Influenza: marketing vaccine by marketing diseaseBMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3441 (Published 24 May 2013) Cite this as: BMJ 2013;346:f3441
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Explicating social and economic issues underlying vaccine policy can enrich interpretation of relevant biologic and epidemiologic data/issues. However, worsening polarization impedes useful debate and policy development in no-one’s best interest. We all share the goals of reducing health risks for individuals and communities and should avoid the lures of misleading usage. The article1 veers into this territory at several points:
Dr. Doshi refers to US influenza vaccine strategy as “a policy without an objective”, citing 2012 CDC recommendations2 that “do not even mention the effect the policy aims to achieve”. In fact, the citation is entitled “ Prevention and control of influenza with vaccines”, which seems to summarize neatly the aims of this and all vaccine programs, i.e. to reduce the incidence, transmission, and adverse consequences of vaccine-preventable infections.
To support the premise that influenza is being mongered and sold as a more severe disease than it is, the author criticizes the CDC statement that “Flu seasons are unpredictable and can be severe”3, referencing his data (Figure 1) showing “ a far less volatile and more reassuring picture” and noting that “deaths from influenza declined sharply over the middle of the 20th century…. before the great expansion of vaccine campaigns ”. This statement is intended to cast doubt on influenza severity and vaccine efficacy. A more reasonable interpretation of the data is that influenza deaths declined sharply because of improved ventilator technology for respiratory failure (driven by pre-vaccine polio epidemics), antibiotics to treat secondary pneumonia (from the 1930s onward as noted4), and even – perhaps – improved influenza vaccines.
Antibiotics and ventilators can prevent many influenza-associated deaths, but I for one am also grateful for vaccines that reduce my risk of contracting this miserable disease by an average of 60% 5, before getting to the ventilator/antibiotic point. I’m even happier if annual vaccination reduces the risk of my transmitting influenza to fragile patients or family members.
1. Doshi. Influenza: Marketing vaccine by marketing disease. BMJ 2013; 346: f3037
2. Grohskopf L, Uyeki T, Bresee J, Cox N. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP) – United States, 2012-13 influenza season. MMWR 2012; 61: 613-8.
4. Doshi P. Trends in Recorded Influenza Mortality: United States, 1900–2004. Am J Pub Health 2008; 98: 939-45.
5. Osterholm MT, Kelley NS, Manske JM, et al. The Compelling Need for Game-Changing Influenza Vaccines: An Analysis of the Influenza Vaccine Enterprise and Recommendations for the Future. CIDRAP. October 15, 2012.
Amy J Behrman, MD
Medical Director, Occupational Medicine
University of Pennsylvania
Competing interests: No competing interests