BY VERN
SMITH
December
7, 2000
http://www.eye.net/eye/issue/issue_12.07.00/news/flu.html
Ontario is going "overboard" with a mass
$38 million flu-shot campaign that could put some people
at risk of other medical problems while potentially
bolstering the growth of superbugs, a U.S. inoculation
watchdog warns.
Contrary to the province's slick television ad
campaign, Barbara Loe Fisher, president of the National
Vaccine Information Center in Vienna, Va., says the flu
shot is not for everyone, especially expectant
mothers. Fisher says healthy young people are better off
building up their own natural immunity to the flu -- and
that mass inoculations could contribute to the creation
of increasingly stubborn strains of the virus.
"You've gone overboard with the idea of
vaccinating everybody," says Fisher. "People
are better able to generate their own permanent
antibodies. Then, when the body is challenged with a
variation, it's better able to resist it.
"We've already created over-resistant strains
with the overuse of antibiotics. What about the overuse
of vaccines? What about never allowing the immune system
to encounter, in a natural way, a virus?
"Of course you don't want to get polio or
tetanus, but it's one thing to say everybody ought to
get a smallpox vaccine. It's quite another to say
everybody should get the flu vaccine."
Fisher says the risks to expectant mothers and unborn
babies remain unclear, and recommends that parents think
twice. "We're most concerned about pregnant women,
because mercury is contained in the flu vaccine,"
she says. "The [U.S. Food and Drug Administration]
directed manufacturers in 1999 to take mercury
thimerosal out of child vaccines, but there was no
directive to take it out of other vaccines. Yet they are
recommending pregnant women get the flu vaccine, which
gives another mercury exposure to the child."
Fisher's comments counter the province's refrain that
the shot is for everyone. "Is this a 100 per cent
guarantee that you will not pick up a viral
infection?" says Geoff Bell, a spokesperson for the
Ministry of Health. "No, but it's the best
protection we can provide."
The province's program offers free shots to all
Ontarians six months and older, and the only warnings go
out to those with allergies to components of the
vaccine, those who have had reactions to previous
vaccines and those with a history of Guillain-Barre
syndrome.
The spin from Queen's Park deems the campaign a
"three-pronged approach" to prevent healthy
people from passing the virus to those in frail health,
lower the number of sick days and take pressure off
hospital emergency rooms.
"Getting the flu is not a good thing," says
Bell. "You feel awful, you miss work. We have
cost-benefit analysis showing that when the population
gets a vaccine it's good for the economy, because people
take fewer sick days."
Fisher, however, condemns the government's campaign.
"It's insidious [to say] that everybody should have
it because it's their duty to protect everybody
else," she says. "I find this the most
dangerous and deceptive part. It's used to make people
feel guilty -- you know, 'Everybody has to do it,' when
the truth is that everybody is not taking an equal risk.
There are genetic and biological differences that make
individuals more or less able to handle vaccinations.
You are requiring people with biological differences to
take more risk than others.
"Science is not infallible in assuming these
vaccines are safe for everyone. They are not factoring
in the differences in response to the flu, let alone the
vaccine. Not everyone responds the same way."
U.S. health officials are particularly concerned
about inoculating those most vulnerable: the elderly;
residents of long-term care facilities; health-care
workers; people with heart, lung or kidney disease;
diabetics and those suffering from other chronic
disorders; and those with weakened immune systems. Of
the more than 20,000 influenza-related deaths each year
in the U.S., 95 per cent occur in people 65 and older.
But the American message is the same.
"It's recommended for everybody," says
Centers for Disease Control spokesperson Charles Sallis.
"The main thing is to protect yourself, but if you
don't have it, obviously you can't give it to someone
else."
People are being reminded of the 1918 influenza
epidemic, blamed for 20 million deaths worldwide.
"Worse," said an NBC report, recalling
epidemics in 1957 and 1968, "it could happen
again." Corporations like Boeing and Microsoft are
responding with employee vaccine programs. But,
according to the province, Ontario's universal program
is the largest in North America.
While there's no guarantee the vaccine targets the
right bugs, the odds aren't discouraging thousands from
getting it. In Toronto, free shots are available at
community centres, malls, hospitals and pharmacies until
Dec. 15, then again between Jan. 8 and 19. "They
generally find it effective," says Jann Houston,
manager of Toronto Public Health's immunization program.
"But there's no guarantee. If another strain
emerges, people wouldn't be protected from it."
While public information about flu shots has
traditionally been aimed at vulnerable groups, this
year's push targets even the young and healthy as B-tour
celebrities -- an actor from The Lion King, an
Olympic medallist -- are trotted out to take the shot.
The trouble is that there are scores of nasty viruses
making the rounds, and determining which are going to be
the flus of the year requires a lot of science and a
little luck. Each spring scientists and researchers
survey viruses around the world in an attempt to
pinpoint which will be dominant the following winter. A
vaccine made of the viruses is concocted to target them
and manufactured and marketed by pharmaceutical
companies as this year's "flu vaccine."
The Centers for Disease Control says at least three
of the targeted viruses are turning up this season, but
it can't be sure of the vaccine's effectiveness until
flu season peaks, early in the new year.
A company named Aventis
is supplying 8 million doses of vaccine in Ontario. At a
little more than $2 a dose, it's looking at sales of
more than $16 million here, and also supplying
Saskatchewan, New Brunswick, Nova Scotia, the Northwest
Territories and Nunavut.
"The track record is pretty good," says Dr.
Pierre Lavigne, the company's director of clinical and
medical affairs. "You have to go back to
the early '70s, when they thought the swine flu was
making a reappearance and they goofed, but they learned
from their experience. The flu virus does change its
genetic makeup, but that's why you come up with a new
recipe each year."
Lavigne says that mercury thimerosal -- which
maintains the product's sterility -- has been removed
from most vaccines over concerns about the effects of
repeated exposure, but that a single exposure presents
no threat. "It contains mercury in an organic
form," he explains. "It's not the type of
mercury you would see in a mercury thermometer. The
concern with thimerosal is that if you're exposed to it
a number of times, you might develop some of the health
effects that have been associated with environmental
exposure to mercury.
"The important thing to
note is that thimerosal is an issue really only for
pediatric vaccines for small children. The developing
nervous system is very sensitive, so if they're exposed
to mercury it's more likely to cause damage.
"With flu, you only need one dose," he
says. "Mercury toxicity is something you get from
being repeatedly exposed. One exposure does not pose a
risk."
Six years ago, however, researchers at San
Francisco's Medical Center suggested it was possible for
flu shots to raise levels of HIV in the blood of
infected patients. According to their report, the
vaccine stimulated the immune system to produce
antibodies that inadvertently encouraged HIV cells to
reproduce.
Most participants had three times the normal amount
of HIV in their blood for a short time after getting
vaccinated, after which replication slowed until the
viral burden decreased to pre-shot levels. The study
also found that about 60 per cent of HIV-infected
patients with low T4 cell counts were unable to mount an
effective response to the vaccine, and remained
vulnerable to the flu. Subsequent studies tend not to
dispute those findings so much as conclude that people
infected with HIV can be vaccinated for the flu
"without adverse affects."
"The health-care provider and the patient should
be aware that they might not get the fully protective
response you would get in a healthy immune system,"
Lavigne says. "Flu vaccine wouldn't pose a risk to
an HIV-positive person, [but] they might not benefit
from it."
AIDS activists here are encouraging patients to
discuss the shot with their physicians. "We don't
recommend the flu shot," says Eric Doyom of the
Community AIDS Treatment Information Exchange in
Toronto. "That's their decision, but we know that
[an HIV-positive patient] will experience an increase in
their viral load for six weeks. That's normal, because
while your body is producing immunity against the flu,
it releases some of the virus into the bloodstream. It
goes back to normal after that." (The AIDS
Committee of Toronto declined to comment on this story.)
Even healthy young patients have reported adverse
reactions to flu shots, which have been explained as the
immune system's reaction to viral matter similar to the
flu itself. However, Ontario health officials say that
those who get sick after the flu shot were probably
already infected with a virus beforehand.
"The flu vaccine cannot give you the flu,
because it does not contain live virus," Dr. Colin
D'Cunha, Ontario's chief medical officer of health,
states on the government's Web site. "Some people
report fever and muscle ache, but this lasts only one or
two days and is not the flu."
Whether or not this year's vaccine protects against
the key virus, D'Cunha says there are always other
strains, meaning everyone runs the risk of getting sick
anyway. "The vaccine takes two weeks to begin
protecting you, so it is possible to get the flu during
that time," D'Cunha says. "And the flu shot
will not protect you against other viruses."
D'Cunha recommends a flu shot every year, saying it's
"for everyone."
But Fisher says "a more enlightened
approach" would be to look at why some people have
a difficult course of flu. She says Ontario's emphasis
should be on care and treatment, "rather than
subjecting everybody to a risk which has not been
properly quantified."
Fisher also says Ontarians' immune systems would be
better served if the government reduced environmental
toxins and the overuse of synthetic drugs and vaccines.
"The flu vaccine is different every year," she
says. "It's an experiment every year with ethics
and safety."
Fisher agrees that the flu shot is a viable option
for high-risk populations, but she adds, "There is
concern about the number of vaccines children receive --
up to 37 doses for 11 vaccines by the time the child
reaches five.
"It may be that the pharmaceutical companies
thought they could go into Canada, suggest everyone get
it, and the population would assume that it meant
children, too, without stating it.
"When you recommend the universal use of a
vaccine," Fisher continues, "you can't just
see it by itself. You have to see it in relationship
with all the other vaccines children are getting.
Doesn't there come a point when it's better to build a
natural immunity? If you have obtained immunity
naturally, even if the virus has mutated, your system is
still going to have memory, and you have a natural
ability to resist that virus. With the vaccination, your
system has no memory, which means you become more
vaccination-dependent."
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