Informed Parent issue 25
FLU AND VACCINATION
Taken from the 1998 AGM report of The Ligue pour Ia Liberte des Vaccinations.
Like Beaujolais Nouveau every year the vaccine nouveau against flu is about to arrive. It even appears before the disease since it is made available to consumers by the end of September. But the subject is serious. The leaflet from health insurance sources tells us that 'the only means of effective protection is vaccination' and that the flu virus, 'being unstable and variable, needs a new updated vaccine each year and this alone can protect against flu.' Even if we take this as read, how can we arrive at the true efficacy of the vaccination? Quite simply by reading the report: 'Incidence of flu vaccination on the consumption of medicare by those aged 60-69 years,' by the CPAM at Nantes and presented at the Epidemiological and Health Congress, Nancy, 3-6 July 1995. It was written by Dr C Peter, Principal, and Dr C Fremont, Director-General of the CPAM, Nantes. It is therefore a distinctly official document. We reproduce several passages:
"For 4 years the CPAM, Nantes, has been in charge of vaccination for those aged 60-69 years through its health and social budget. This has gone from 243,762F in 1990 to 697,845F in
1993. Taking account of the sums for the years ahead, and considering that in 1993 only a quarter of the target group were covered, it has become necessary to evaluate the efficiency of this preventative procedure.
"The vaccinated have been compared with the unvaccinated in terms of medicare during the epidemic period for weeks 47 to 50 in 1993. Two groups of 257 individuals were chosen at random from the 43,735 target base."
"We saw that the proportion of individuals who showed no evidence of flu was effectively the same in the two groups (86% and 87%), ie. 86% vaccinated and 87% unvaccinated or, more clearly, 14% of the vaccinated had flu against 13% unvaccinated." This 'attempt at protection' has cost the CPAM 697,845F to vaccinate 12,034 individuals, ie 58F per person. The study also tells us that the average cost for the flu-affected was 382F per vaccinee and 294F per non-vaccinee. (Cost of consultations, visits, pharmaceuticals, biology), i.e. a difference of 88F per individual to the detriment of the vaccinated.
With no vaccination the saving per person would be 58+88F=146F Therefore: 146F x 12,034 (no. of vaccinated) = 1,757,OOOF.
If all of the target group had been vaccinated the additional cost would have been 146 x 43,735 = 6,400,OOOF.
Since the purpose of the national campaign is to vaccinate all those of 60+ years and there are 4,700,000 in France (source INSEE), that would indicate an additional cost to Social Security of 146 x 4,700,000 = 686,000,000F.
In this straitened period of restricted budgets, obligatory economies and penalties for over-prescribing doctors, these figures provide food for thought. And they are based on 1993 costs; 1998 costs would be 15% higher. The effect on each of us of the consequent increased social costs is evident. Note also that all the figures relate to 4 weeks (47-50) and we know that flu rages all winter.
Long term costs are unknown. No long-term study has been carried out, because judged very difficult, if not impossible, to do. Hence remaining ignorant of reality is preferred. One study seems to have been done in Great Britain on 50,000 postal workers. The Lancet, 10/8/74, presented unconvincing results. (S.Simon, Medico-Scientific Dictatorship, p176.)
In relation to certainty and hypothesis we can read: "This study had led us to formulate the hypothesis that during the epidemic period the vaccinated, because they are vaccinated, would consume less than those who are not. On this last point the findings were indisputable: we found, with some surprise, that the vaccinated consumed appreciably more than the unvaccinated. This is the main observation of the study."
We certainly agree. It is unquestionable that flu vaccination is not only useless but also costly. And it is a 'surprise' only to those who obstinately ignore reality or who still harbour illusions because they are poorly or totally uninformed on this vaccination (and other vaccinations).
Let us end with the conclusion: "The question of its medical usefulness in the target population remains unresolved, and serves to open debate on the point of the preventive policy of the CPAM."
*The flu vaccine is entirely free for the 70+.
Editor: In the Pulse, October 17, 1998 there was a question/answer feature looking at the problem of left-over flu vaccines.... "Last year we had 30 to 40 doses of flu vaccine left over and had a rather undignified scramble to find people to inject them into! How can we avoid having vaccine left that we can't get our money back on?"
Answer: "I don't think you really have a problem but the answer depends on your attitude to risk. I am willing to accept a small amount of risk in order to increase profitability so I like to order 50 doses more than the previous year in the expectation that there will be a scramble to use the last few.
The idea of losing £5 for every unused dose seems to motivate everyone, including me, to find willing recipients. If you are risk-adverse you could order 50 less than you used the previous year and send the last few patients to a retail pharmacist with an NHS prescription. If you are risk-neutral you will order the same number as the previous year but arrange small deliveries during late October and early November with an option to cancel the last few batches if demand is low.