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Richard Bath: Missing the point of swine flu
Source: http://news.scotsman.com/opinion/Ric...int.5907420.jp
Richard Bath: Missing the point of swine flu
Published Date: 13 December 2009
SHORTLY before midday yesterday, protestors met outside St Giles' Cathedral in the heart of Edinburgh's Old Town before striding purposefully down the Royal Mile.
The Scottish Parliament was the immediate objective for this rag-tag band of activists, but their final destination was no less than the complete derailment of the government's plans to immunise Scotland's at-risk population ? which primarily means pregnant mothers and all under-fives ? against swine flu.
According to health minister Nicola Sturgeon, they are pursuing a reckless cause that risks the health of unborn babies and the nation's preschool children. Were the Vaccine Awareness Network's protests to succeed, say Health Protection Scotland, there might be needless deaths.
Yet this is unlikely to deter Claire Knox, a young mother from the Edinburgh district of Trinity. She is one of a growing number of deniers, people utterly convinced that government doesn't know best. They think the risk to their children's health from vaccines is immeasurably worse than the possibility that they will be killed by swine flu, and that behind the scenes, drugs multinationals are manipulating the evidence for their own commercial ends.
"I'm just an ordinary citizen who is sick to death of the rubbish, the propaganda that is spewed out about swine flu vaccines," said Knox. "I'm very concerned about the issue of vaccines across the board, but specifically this one. They keep saying it's safe but they're injecting H1N1 (the scientific name of the strain of the flu virus] into the bloodstream, and they've simply no idea of what the long-term consequences might be.
"The possibility of this vaccine being given to my child (seven-month-old daughter Mae] is enough to make anyone want to act. That's why my husband Jonathan and I decided to stage this protest. We initially thought that it would be just the two of us, but as soon as word began to spread, so many people got in touch and it's just snowballed from there. We've clearly struck a chord with people in general and other parents in particular."
That possibility is worrying the country's medical authorities. The scare that the combined measles-mumps-rubella vaccination might be linked to autism was responsible for a shortfall in vaccinations that undermined efforts to achieve the 90 per cent levels of immunisation to ensure herd immunity. Although the number of refuseniks was substantially bigger in England than in Scotland, avoiding such a revolt by parents over the swine flu vaccine is now a priority for the government.
Although the constantly evolving nature of swine flu means that herd immunity is not the goal, Scotland's chief medical officer Dr Harry Burns believes that with the onset of winter the failure to immunise a substantial majority of at-risk groups ? of whom only 27.5 per cent have so far had the swine flu vaccine ? could kill a significant number of vulnerable Scots. He was also keen to react to the charges from protestors ? that immunisations will be mandatory, and so tantamount to state coercion ? and the allegation that the vaccine has yet to be properly tested.
"The H1N1 vaccination is not mandatory," said Burns. "However, vaccination is our best defence against the pandemic and I urge everyone invited for vaccination to take up the offer ? particularly pregnant women, whom we know are more at risk of developing complications if they contract this illness.
"Both H1N1 vaccines have been licensed by the European Medicines Agency and the European Commission. We have always stated that we would only use the vaccine if we have confidence in its safety."
Burns and his fellow health professionals are staging a concerted campaign to ensure that Britain doesn't follow the example of the US, where a campaign against universal immunisation for children spooked parents, with the result that just 52 per cent of American children have been vaccinated against H1N1.
One problem is the attitude of those who have to administer the vaccines, general practitioners. Despite lengthy talks there is still an impasse over the terms under which some GPs would be prepared to immunise children and pregnant women. The government was offering ?5.25 per jab, while the BMA was holding out for ?7 and a formal understanding that there would be a temporary moratorium on meeting the 48-hour waiting time target upon which surgeries are paid.
Some GPs may also be unconvinced of the need for the vaccination. A survey in Pulse magazine found only 41 per cent would be taking the jab themselves. Richard Hoey, the editor of Pulse, said: "The medical profession has yet to be convinced by the government's whole approach to swine flu, with most GPs now feeling that the Department of Health overreacted in its policy on the blanket use of Tamiflu (an antiviral given to those who contract swine flu]. The view among many doctors is that the government hasn't yet made its case for why such a huge vaccination programme needs to be rushed in for what seems an unusually mild virus."
There seems some basis in fact for the medical profession's scepticism. Not only did the National Institute for Clinical Excellence refuse to approve Tamiflu a decade ago because it considered it ineffective, but the last major review of the drug, by the Cochrane Collaboration, which reviewed 20 studies and published its findings on the British Medical Journal website in 2005, found "no clear evidence" to support the maker's insistence that the ?500m stockpile of Tamiflu will reduce the risk of patients developing the life-threatening complications that accompany swine flu, such as pneumonia.
The problems with diagnosing swine flu have also been an open goal for the deniers. The World Health Organisation says that healthy people with straightforward symptoms shouldn't be prescribed antivirals, yet the Health Protection Agency has admitted that across Britain one million people have been given an antiviral, including 800,000 people who were wrongly diagnosed as having swine flu by inexperienced emergency helpline staff. At one stage, only one in 20 of those diagnosed actually had swine flu. Not only did those 800,000 people take a day off work, but each was prescribed a course of Tamiflu costing ?15.
This is at the nub of many of the deniers' wildest accusations. The conviction that the swine flu pandemic is simply a massive conspiracy by greedy drugs companies to make windfall profits is whizzing around cyberspace and poisoning rational debate. There is certainly a good case to question why a disease that has only killed just over 150 Britons ? compared to 4000-8000 annually for winter flu, and 21,000 in the last epidemic in 1992; not to mention 230,000 British deaths in 1918, 33,000 in 1957-58, and 30,000 in 1968-69 ? is worthy of being labelled a pandemic.
But some of the more lurid accusations move well outside such legitimate questions. The heroine of the hard-core deniers, an Austrian single-issue obsessive called Jane Burgermeister, who is currently suing pharmaceuticals company Baxter for allegedly releasing 72kgs of bird flu-contaminated vaccine in order to foment a pandemic, has become a cause c?l?bre. On her hugely popular blog, www.theflucase.com, she outlines a whole range of apparent revelations and quasi-scientific theories, such as the alleged causal link between the devastating Guillain Barre Syndrome and swine flu vaccination. She's like MMR refusenik Dr Andrew Wakefield, climate change sceptic George Bush and 9/11 conspiracy theorist Dylan Avery all rolled into one, but she and people like her are providing a theoretical basis, no matter how flawed, for rejecting mass immunisation.
If the musings of background figures like Burgermeister provide a pretext for those who dispute the need to vaccinate all at-risk groups against swine flu, then the current trends have made their protests against the immunisation campaign all the more shrill. Tests indicate that one third of British children have had swine flu, but that only 10 per cent have shown any symptoms, while in Scotland all the indicators are that, after 54 deaths, the disease is on the decline. The number of Scots who contracted swine flu last week was 8,900, down 27.6 per cent on the week before, and the number of Scots hospitalised last week was 70, compared to an average of 144 for the four weeks before that, representing a drop of 57 per cent. Meanwhile, the number of antivirals prescribed last week was 39 per cent lower than in the preceding week.
Statistics, however, are always problematic. In particular, they mask the fact that, while only two under-fives have so far died of the disease, the rate of kids aged four and under going to doctors' surgeries has doubled in the past week. They also conceal that the highest rate of hospitalisations for swine flu is now among that same 0-4 age group, which are running at three to four times the Scottish average. The elderly, so often the most vulnerable sector of society, seems to have a high degree of immunity, as anyone over 50 may have built up a degree of immunity from the previous pandemic.
The decision to try to immunise all children under the age of five is, in many regards, a belt-and-braces approach that recognises that most pandemics have a second, more deadly, wave, and that the rates of complications in the under-fives are already significantly higher than for any other segment of the population.
As Martin Donaghy, the health director of Health Protection Scotland, says: "Although levels of the infection are starting to fall, it is likely to take some weeks before they cease to be a significant public health problem. With the winter starting, the incidence of other respiratory pathogens ? including bacterial ? is likely to increase, which may lead to a worsening of the clinical spectrum. It is therefore in the interests of children to receive the swine flu vaccination."
That simply won't wash with Knox and her colleagues. Nothing less than the cessation of the immunisation campaign will satisfy her, although "empowering people and giving them the information they need to make up their own minds" will come a close second-best, she says.
"There are people out there who will look at me and see some sort of nutter and crackpot conspiracy theorist," she says, "but it's outrageous that we've reached level 6 pandemic on the back of dodgy figures. Someone's got to fight the vested interests and campaign on behalf of children who are too young to stand up for themselves. I owe my daughter that."
Treatment timetable for H1N1 vaccination
The Scottish Government, along with the administrations of the other UK nations, has purchased sufficient vaccine to protect the whole population if required. The initial vaccination programme, already underway, has been split into three main phases.
1) Guidance has already been issued to GPs, who have been told to use their limited supplies of the H1N1 vaccine to immunise the following at-risk groups first. These are:
? People aged over six months and up to 65 years in the current seasonal flu at-risk groups
? All pregnant women
? Household contacts of people with compromised immune systems, for example people in regular close contact with patients on treatment for cancer
? People aged 65 and over in the current seasonal flu at-risk groups. This does not include otherwise healthy over-65s, since they appear to have some natural immunity to the virus
? Healthcare workers with direct patient contact and social care staff employed to provide care to children and adults.
So far, only 27.5 per cent in these at-risk groups have been vaccinated.
2) All children aged between six months and five years are to be invited to receive their pandemic flu vaccination. Children will begin to be invited for vaccination before the Christmas break and the programme will proceed throughout January.
3) Preparations are continuing to extend the programme and the Joint Committee on Vaccination and Immunisation have advised use of the vaccine in the wider population should depend on the evolution of the pandemic as well as new and emerging clinical data.
Page 1 of 1
* Last Updated: 12 December 2009 7:44 PM
* Source: Scotland On Sunday
* Location: Scotland
Richard Bath: Missing the point of swine flu
Published Date: 13 December 2009
SHORTLY before midday yesterday, protestors met outside St Giles' Cathedral in the heart of Edinburgh's Old Town before striding purposefully down the Royal Mile.
The Scottish Parliament was the immediate objective for this rag-tag band of activists, but their final destination was no less than the complete derailment of the government's plans to immunise Scotland's at-risk population ? which primarily means pregnant mothers and all under-fives ? against swine flu.
According to health minister Nicola Sturgeon, they are pursuing a reckless cause that risks the health of unborn babies and the nation's preschool children. Were the Vaccine Awareness Network's protests to succeed, say Health Protection Scotland, there might be needless deaths.
Yet this is unlikely to deter Claire Knox, a young mother from the Edinburgh district of Trinity. She is one of a growing number of deniers, people utterly convinced that government doesn't know best. They think the risk to their children's health from vaccines is immeasurably worse than the possibility that they will be killed by swine flu, and that behind the scenes, drugs multinationals are manipulating the evidence for their own commercial ends.
"I'm just an ordinary citizen who is sick to death of the rubbish, the propaganda that is spewed out about swine flu vaccines," said Knox. "I'm very concerned about the issue of vaccines across the board, but specifically this one. They keep saying it's safe but they're injecting H1N1 (the scientific name of the strain of the flu virus] into the bloodstream, and they've simply no idea of what the long-term consequences might be.
"The possibility of this vaccine being given to my child (seven-month-old daughter Mae] is enough to make anyone want to act. That's why my husband Jonathan and I decided to stage this protest. We initially thought that it would be just the two of us, but as soon as word began to spread, so many people got in touch and it's just snowballed from there. We've clearly struck a chord with people in general and other parents in particular."
That possibility is worrying the country's medical authorities. The scare that the combined measles-mumps-rubella vaccination might be linked to autism was responsible for a shortfall in vaccinations that undermined efforts to achieve the 90 per cent levels of immunisation to ensure herd immunity. Although the number of refuseniks was substantially bigger in England than in Scotland, avoiding such a revolt by parents over the swine flu vaccine is now a priority for the government.
Although the constantly evolving nature of swine flu means that herd immunity is not the goal, Scotland's chief medical officer Dr Harry Burns believes that with the onset of winter the failure to immunise a substantial majority of at-risk groups ? of whom only 27.5 per cent have so far had the swine flu vaccine ? could kill a significant number of vulnerable Scots. He was also keen to react to the charges from protestors ? that immunisations will be mandatory, and so tantamount to state coercion ? and the allegation that the vaccine has yet to be properly tested.
"The H1N1 vaccination is not mandatory," said Burns. "However, vaccination is our best defence against the pandemic and I urge everyone invited for vaccination to take up the offer ? particularly pregnant women, whom we know are more at risk of developing complications if they contract this illness.
"Both H1N1 vaccines have been licensed by the European Medicines Agency and the European Commission. We have always stated that we would only use the vaccine if we have confidence in its safety."
Burns and his fellow health professionals are staging a concerted campaign to ensure that Britain doesn't follow the example of the US, where a campaign against universal immunisation for children spooked parents, with the result that just 52 per cent of American children have been vaccinated against H1N1.
One problem is the attitude of those who have to administer the vaccines, general practitioners. Despite lengthy talks there is still an impasse over the terms under which some GPs would be prepared to immunise children and pregnant women. The government was offering ?5.25 per jab, while the BMA was holding out for ?7 and a formal understanding that there would be a temporary moratorium on meeting the 48-hour waiting time target upon which surgeries are paid.
Some GPs may also be unconvinced of the need for the vaccination. A survey in Pulse magazine found only 41 per cent would be taking the jab themselves. Richard Hoey, the editor of Pulse, said: "The medical profession has yet to be convinced by the government's whole approach to swine flu, with most GPs now feeling that the Department of Health overreacted in its policy on the blanket use of Tamiflu (an antiviral given to those who contract swine flu]. The view among many doctors is that the government hasn't yet made its case for why such a huge vaccination programme needs to be rushed in for what seems an unusually mild virus."
There seems some basis in fact for the medical profession's scepticism. Not only did the National Institute for Clinical Excellence refuse to approve Tamiflu a decade ago because it considered it ineffective, but the last major review of the drug, by the Cochrane Collaboration, which reviewed 20 studies and published its findings on the British Medical Journal website in 2005, found "no clear evidence" to support the maker's insistence that the ?500m stockpile of Tamiflu will reduce the risk of patients developing the life-threatening complications that accompany swine flu, such as pneumonia.
The problems with diagnosing swine flu have also been an open goal for the deniers. The World Health Organisation says that healthy people with straightforward symptoms shouldn't be prescribed antivirals, yet the Health Protection Agency has admitted that across Britain one million people have been given an antiviral, including 800,000 people who were wrongly diagnosed as having swine flu by inexperienced emergency helpline staff. At one stage, only one in 20 of those diagnosed actually had swine flu. Not only did those 800,000 people take a day off work, but each was prescribed a course of Tamiflu costing ?15.
This is at the nub of many of the deniers' wildest accusations. The conviction that the swine flu pandemic is simply a massive conspiracy by greedy drugs companies to make windfall profits is whizzing around cyberspace and poisoning rational debate. There is certainly a good case to question why a disease that has only killed just over 150 Britons ? compared to 4000-8000 annually for winter flu, and 21,000 in the last epidemic in 1992; not to mention 230,000 British deaths in 1918, 33,000 in 1957-58, and 30,000 in 1968-69 ? is worthy of being labelled a pandemic.
But some of the more lurid accusations move well outside such legitimate questions. The heroine of the hard-core deniers, an Austrian single-issue obsessive called Jane Burgermeister, who is currently suing pharmaceuticals company Baxter for allegedly releasing 72kgs of bird flu-contaminated vaccine in order to foment a pandemic, has become a cause c?l?bre. On her hugely popular blog, www.theflucase.com, she outlines a whole range of apparent revelations and quasi-scientific theories, such as the alleged causal link between the devastating Guillain Barre Syndrome and swine flu vaccination. She's like MMR refusenik Dr Andrew Wakefield, climate change sceptic George Bush and 9/11 conspiracy theorist Dylan Avery all rolled into one, but she and people like her are providing a theoretical basis, no matter how flawed, for rejecting mass immunisation.
If the musings of background figures like Burgermeister provide a pretext for those who dispute the need to vaccinate all at-risk groups against swine flu, then the current trends have made their protests against the immunisation campaign all the more shrill. Tests indicate that one third of British children have had swine flu, but that only 10 per cent have shown any symptoms, while in Scotland all the indicators are that, after 54 deaths, the disease is on the decline. The number of Scots who contracted swine flu last week was 8,900, down 27.6 per cent on the week before, and the number of Scots hospitalised last week was 70, compared to an average of 144 for the four weeks before that, representing a drop of 57 per cent. Meanwhile, the number of antivirals prescribed last week was 39 per cent lower than in the preceding week.
Statistics, however, are always problematic. In particular, they mask the fact that, while only two under-fives have so far died of the disease, the rate of kids aged four and under going to doctors' surgeries has doubled in the past week. They also conceal that the highest rate of hospitalisations for swine flu is now among that same 0-4 age group, which are running at three to four times the Scottish average. The elderly, so often the most vulnerable sector of society, seems to have a high degree of immunity, as anyone over 50 may have built up a degree of immunity from the previous pandemic.
The decision to try to immunise all children under the age of five is, in many regards, a belt-and-braces approach that recognises that most pandemics have a second, more deadly, wave, and that the rates of complications in the under-fives are already significantly higher than for any other segment of the population.
As Martin Donaghy, the health director of Health Protection Scotland, says: "Although levels of the infection are starting to fall, it is likely to take some weeks before they cease to be a significant public health problem. With the winter starting, the incidence of other respiratory pathogens ? including bacterial ? is likely to increase, which may lead to a worsening of the clinical spectrum. It is therefore in the interests of children to receive the swine flu vaccination."
That simply won't wash with Knox and her colleagues. Nothing less than the cessation of the immunisation campaign will satisfy her, although "empowering people and giving them the information they need to make up their own minds" will come a close second-best, she says.
"There are people out there who will look at me and see some sort of nutter and crackpot conspiracy theorist," she says, "but it's outrageous that we've reached level 6 pandemic on the back of dodgy figures. Someone's got to fight the vested interests and campaign on behalf of children who are too young to stand up for themselves. I owe my daughter that."
Treatment timetable for H1N1 vaccination
The Scottish Government, along with the administrations of the other UK nations, has purchased sufficient vaccine to protect the whole population if required. The initial vaccination programme, already underway, has been split into three main phases.
1) Guidance has already been issued to GPs, who have been told to use their limited supplies of the H1N1 vaccine to immunise the following at-risk groups first. These are:
? People aged over six months and up to 65 years in the current seasonal flu at-risk groups
? All pregnant women
? Household contacts of people with compromised immune systems, for example people in regular close contact with patients on treatment for cancer
? People aged 65 and over in the current seasonal flu at-risk groups. This does not include otherwise healthy over-65s, since they appear to have some natural immunity to the virus
? Healthcare workers with direct patient contact and social care staff employed to provide care to children and adults.
So far, only 27.5 per cent in these at-risk groups have been vaccinated.
2) All children aged between six months and five years are to be invited to receive their pandemic flu vaccination. Children will begin to be invited for vaccination before the Christmas break and the programme will proceed throughout January.
3) Preparations are continuing to extend the programme and the Joint Committee on Vaccination and Immunisation have advised use of the vaccine in the wider population should depend on the evolution of the pandemic as well as new and emerging clinical data.
Page 1 of 1
* Last Updated: 12 December 2009 7:44 PM
* Source: Scotland On Sunday
* Location: Scotland