Is giving all citizens a flu shot an effective way to spend limited health dollars?

Great Debates
1

Here in Ontario, and probably the rest of Canada, and I would assume other countries with subsidized health care systems everyone is able to get a free flu shot. Now I don’t have actual numbers, but I would imagine that this costs quite a lot. I can’t imagine the big drug companies just giving away the flu vaccince for free. The health care system, in Ontario at least, is a constant source of griping, be it complaining about long wait times for surgery, closed emergency rooms/long wait times in them, not covering certain drugs and so forth. This is due basically to lack of funds.

Recently the flu shot has been under fire for its effectiveness in preventing the flu, and lowering the associated costs (sick days/emergency room visits/people dieing). According to this

CNN report

and this

Study on flu vaccine

(with thanks to Wesley Clark for the links).

CNN says this: “Of the 1,000 people who got the vaccine before November 1, 149 went on to develop influenza-like illness (14.9 percent). Of the 402 people who did not get the vaccine, 68 got an influenza-like illness (16.9 percent), the study said.”

Not a very effective rate I would say.

The study says this: “The influenza vaccine did not reduce the number of working days lost, nor did it reduce flu-related complications, deaths or hospitalizations.”

Again a rather disappointing ROI.

I don’t dispute that Influenza can be a rather deadly disease for a small subset of the population, particularly to the elderly or chronically ill. These people should probably get the flu shot. My beef is with the huge cost in tax dollars that could be spent more effectively elsewhere, such as hiring more Doctors, more nurses, giving to R & D to help cure diseases that kill or greivously harm a lot of people (cancer/heart disease/diabetes and so on). Seems to me the flu shot is a giant waste of tax payers money and I would prefer my government stop giving them away for free.
Related Straight dope threads:

about whether or not you should/are getting the flu shot

Ever so clever question asked by me

2

CNN report,

3

I am aware that both of the links provided only cover a single year, but I can’t find any other studies of past years. The fact that the flu shot did not even cover the predominant strain of flu, imo, improves my arguement. The flu shot might not even cover the flu we get, making it even more of a waste of money. I assume you were attempting to point out the opposite? Hard to tell when you don’t actually say anything.

4

Here’s what the Centers for Disease Control has to say about flu vaccine effectiveness

http://www.cdc.gov/flu/professionals/vaccination/efficacy.htm

“Adults Aged <65 Years. When the vaccine and circulating viruses are antigenically similar, influenza vaccine prevents influenza illness among approximately 70%–90% of healthy adults aged <65 years.”

This represents more of a long-term view, rather than just a one-year study of a year where there was an admittedly poor match between the vaccine and the main flu virus.

Around here the cost to get a flu vaccine, even if you don’t have insurance, is about $25 US. So presumably that is covering the cost. I paid that in cash myself this year. Employers often provide flu shots for employees. They probably get a “bulk rate” and do this based on a cost-benefit analysis of time lost from work.

Canada may well have a cost-benefit analysis based on preventing whatever % of the people who get the flu needing at least one office visit and/or prescription medication. And then some hospitalizations and deaths. Since the Canadian healthcare system also has to pick up the cost of treating the flu, as well as lost productivity that has to be accounted for somehow, they may well have a cost-benefit analysis that says making flu shots available for free to all has a positive ROI.

Alternatively, they could provide them free only to the high risk groups. A private market might well develop for people like me who think $25 is a good deal to reduce the risk of losing a week of my time to pure misery.

5

Not sure how much of a long term study that is, considering it says “A 2-year randomized study” in it, as well as not giving any time period for any of the other studies it talked about. In the link I (well Wesley Clark first found it) provided says this

“They found 25 clinical trials in which healthy people between the ages of 14 and 60 years had been randomly assigned to have a flu vaccine or a placebo (inactive) vaccine. All the trials had been published in medical journals between 1969 and 2002. Altogether they involved 59,566 participants. Here is the Cochrane Review conclusion: Influenza vaccines are effective in reducing influenza A and B, but they do not work against the overwhelming majority of influenza-like illnesses.”

Seems to me that is a long term view, 1969-2002.

The CDC also says this, “Among elderly persons not living in nursing homes or similar chronic-care facilities, influenza vaccine is 30%–70% effective in preventing hospitalization for pneumonia and influenza. Among older persons who do reside in nursing homes, influenza vaccine is most effective in preventing severe illness, secondary complications, and deaths. Among this population, the vaccine can be 50%–60% effective in preventing influenza-related hospitalization or pneumonia and 80% effective in preventing influenza-related death, although the effectiveness in preventing influenza illness often ranges from 30% to 40%.”

30-70% is a rather large range, and I think weakens the arguement.

The study linked to in the OP says the exact opposite about work days lost. So I suppose it boils to down to who do we beleive? The CDC or the Centre for Medical Consumers?

The CMC: Founded in 1976 the Center for Medical Consumers is a non-profit advocacy organization active in both statewide and national efforts to improve the quality of health care. We are entirely supported by private contributions, newsletter subscriptions, and the generous support of the Judson Memorial Church. The Center is a 501©3 corporation and contributions are tax-deductible. We take no funding from the drug and device industries.

So they are apparently free from influence from the giants of the drug industry.

The CDC is a government agency. Draw your own conclusions.

I won’t comment on the private market thing, that is a very contentious issue in Canada.

6

Sorry, it was dinnertime!

Quotes from Wesley Clark’s link.

My first problem, either it’s influenza or it’s not. “Influenza-like” is bad science, cancer-like?, heart attack-like? If your Influenza-like cold is caused by a rhinovirus or a coronavirus you DON’T have the flu. Just because the symptoms are the same, it does not make it the same disease.

What’s disingenuous is claiming the CDC put a positive spin on things!
You can’t make a vaccine if you can’t isolate and grow the virus.
I really can’t understand Fisher’s problem with the CDC, although after looking at the website she’s associated with, it sounds like she’s bordering on anti-vaccine nuttiness.

These numbers are meaningless if we can’t break down how many people actually got influenza A or B and how many just got influenza-like illnesses.

Admittedly I don’t know if rhinoviruses, coronaviruses, and influenza A and B viruses are so closely related that a vaccine made from influenza would give some limited protection from rhino/coronaviruses, but I doubt it.

7

I don’t know where anyone got information that the CDC didn’t predict Fujian A would be a major player; they had. The problem was exclusively that the companies couldn’t get it to grow n time, not with using the antiquated egg technology that they are currently stuck with. They came at the appointed time and told the truth: “We can’t get it to grow yet, maybe in another month or so. Tell us to do that and we’ll do our best, but given egg technology we’ll never make more than half of what you want us to make in time. There would be a shortage. Or approve last years shot and hope for cross coverage.” They went for the latter, hoping that they were wrong about Fujian A or that there would be good cross coverage. Turned out the nasal flu vaccine did pretty good, but not the shot.

The CDC crystal ball gazers almost always do damn good. The problems are entirely different than that.

Big problem number one: Production methods are antiquated and slow but that is what is approved. One of the best things about Bush’s pandemic preparedness proposal is over $2 billion to bring cell culture technology for influenza vaccine production on line. Bluntly put, the money and lives saved by that in regular year in and year out influenza vaccine readiness will pay for the rest of pandemic preparation in just a few years.

But to the op … which asks about immunizing everyone, not just high riskers. And this is actually a key question. It may be that aiming to immunize high riskers is exactly the wrong target. Ram Yogev explains it well in this month’s Pediatrics

High riskers have a fairly limited response to vaccination whereas kids respond vigously. The disease speads via kids in schools and daycares to parents to workplaces to high riskers. Stop it in the schools and you do more for the high riskers than by immunizing them directly. Immunize everyone and you get real effective herd immunity, and really protect the high risk crowd from getting exposed in the first place. That’s when the savings starts to explode.

8

Well I must say the piece quoted by you was rather interesting and informative. I do have a question though (it could be I am just reading it wrong) but this line:

does the (17.5-48.1%) mean a spread of 30.6%? Again that seems like a very large range. Is this common in medical studies? As the CDC article provided Harriet the Spy also seemed to have a very large range.

Does this mean you think we should just immunize children? Or that we should give everyone the shot? As well, if we are to give everyone the shot, should it be mandatory, because wouldn’t people like me who have never recieved the flu shot and probably never will (unless I am convinced otherwise).

To crowmanyclouds no problem, I hope your dinner was good :).

I would guess not. My next question would be, how common is this? If it is common, it would seem to support my point, that the flu vaccince is a giant waste of taxpayers dollars.

However I do suppose that supports Dseid’s point that the problem isn’t the flu shot but rather the infrastructure.

9

WAG reduction per age group, i.e. 17.5% in ages a-b, 48.1% in ages d-e.

10

Not too uncommon. That particular study doesn’t have its abstract online but one farther down (Peidra et al) does. Their 8 - 18% figures refers to the numbers spread over three different seasons. I suspect that such is the range refered to in this study as well. There are a lot of other uncontrolled variables going on.

I think that within five years you will see the policy wonks all advising annual vaccination for all school kids and that such will likely become a requirement for public school attendence in most states soon after. (Although as this would be an annual event in late Fall, after school start, enforcement would be tricky.) This will be in addition to advising the targetting of high risk individuals, and others as supplies and interest allow. The precedent of mandating childhood immunization for the benefit of others than the child vaccinated is well established (Rubeola, aka German Measles, never caused serious illness in kids. We immunized for it to prevent pregnant women from catching it as that disease caused serious problems to a developing fetus and subsequent birth defects.) The rest would be encouraged but not required. Another advantage from the infrastructure perspective is that it allows a bit more predictability in demand for the manufacturers.

11

Really? This kind of huge range is accepted in medical studies? I admit to never having run an expirement, so I have no real idea about the actual results you get, however a range of this sort seems somewhat unacceptable to me. To my thinking something that works almost 50% of the time is well effective, and a potentially worthwhile way to spend money. However something that works less then 1/5 of the time would seem to be a huge waste of money. Are new drug tests run this way too? Oh this drug it works on 17.5 of the people sometimes, other times almost half the people. We think it has to do with phases of the moon and where Jupiter is.

What kind of uncontrolled variables? How come they weren’t controlled? Is it inherently impossible to control these variables?

Never knew that about German Measles, I suppose that isn’t to shocking with my lack of medical knowledge, and scientific as well to be honest (never was good at the hard sciences). Thank you for the knowledge you are imparting. Hell, maybe I will get a flu shot, mind control be damned!

12

These are studies that look at the effect of vaccinating one subpopulation on the rate of a disease iin the community at large (including the unvaccinated) over multiple seasons. They are not benchtop studies. Different numbers actually get the vaccines in both populations year to year. The bug is different each year, the weather is different, and on and on. Depending on the outcome and the intervention, a positive effect of 5% may be very significant … reducing 5% of deaths would be a big deal if death from a particular disease process was common enough and the intervention benign and cheap enough. In every case you need to do a real and honest cost benefit analysis.

13

Bolding mine.

This set off some red flags. It seems a little odd that a church is going around funding a healthcare advocacy site.

They seem like a pretty cool church where I might like to get my religion, but not my science.

Here are links to 2 sermons they post online regarding healthcare issues

http://www.judson.org/sermons/laarman/01-27-02.htm

http://www.judson.org/sermons/guests/02-29-04_levin.htm

A brief quote from the 2nd link

"The Center has always encouraged an inclusive view of what health information should be accessible to support consumers and patient’s ability to make informed decisions. From the beginning we had no doubt that information about non-allopathic (herbs, needles, hands, tinctures, and the like) medicine, in all its forms should be integrated into the Center’s information services. We had no other choice if we really valued an individual’s capacity and right both to define their own goals and to make choices designed to achieve those goals. And if we believed much of allopathic medical practice was itself not supported by evidence then there was no rationale for excluding alternative or complimentary healing modalities on the basis of a lack of scientific rigor. ’

It’s not that I completely disagree with them, they make some valid points, but in terms of citing a source these folks certainly have an agenda.