Medical Swine Flu Vaccination: Reasoning Behind National Programs

[Borek]

From what I understand swine flu so far seems to be not more dangerous than seasonal flu. Vaccination for seasonal flu (at least in Poland) is voluntary and vaccine is distributed through pharmacies, but in the case of swine flu there are suggestions that vaccination should be done on the national level and founded by the government. Many countries already decided to do so.

What is the reasoning behind?

 

[DanP]

What is the reasoning behind?

Stupidity.

 

[Topher925]

...and don't forget ignorance.

 

[windwitch]

I live in Canada, and in here we have also issued a national Swine Flu vaccination. I can't help but agree that it is out of plain stupidity that the vaccination is being so widely issued.

It is all political. If we do not issue a national swine flu vaccination plan, laypeople will believe that the government is incompetent. If we do issue a national swine flu vaccination plan, nonlaypeople will believe that the government is incompetent. Machiavellian methods say that you only need to please the majority, as long as the minority is a very very small minority and scientifically informed people are a very very small minority.

 

[berkeman]

Here is what I sent to my ERT team here at my work. The issue isn't what H1N1 will do to you if you are healthy, the issue is the capability of H1N1 to spread much more widely than the seasonal flu, and what that could do to the at-risk populations.

The fundamental issue with the H1N1 virus is that young people up to about 25 years old have basically zero immunity to the virus. That makes the infection rate much higher than the seasonal flu and cold viruses, which means that many more (10x? higher-x?) people get the H1N1 flu. This exposes many more high-risk folks (not necessarily under 25) to the virus, which can and will lead to many more deaths this year compared to a normal flu year, unless we all work together to try to sever the infection pathways.

Best case, all of our efforts to sever infection pathways pays off some, and we blunt the order-of-magnitude higher spread of H1N1, and keep the order-of-magnitude of high-risk folks from dying. Worst case, we don't and lots more people die because of this pandemic.

 

[berkeman]

BTW, my sister, and a couple other close relatives, have medical conditions that would make catching the H1N1 virus (or any strong flu virus) a life-threatening ordeal. I don't like the way the odds are increased of them catching a flu virus by other folks not getting vaccinated this year.

 

[DanP]

BTW, my sister, and a couple other close relatives, have medical conditions that would make catching the H1N1 virus (or any strong flu virus) a life-threatening ordeal. I don't like the way the odds are increased of them catching a flu virus by other folks not getting vaccinated this year.

I am very sorry for the condition of your sister and other members of your family.

But the questions is, if they are part of a population with risks, why they don't get the vaccine ? Unless they suffer buy some immune disease in which getting vaccinated represent a risk, they should take all required steps to protect themselves.

We can't blame population at large if they choose not to get an immunization, can we ? If you are at risk, get an immunization

 

[berkeman]

I am very sorry for the condition of your sister and other members of your family.

But the questions is, if they are part of a population with risks, why they don't get the vaccine ? Unless they suffer buy some immune disease in which getting vaccinated represent a risk, they should take all required steps to protect themselves.

We can't blame population at large if they choose not to get an immunization, can we ? If you are at risk, get an immunization

Good point, and yes, they are getting vaccinated as high risk priority patients. But since the vaccine wasn't available at the beginning of the outbreak in many areas (and still isn't in some areas), the more folks getting vaccinated, the better.

And although my sister and mother in law have good health insurance coverage, and can now get the vaccine at their primary care physician's offices, that is not true for a large number of other at-risk people.

As a member of our local Medical Reserve Corps (MRC) and Community Emergency Response Team (CERT), I have been helping at the mass immunization clinics that our county Public Health Department has been sponsoring for un-insured folks. Last weekend we had about 3000 people come through our Point of Dispensing (POD) clinic in Fremont (CA) in 5 hours, and this coming weekend we expect a similar number at a POD in Newark. We've trained and exercised these mass dispensing clinics before, but this is the first time we've activated them on a large scale for real.

http://www.acphd.org/H1N1/documents/POD_Clinic_Schedule_Current.pdf

.

 

[Evo]

Good point Berkeman, a lot of the elderly and poor won't have access to the vaccine or be able to afford it. They're also the ones that won't be able to get help until it's too late if they do catch it.

 

[mgb_phys]

It's even funnier in my bit of Canada.

Swine flu vacination is apparently less effective if given after the regular flu shot (although only in this and one other province ?)
But stocks of swine flu vaccine are scarce/delayed.
So all the regular flu shots have been canceled !

 

[cristo]

Good point Berkeman, a lot of the elderly and poor won't have access to the vaccine or be able to afford it. They're also the ones that won't be able to get help until it's too late if they do catch it.

How expensive is a vaccine? Shouldn't one's health insurance cover the vaccine for those who are high risk?

 

[berkeman]

How expensive is a vaccine? Shouldn't one's health insurance cover the vaccine for those who are high risk?

If you have health insurance, then the co-pay is probably nominal, $10 or so.

Walk-ins at the drug stores pay about $30 for the seasonal flu shot, and hopefully the H1N1 shot/spray will be comparable. So it's not cost prohibitive, but not free either.

Also, at least right now, with H1N! vaccine still in short supply, the triage is turning out to be at-risk patients who have health insurance and doctors (so they have a place to get the shot), and the free mass immunizations for un-insured folks like the PODs that I've been volunteering at. I don't think I've seen any places yet where drop-ins can get the H1N1 shot for $30.

 

[Moonbear]

Good point Berkeman, a lot of the elderly and poor won't have access to the vaccine or be able to afford it. They're also the ones that won't be able to get help until it's too late if they do catch it.

They're also the ones likely to be shut-ins who aren't in contact with many people who will give it to them.

People who are care-givers for the elderly, though, are on the list of people who should get the vaccine.

Right now, we still have shortages of the vaccine. From a public health standpoint, it is better for those with low risk of complications, and who are not directly responsible for care of someone who is high risk, to not get the vaccine. Save what is available for the high risk population. Those who are lower risk of complications, the best course of action is to self-quarantine if they think they have flu, to avoid spreading it.

Those high risk populations, though, are also at risk for complications from seasonal flu. It doesn't even seem like as many people are developing those complications with swine flu. Sure, the media makes it sound really bad, because they're reporting EVERY case of someone going to the hospital with swine flu, but really, those numbers are still really low. The press went crazy around here when they were reporting ONE student from a local school died from swine flu. More than a week later, we find out, oh, yeah, that student had MS and was on immunosuppressant therapy...no longer front page news now that all the local parents are already worked up into a froth about a "kid" dying from swine flu.

The physicians in our student health office don't seem overly worried. They are following CDC guidelines, and recommending students who think they have flu just stay home and don't even bother going to a doctor unless they do have some other underlying medical condition or it doesn't follow the predicted course.

On the other hand, I do know of one coworker whose daughter has had a violent reaction to the vaccine (they are starting vaccination in the elementary schools). She's an otherwise healthy child, and ended up hospitalized, unable to breathe within a few hours following her vaccination. She has not had any vaccine reactions before. So, I would NOT force this vaccine on anyone.

 

[Proton Soup]

one kid with a bad reaction? now you're using anecdote to make decisions. ;)

really tho, the press isn't entirely to blame here. one of the WHO pamphlets i saw was recommending that people store up 2 months' supply of food.

 

[DanP]

e.

On the other hand, I do know of one coworker whose daughter has had a violent reaction to the vaccine (they are starting vaccination in the elementary schools). She's an otherwise healthy child, and ended up hospitalized, unable to breathe within a few hours following her vaccination. She has not had any vaccine reactions before. So, I would NOT force this vaccine on anyone.

Is immunization in school made without parental accept ? Or was it just a unfortunate case where parents did accept for immunization ?

 

[Evo]

Severe reactions to the vaccine are extremely rare. They are tracking this more closely now because of the irrational fear of vaccines being proliferated through the internet. i posted an articvle about this in another thread.

I was at the doctor today and he said that many people are coming in thinking they have the flu, and only a few of them do. The actual documented cases of seasonal and swine flu seem to be normal for this time of year. The difference is in the reporting, more people are going to the doctor and more peopel are being tested, that makes it "seem" like there are more cases, the CDC has said any increase in reported cases is due to the new reporting. I posted that also.

 

[berkeman]

Good point, and yes, they are getting vaccinated as high risk priority patients. But since the vaccine wasn't available at the beginning of the outbreak in many areas (and still isn't in some areas), the more folks getting vaccinated, the better.

And although my sister and mother in law have good health insurance coverage, and can now get the vaccine at their primary care physician's offices, that is not true for a large number of other at-risk people.

As a member of our local Medical Reserve Corps (MRC) and Community Emergency Response Team (CERT), I have been helping at the mass immunization clinics that our county Public Health Department has been sponsoring for un-insured folks. Last weekend we had about 3000 people come through our Point of Dispensing (POD) clinic in Fremont (CA) in 5 hours, and this coming weekend we expect a similar number at a POD in Newark. We've trained and exercised these mass dispensing clinics before, but this is the first time we've activated them on a large scale for real.

http://www.acphd.org/H1N1/documents/POD_Clinic_Schedule_Current.pdf

.

For those interested, here is a training video that we use for our volunteers for the POD sites. The video is geared more towards a terrorist weaponized anthrax attack, and our response with antibiotics dispensing at the PODs, but if you just substitute "H1N1 vaccination" for "receive antibiotics", the overall flow is pretty much the same.



I was especially impressed by the Command Staff at our H1N1 POD in Fremont last weekend, by the way that they worked to find bottlenecks and fix them real-time. Very impressive and experienced folks to work with. But they get a lot of practice at wildland fires and MCAs. Great experience.

 

[DanP]

Severe reactions to the vaccine are extremely rare. They are tracking this more closely now because of the irrational fear of vaccines being proliferated through the internet. i posted an articvle about this in another thread.

Maybe, but its not the point. As far as I know, there is still outgoing research in immunology on the topics of vaccines and autoimmune diseases. The point is , if you don't need a inoculation, don't do it. Irrational fear tends to get substance when it happens to your child, Id say :P

 

[Ygggdrasil]

Children have also died because of H1N1, so there are irrational fears for on both sides of the issue. You have to look at the risks on both sides and decide whether it is a greater risk to be vaccinated or not to be vaccinated? What are the risks associated with getting vaccinated? How often do adverse reactions happen? If you are not vaccinated, how likely are you to get H1N1? What are the potential consequences of getting H1N1?

 

[martharon]

Might be i hope to avoid the unnecessary rise in cost of the vaccine they have decided so.

 

[mgb_phys]

You have to look at the risks on both sides and decide whether it is a greater risk to be vaccinated or not to be vaccinated?

It's also a population game, the more other people are vaccinated the less chance of you catching H1N1 - so it's best for everybody but you to be vaccinated.

 

[vanesch]

I'm in doubt, actually. Here in France, there will be a national vaccination campaign, and kids at school (with parents' approval) will be vaccinated around the end of the month. I would tend to have my kid have his shot, but my wife is rather of the opposite opinion (not because of disinformation, but her idea is that you should only take medicine if there's a real need - and the flu is no real need for her - kids do get sometimes a flu, this has been so since years without any discussion around it, so why should one do anything different now). I think I will follow her PoV, for the trivial egoistic reason that if ever things turn out sour, it will be her fault, and not mine...

I myself will get a flu shot if I can. I have taken flu shots for the last 15 years or more, and don't see why I shouldn't get this one. I already took the "normal" flu shot, but as I'm in no special target group, I will get my shot probably pretty late (mid-december ?). I simply don't want to ruin my skiing holidays with a flu - but that's about as far as my reasoning goes.

 

[Moonbear]

Children have also died because of H1N1, so there are irrational fears for on both sides of the issue. You have to look at the risks on both sides and decide whether it is a greater risk to be vaccinated or not to be vaccinated? What are the risks associated with getting vaccinated? How often do adverse reactions happen? If you are not vaccinated, how likely are you to get H1N1? What are the potential consequences of getting H1N1?

The point is that this particular vaccine may have more side effects than other flu vaccines. The chance of an otherwise healthy child dying of flu are miniscule. The deaths being reported from the 2009 H1N1 are primarily people with other underlying conditions. Compared to other strains of flu, the symptoms are actually quite mild. So, to me, it is not very sensible to get a vaccination that has a high risk of side effects to treat a mild illness with a low risk of serious complications. The only thing "special" about swine flu is that it isn't following the regular seasonal patterns of other strains of flu. I have had a lot of physicians tell me that if they were not working in the clinics where they needed to be concerned about their patients, they would not be getting this vaccination either.

I think it is completely reasonable for people to decide they want to wait and see what the data are on incidence and severity of adverse reactions to this current vaccine in the general population before they get it for themselves. The reality is that there isn't much evidence of adverse reactions because there isn't much data on it. This year's vaccine recipients are the experimental subjects who will provide the dataset of adverse reactions.

 

[martharon]

Dont know for sure is it true that if a normal person takes the swine flu vaccination will it be fatal? , if that's the case, then it might also be a reason.

 

[hypatia]

Dont know for sure is it true that if a normal person takes the swine flu vaccination will it be fatal? , if that's the case, then it might also be a reason.

Their is no truth to that statement what so ever. Thousands of normal people have received the vaccination with no bad effects at all.

 

[DanP]

I think I will follow her PoV, for the trivial egoistic reason that if ever things turn out sour, it will be her fault, and not mine...

Way to go !

I myself will get a flu shot if I can. I have taken flu shots for the last 15 years or more, and don't see why I shouldn't get this one.

I never took any flue vaccine , and frankly can't recall in the last 10 years if I ever got flue.
Judging by the intensity of symptoms and recovery times, I don't believe I ever got anything else but colds. One time it got serious, but it turns out it was bacterial and I had to take antibiotics. My holidays were never ruined.

I see no much use to take immunizations only for the sake of it.

 

[vanesch]

Way to go !

I never took any flue vaccine , and frankly can't recall in the last 10 years if I ever got flue.
Judging by the intensity of symptoms and recovery times, I don't believe I ever got anything else but colds.

I had the flu twice (at least, that's what the doctor told me back then - without any specific test), and I really got it badly: 2 weeks in bed, and several weeks afterwards not quite ok. I think each time I got a bacterial complication following it.

Since then, I always take a flu shot. Not because I "fear for my life" but rather because I want to avoid the unpleasantness of being so ill.

 

[DrGreg]

I think one of the reasons governments are worried about swine flu is the risk that large numbers of people could fall ill at the same time. This could leave essential services understaffed.

 

[CRGreathouse]

I think one of the reasons governments are worried about swine flu is the risk that large numbers of people could fall ill at the same time. This could leave essential services understaffed.

That's precisely why I got (had to get?) my shot.

 

[Borek]

large numbers of people could fall ill at the same time.

That's precisely why I got (had to get?) my shot.

And now you will get ill at some other time?

 

[berkeman]

And now you will get ill at some other time?

Yeah, but I think he had a good point. At my work, that's one of the contingency plans that we've had to work on because of H1N1. We have a number of employees with VPN access that regularly telecommute, but to have 10x that number with VPN access for a few weeks would be a very expensive option.

 

[vanesch]

Yeah, but I think he had a good point. At my work, that's one of the contingency plans that we've had to work on because of H1N1. We have a number of employees with VPN access that regularly telecommute, but to have 10x that number with VPN access for a few weeks would be a very expensive option.

This is already the case at our place. There was a rather drastic plan beginning september, when a peak of infection was expected beginning of october: even planning to put some healthy people in quarantine, to "keep them" for during the peak (essentially reactor operators), and send all the rest home, with VPN connections in order not to compromise the health of those that are absolutely necessary. But that peak turned out not to be the case (maybe due to the exceptionally nice weather we had for most of the autumn). Now that vaccination campaigns have started, unless we get a sudden very strong peak in the coming 2 or 3 weeks, this worry is probably behind us.