Learning valuable public health lessons from influenza vaccination

In response to low immunization rates in my community, I served on a task force to develop a community-based pilot to increase influenza vaccination. We worked in collaboration with the NYC Department of Health and Mental Hygiene, Department for Aging, Visiting Nurse Services of New York (VNSNY) and a local church health ministry.

On a Sunday morning in late November (during the CDC’s National Influenza Vaccine Week) nearly 100 African-Americans received their flu shots, we also held informational talks to dispel myths and fears, made time for physician-led Q&A and served healthy refreshments throughout the day, anyone was welcome to attend. A few doctors and nurses also received their flu shots to demonstrate leadership.

We carried the message, “Flu shots are for the people you love. And for you. Flu shots save lives” with health alerts, announcements and relevant educational materials. Our success led to more expansive efforts.

A few years later when my community became the epicenter of the 2009 pandemic influenza A (H1N1) outbreak, I understood more clearly the significance of our unique efforts toward community immunity and health. In our neighborhood, there are many intergenerational families making vaccination important to protect those most vulnerable, the young and the elderly who often live in the same household. The outbreak began in nearby high school. The intensity of our local health department, leaders and communities working together is noteworthy. The outbreak took its natural, rapid and widespread course, but did not cause severe illness among those confirmed with 2009 H1N1 influenza or with influenza-like illness. While there were sharp increases in emergency department visits as well as overwhelming public concern local health care providers were able to manage the outbreak.

Seasonal influenza and H1N1 are different viruses — the 2011 influenza vaccine includes protection against H1N1 along other influenza strains.  It seems that every neighborhood in New York City now has multiple options to a receive flu shot and the public health messages abound locally and nationally because it’s important.

As a physician-in-training, I’ve learned valuable lessons from this experience about public health.

Katherine Ellington is a medical student who blogs at World House Medicine.

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  • http://profiles.google.com/mhirzel Mary L. Hirzel

    Medical school, it would seem, is no place for Fairy Tales.  However, that’s, apparently, just what you get and fall for all too easily.  As a non-physician, it is beyond puzzling to me.

    And sad……

    http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2811%2970295-X/abstract

  • http://twitter.com/katellington Katherine Ellington

    Mary,

    Your post reminds me of our need for balance in science and medicine.  The Lancet article is a call for more effective vaccines and the need for more research. The lack of RCT evidence is a sore spot.  We’ll just have to let the ongoing data and research continue to inform the future.  The basic principles of the flu vaccine and community immunity approaches in prevention are good for medicine.

    • http://profiles.google.com/mhirzel Mary L. Hirzel

      “The basic principles of the flu vaccine and community immunity approaches in prevention are good for medicine.”

      I’ll assume that by “good for medicine,” you mean “good for public health.  There can be no question that it is good for the medical-pharmaceutical industry.

      However, until there is some valid evidence that these things prevent the flu at a rate that exceeds the, rate of serious, life-altering adverse reactions, that statement remains pure conjecture.

      Yes, it is unfortunate that there has never been any RCT for any vaccine ever on the market.  As soon as any vaccine gains approval, the excuse not to be required to actually prove they work is always, “It would be unethical to withhold this life-saving product from a control group.”  When you think about it, it’s the PERFECT business plan, coupled, as it is now, with complete immunity from liability from all involved in the manufacture, approval, marketing and administration of these concoctions.  Since there has also never been an effort to track adverse reactions conscientiously, your future industry has NO IDEA whatsoever, what the risks are.  (Former FDA head, David Kessler is on record as estimating that somewhere between 1-10% of adverse reactions are ever even reported.)  The statement so often made to the public is “The benefits outweigh the risks,” which is based on absolutely nothing but wishful thinking, at best.  Additionally, I think we all know by now the infamous story of how the CDC comes up with it’s ludicrous estimate that the flu “kills 36,000 people in the US per year….. 

      Nonetheless, I think the concept out of which the idea of immunization grew was a brilliant idea, for it’s time.  It deserved what it never got: validation.  And, it never will be, as putting it to the test would require the courage to gamble billions of dollars in profits against truth.  Truth loses in that competition every time.

      Simply proving a vaccine provokes antibodies does NOT prove it prevents flu or anything else.

      Chew on these for a bit:

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      http://www.nytimes.com/2004/01/22/nyregion/22CHAS.html

       

      http://www.pediatricsupersite.com/view.aspx?rid=90219

       

      http://www.ncbi.nlm.nih.gov/pubmed/21880755

      Despite now understanding that there is far more to immune response and protection than the simple presence of artificially provoked antibodies, the medical industry chooses not to attempt, or even talk about, reconciling those facts with the theory (which is what it is) of vaccination.

      I do appreciate your response, and I also am aware that most – if not all – young people who decide to study medicine sacrifice greatly and work very hard to make their dreams of helping people a reality.  And, I do not usually spend any time at all responding to articles by the medical community touting the urgency of getting everyone vaccinated, as I’ve learned one does not argue about religious belief.

      However, when I saw this one and thought about how you’ve taken on this additional work during a very demanding time in your life, with every good intention, I felt the same way I do when I see those newspaper photos of toddlers peddling along with pink ribbons tied to their tricycles, biking for “The Cure.”

      If you don’t want to be used like that and you do actually want to wind up helping people by “Doing no harm,” you’ll have to get some questions answered for yourself.  (But, DON’T bring it up in medical school, if you want to finish.)

      P.S. Pasteur was wrong.  Beauchamp is where you’ll find the key to preventing disease.  It is the “terrain” and not the bug!  Vaccines are so yesterday……….

  • http://twitter.com/katellington Katherine Ellington

    There are clinicians and credible leaders around the world on both sides of this debate.  I’ve given an account here of my experience. Premeds and preclinical medical students are encouraged  to volunteer as well as do research.  We get to observe, gain exposure and have real interactions this post and are few others are reflective. The reflective practice and writing has shape my lens.

    Thanks for your comments.

    Best,
    Katherine

    • http://profiles.google.com/mhirzel Mary L. Hirzel

      Thank you, Katherine.

      I’d say there are far, far more “clinicians and credible leaders” on the “vaccines are safe and effective side” than not.

      History, however, both general and medical, is replete with examples of overwhelming consensus being absolutely wrong.  There are solid dynamics at work in creating consensus and Mark Twain grasped this and humorously and observed, 

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      “Whenever
      you find yourself on the side of the majority, it is time to pause and
      reflect.”

      Of course, the classic on this phenomenon is Thomas Kuhn’s “The Structure of Scientific Revolutions.” 

      The fact remains there are a number of unresolved, unaddressed questions about both vaccine safety and efficacy that are not being addressed by devoted adherents of the practice.  Instead, the rhetoric directed at questioners and victims of adverse reactions is becoming increasingly viscous and full of fear-mongering.  That works beautifully, frankly, but it only diverts attention from the real issues and does nothing for putting valid, though inconvenient, questions to rest.  In the long run, this approach is helping to discredit the “consensus” in the eyes of the public.

      Michael Chrichton, M.D. said it best:

      “There is no such thing as consensus science. If it’s consensus, it isn’t science. If it’s science, it isn’t consensus. Period.”

      Consensus isn’t good enough for me when making decisions about my family’s health and medical care. 

      And, it shouldn’t be for you, either.

      Every good wish,
      Mary