Inc. is a unit of Aventis a large multinational pharmaceutical company with headquarters in Strasbourg, France and Bridgewater Crossings, NJ, USA. Aventis Pasteur has its headquarters in Lyon, France. They produce vaccines in several locations including in the US.

[hollyL]

I've really been lost on this flu shot thing. I honestly never heard of a flu shot until a few years ago. I completely understand those who are young/old/immune deficient but I've never had a flu shot (I'm 30 - yes wupto I am 30...cats out of the bag...and no not a real cat johnb that would be cruel). I don't see why any reasonably healthy adult would need one.

I'll tell you another thing...I went to the hospital for a injury (lots of blood and bone) and I saw those people with 'the flu' in the emergency room. I was 10 times sicker than they were when I had the flu but I toughed it out over my own toilet bowl :-X . Just because you are throwing up and you have a 99 fever doesn't mean you run to the emergency room. People go to the Dr way too much...wussies! Now no one say lecture me about kids and old people dying because I already said they should have a flu shot.

[dhyatt]

Don your fact checking skills are not improving.

[snip]

And neither is your sense of humor. You think it's mere coincidence that Chiron and Chirac are so similar :-) It was 'Rather' (another pun) dry humor. I guess I should have been less subtle... Sorry to anybody I may have confused.

[hollyL]

dhyatt - humorist or flip flopper? :lol:

[washere]

I don't see why any reasonably healthy adult would need one.


I thought I'd list some reasons why healthy adults should get flu shots (not to jab, just to put the info out there :wink: ):

***PREGNANT WOMEN*** (have compromised immune systems)
--also, recently postpartum women, and nursing mothers

-healthy adults who have an infant under 6 months of age. The flu vax isn't approved for babies younger than 6 months, so the alternative is to vax everyone living with them.

--health care workers

--people who work with children who may come in contact with the flu (espcially daycare workers working with babies under 6 months).

Ofcourse we could all just wash our hands...but that won't really help the pregnant women :lol: .

[dhyatt]

dhyatt - humorist or flip flopper? :lol:

For me to know and you to guess ;-)

[hollyL]

I don't see why any reasonably healthy adult would need one.


I thought I'd list some reasons why healthy adults should get flu shots (not to jab, just to put the info out there :wink: ):

***PREGNANT WOMEN*** (have compromised immune systems)
--also, recently postpartum women, and nursing mothers

-healthy adults who have an infant under 6 months of age. The flu vax isn't approved for babies younger than 6 months, so the alternative is to vax everyone living with them.

--health care workers

--people who work with children who may come in contact with the flu (espcially daycare workers working with babies under 6 months).

Ofcourse we could all just wash our hands...but that won't really help the pregnant women :lol: .

Yeah I suppose those make sense too. I thought pregnant woman couldn't get flu shots but my friend who hugs trees told me that so maybe she's bias/crazy :-D

[dhyatt]

According to a Bush spokeman, Kerry voted against a measure that would have protected vaccine manufacturers from punative damages
He's blaming Bush but he and his smarmy lawyer running mate are part of the real problem


Litigation Could Make Vaccines Extinct
Congress must act--it has the legislative model in hand

By James M. Wood of The Scientist (http://www.the-scientist.com/yr2004/jan/opinion_040119.html)


Vaccines have eradicated some killer diseases and protected against others. But they face eradication themselves--by litigation. As the United States rushes to defend itself against bioterrorism by developing vaccines against biological agents, Congress must pass legislation to ensure that vaccines themselves do not become extinct.

All vaccines carry risks, including side effects such as encephalitis. For example, severe allergic reactions, such as breathing problems and shock, can occur in less than one in a million doses of diphtheria, tetanus and pertussis vaccine.1 Almost all US children enjoy the health benefit from immunization, but a tiny proportion, despite efforts to make the vaccine safe, have severe side effects. Before Congress acted in 1986, these children often had no financial recourse2 for their medical and rehabilitative needs other than the tort system.

The result was a dwindling supply of vaccines and an increased cost of inoculations. Case in point: The 1994 Nevada case of Allison v. Merck, in which the DPT vaccine became the object of personal injury litigation.

In this case, the Nevada State Supreme Court held that any product, including a vaccine, is defective when it fails to perform in a reasonably expected manner. In holding Merck responsible for the disclosed adverse reaction of encephalitis, the Court reasoned that the DPT vaccine's intended function was to immunize a child without causing this side effect. Because the vaccine may have resulted in this side effect and its sequellae, the Court concluded that it was defective.

Even before Allison, similar litigation had resulted in reducing the DPT vaccine supply; by 1986, only two companies produced it. Overall, the number of vaccine producers has dropped, from 25 in the 1970s to five today.3 Litigation continues against manufacturers of polio vaccine (in asbestos litigation) and of DPT (claiming that the vaccine's preservative, thimerosal, causes autism). Unless checked, the threat of litigation against unavoidable, yet rare, reactions to vaccines designed to protect against and to treat viruses and bacteria used by terrorists might have the same effect.

Congress adopted liability protection as part of the 2002 Safety Act to protect those who develop counter-bioterrorism measures. But, it didn't go far enough to ensure that companies don't abandon the opportunity to manufacture vaccines because of the real ongoing threat of litigation.

There is a model. In 1986, Congress passed the National Childhood Vaccine Injury Act, recognizing the importance of inoculations and the deleterious health consequences of litigation. The act mandates, among other things, that health providers report adverse reactions to the federal government, and that injured children are entitled to "no-fault compensation."

The legislators determined that:

* The availability and use of vaccines to prevent childhood diseases is a top public health priority;
* The Federal government should make immunization available to all children; injured youngsters should have access to sufficient compensation;
* Private or nongovernmental activities have proven inadequate in achieving either of the above goals;
* Economic conditions have resulted in an unstable and unpredictable childhood vaccine market, making the threat of vaccine shortages a real possibility.

Substitute "children" for today's "national population" and these policies are as relevant today as they were in the 1980s.

The following features of the Vaccine Act could be a model for an amended Safety Act:

* Claims are filed with the US Court of Federal Claims;
* The injury must be one that is recognized as an adverse reaction to the specific vaccine within identified time frames as established by a Vaccine Injury Table;
* Proof of the vaccination must be offered within the time periods specified;
* If these are satisfied, then it's presumed that the vaccine caused the injury; if not, the individual must prove that the vaccine caused the specific harm;
* A special master determines the compensation amount that would include, at a cap of $250,000, prior reimbursements as well as future medical expenses, lost earnings, damages for pain and suffering, and reasonable attorneys' fees and costs. If the patient has died, the cap is set at $250,000, and punitive damages cannot be recovered. Taxes collected from vaccine sales would pay for the plan.

A possible additional source of funding: taxing the 25% to 40% contingency fees recovered by plaintiffs' attorneys who continue to sue the vaccine industry.

James M. Wood, a partner in the law firm of Reed Smith Crosby Heafey, is based in Oakland, Calif. He focuses on product liability cases, with a special emphasis on representing manufacturers of pharmaceuticals, vaccines, and medical devices.

[washere]

[quote="charchar"][quote=hollyL]
Yeah I suppose those make sense too. I thought pregnant woman couldn't get flu shots but my friend who hugs trees told me that so maybe she's bias/crazy :-D

Women who are pregnant during flu season are definitely encouraged to get the flu vax (as long as they're outside the first trimester).

There's definitely a huge backlash against vaxing right now (good grief), so maybe that's what your friend is referring to???

[washere]

In response to dhyatt's post:

I'm going to play devil's advocate here. Vaccinations are a huge source of debate among parents of young children. They're under fire for all sorts of reasons: necessity, safety, and most commonly, as a potential cause for autism.

While I vax both my children, and am VERY well informed on the subject (I did honors work on this subject in school), I can see why other parents freak out.

Think about it. If your child was diagnosed with autism, and you really believed that the MMR booster your child received caused the disorder, you bet your bottom dollar you'd hold someone responsible.

And, the vaccine compensation fund is a real joke. $250K cap?!?!! No pain and suffering??? Honey, $250K wouldn't BEGIN to cover the treatments necessary if your child had permanent brain damage/serious adverse reaction to a vaccine and no insurance.

Are the side effects disclosed? Maybe. People get upset, because vaccinations are so common, and so generally safe that their doctors barely mentioned the possibility (other than crankiness and fever).

Oh, and I'd like to point out that from a medical liability standpoint, shoving a pamphlet in someone's face while in the process of giving someone's child a shot most definitely DOES NOT constitute informed consent. And it most certainly should not.

It's sorta like if your loved one died having gallbladder surgery. Did the doctor tell you that that was a possibility? Sure. Of course, they probably told you it *could* happen, but that it's never happened to them...one in 300,000 chance... Did they fully explain every possible eventuality such that you could make an informed choice?

Probably not.

[Wuptdo]

My former father-in-law invited me to attend his men's group on Friday. It is just a bunch of men living in Leisure World, MD (off Georgia Ave.) This is one of the first senior PUDs built in the U.S. At first I thought it would be a bunch of "old men" just sitting around BS'ing. After about 5 minutes I knew these "old men" where not "old fools." These guys were sharp, and they used this "group" to stay sharp. Anyway, they get togather and discuss "issues of the day." Someone would pose a question and others would response in one way or another. (Sort of like here, but in person, - - very strange).

That days question was this (more or less): Gentleman, over the last few days you have notice the line outside the clinic for flu shots. Yet, there is a shortage of flu vaccine nationwide. Why should we seniors get the flu shots, when the people who actually "support" us, the working people do without?

Needless to say, it was a very interesting discussion.


A little humor to go along with the subject:

http://cagle.slate.msn.com/politicalcartoons/PCcartoons/asay.asp

Wuptdo B-)