Does the FLU JAB actually WORK?
Flu vaccination costs the NHS £100 million, but last year it was worryingly ineffective. Now take-up’s falling as more and more people ask ...
SHouLd you or shouldn’t you? It’s the big question surrounding this year’s flu jab as Britons wrangle with concerns about the vaccine’s effectiveness.
As the influenza season takes hold, official figures show the number of people being vaccinated against it is low.
Last month, the royal College of General Practitioners warned that vaccination rates in october were an ‘alarming’ 6 per cent lower compared with the same time last year.
The problem has been particularly acute among ‘at-risk’ groups, which include the over65s, pregnant women and those with serious long-term health conditions, such as heart, lung or kidney disease (who are all offered the jabs free on the nHS).
Frontline nHS staff — those in direct contact with patients — were also failing, in large numbers, to get the jab.
The latest figures show that in november the numbers rose, and were even slightly up on those from the same time in 2014 — though officials are warning that ‘there is no place for complacency’ about the statistics. Indeed. Clearly public confidence in the jab has been affected by the fact that last year’s vaccine didn’t work very well — scientists had identified the wrong strain of flu to target and, as a result, the jab worked in a mere 3 per cent of cases, it was initially thought.
This figure has recently been revised up to 34 per cent, but is still much lower than usual. And the inefficiency of the jab has been blamed by Patient Concern for the fact that last year, England and Wales had the highest winter death toll in a decade and a half.
JUST HOW EFFECTIVE ARE FLU JABS?
WHILE last year’s problems are regarded as a ‘one-off’, there are more serious questions about how effective the jab is generally.
The nHS spends around £100million a year on the national flu jab campaign, but now a leading expert suggests it’s a waste of money and effort. A major problem with the jab is that flu viruses are a constantly moving target. They evolve and mutate rapidly, with new strains continuously emerging.
The new viruses often appear first in the Far East, jumping from poultry and pigs into humans and altering their genetic make-up.
A global surveillance team run by the World Health organisation (WHo) is employed to identify these strains as they emerge. The experts try to predict which strains of the virus are most likely to be prevalent in the coming year. They then advise governments on this six months ahead of the flu season.
Last year, the experts failed to predict a mutant strain, called A(H3n2), that was appearing in Australia would become globally epidemic. By the time they found out they’d been wrongfooted, it was too late to develop a new jab.
In previous years, when the WHo experts have predicted better, the jab’s effectiveness rates have usually been around 50 per cent — meaning that about half the people inoculated will be protected against contracting flu that year.
other viruses, such as polio, offer more static targets as they don’t mutate rapidly. After a course of the standard polio vaccine, for example, more than 99 per cent of recipients develop protective antibodies against the disease.
Last year’s flu jab prediction went ‘horribly wrong,’ admits Andrew Lee, a consultant in communicable disease control.
He adds: ‘It is possible that the low rates of effectiveness reported for the vaccine could have diminished both the public and health professionals’ confidence in the vaccine.’
But the inadequacies of last year’s jab are not the only issue.
STATINS MAY LOWER VACCINE’S PROTECTION
Around seven million Britons are currently taking statins — cholesterollowering drugs — and now two major studies have warned that the pills seem to stop the flu jab working properly.
When people on statins have the jab, they do not produce as many antibodies to the flu virus as normal. This means they may not be adequately protected against developing the illness.
dr Steven Black, a paediatric infectious diseases specialist at the Cincinnati Children’s Hospital, who led one of the new studies, analysed people’s responses to vaccines in four countries.
He found that among 7,000 over-65s, statin users had a significantly reduced immune response to the vaccines.
dr Black explains: ‘Apparently, statins interfere with the response to the influenza vaccine and lower the immune response. This would seem to result in a lower effectiveness of flu vaccines.’
The second study looked at the vaccine’s effectiveness in preventing people from getting ill enough to need medical attention. researchers at the Emory Vaccine Centre at Emory university in Atlanta found more illness in vaccinated people who were taking statins.
For some, the question is not the jab’s effectiveness, but — rightly or wrongly — its safety. Andrew Lee acknowledges that ‘in previous years, low uptake has been caused by concerns about the safety of the vaccine’.
More than 100 Britons are currently involved in a long-running legal battle for compensation for the narcolepsy — overpowering daytime sleepiness — they blame on the Pandemrix vaccine. This was the jab rushed out to combat the swine flu epidemic in 2009. It has not been used since.
Earlier this year it was suggested that the jab might have affected a receptor in brain cells that regulates sleepiness.
In June, a 12-year-old British boy won £120,000 in compensation after a threeyear legal battle — his narcolepsy has left him unable even to shower by himself.
However, the Government is appealing against the decision, and for many others the legal battle continues to drag — Peter Todd, the boy’s lawyer, represents 85 other narcolepsy victims.
WORRIES ABOUT PUBLIC CONFIDENCE IN THE JAB
THE worry for the health authorities is that these factors undermine public confidence in the flu jab, affecting the numbers choosing to have it.
And anything that lowers public uptake of flu vaccines also potentially cuts their effectiveness due to ‘herd immunity’. If a large enough section of the population can be vaccinated, the virus can’t spread as easily, giving protection to those left unvaccinated.
Andrew Lee argues that achieving herd immunity may prevent around 1.2 million flu cases a year and reduce deaths in the over-65s by nearly one in 20.
The uK target for herd immunity is to vaccinate 75 per cent of at-risk people. But QualityWatch, an independent health watchdog, suggests the nHS missed this target last flu season, as it has done in most years since 2000.
Many experts believe that the target is too low anyway; in the u.S., for instance, the target is 80 per cent of healthy people and 90 per cent of those considered high-risk.
But should we really be pushing more people in the uK to have the current flu vaccine? one leading expert in this field vehemently says no.
IT WORKS BEST IN HEALTHY PEOPLE
dr ToM JEFFErSon is an honorary fellow of the oxford university Centre for Evidence-Based Medicine. He’s also an author and editor for the world renowned Cochrane Collaboration, an independent body that analyses research, as well as a practising GP and public health specialist whose expert field is respiratory infections.
dr Jefferson has spent 20 years meticulously studying the research data on influenza vaccination and passionately believes the medical evidence does not justify national flu jab campaigns.
He says the vast majority of clinical studies have been badly run — for instance, they were too small or sloppy with their analysis or open to influence from pharmaceutical companies.
What’s more, he argues results from studies funded by pharmaceutical companies have only been released selectively to show positive results, and have been spun by drug company representatives to give the impression their vaccines are more effective than they are in practice. ‘There have been very few gold-standard studies, called randomised controlled trials (rCTs),’ he says. In rCTs, a number of similar people are randomly split into groups. one group receives the treatment being tested, the others get an alternative treatment — a placebo — or no treatment. The groups are followed up to see if the treatment tested improved things. ‘The rCTs that have been performed don’t change the picture very much. The flu inoculation is a poorly performing vaccine that is insufficiently studied.’
dr Jefferson has repeatedly published such findings in the Cochrane organisation’s regular research updates over the past two decades.
‘Every winter there is a panic about a new strain of flu, or a flu-like illness,’ he says. ‘But there is very little evidence that such vaccinations do very much.
‘Most flu infections are benign and self-limiting. The benefit of vaccines for high-risk individuals is not proven by research. The available studies show that the people in whom the vaccines work best are healthy adults — who need them least.’
WEAK EVIDENCE THAT JABS CUT DEATHS
dr JEFFErSon adds: ‘The available evidence indicates that you’d need to vaccinate between 33 and 99 people in
order to avoid one person having symptoms. There is no evidence to show that it reduces hospitalisations and deaths, even in the at-risk groups, which is more important.’
Lack of respected independent research means there are also questions about the vaccine’s longterm safety, says Dr Jefferson.
‘One of the things claimed about flu vaccines is that they are fine to give because they don’t harm anyone. But the harms are underresearched and under-reported.
‘We don’t have access to thousands of pages of original research from studies that were funded by drug companies.’ This concern is disputed by the Association of the British Pharmaceutical Industry. A spokeswoman says: ‘Flu vaccines, like all medicines, undergo rigorous evaluation for safety and quality by the appropriate global regulatory agencies — including the UK’s Medicines and Healthcare Products Regulatory Agency — before they can be licensed for use.
‘Flu is a common condition that can cause serious risk to some groups of people, and flu vaccines currently offer the best protection.’ Dr Jefferson calls this into doubt, however. He says: ‘Some studies show that repeated vaccinations weaken a person’s response to the flu virus. But I don’t know whether that is right or wrong, thanks to a lack of proper authoritative research.’
It is time, he says, the authorities ‘stopped treating people like children’. ‘We should tell them these vaccines are not very good — that our figures show they might prevent only 5-10 per cent of cases and that there are alternatives.’. These alternatives include practising better personal hygiene, particularly encouraging schoolchildren to wash their hands at break times to stop viruses spreading.
‘This can significantly reduce the levels of epidemics, but such strategies are under-resourced and under-researched because of the fatal attraction that vaccines hold on policymakers.’
And while many experts would vehemently disagree, Dr Jefferson says that current flu vaccines do not have any proven value for atrisk people, even those with severe respiratory conditions.
‘In high-risk groups, the evidence for any benefit is very poor. Some may argue that “taking something is better than nothing”. But I have no sympathy with that. We could be doing far better things with the money.’
Scientists are now busy working on new generations of more effective vaccines. But in the meantime, if health authorities are to achieve the levels of herd immunity that appear essential to make current vaccines optimally effective, they must convince us they’re worth having.
That means providing us with better information and transparent research so we are convinced by the weight of reasoned scientific evidence. Trying to panic or cajole us is clearly not proving effective.