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Shannon Brownlee: Does the Vaccine Matter?

StoryNovember 02, 2009
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Shannon Brownlee

award-winning medical journalist and senior research fellow at the New America Foundation. Her latest article in the Atlantic Monthly, co-authored with Jeanne Lenzer, is titled 'Does the Vaccine Matter?'. She is also the author of the bestselling book Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer.

In a new article in The Atlantic, Shannon Brownlee examines how some flu experts are challenging the medical orthodoxy and arguing that for those most in need of protection, flu shots and antiviral drugs may provide little to none. So where does that leave us if a bad pandemic strikes? Shannon Brownlee is the author of the bestselling book Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer. [includes rush transcript]

This is a rush transcript. Copy may not be in its final form.


One week after President Obama declared swine flu a national emergency, demand for the H1N1 vaccine continues to outstrip supply. The government’s vaccination program that began last month is described as the most ambitious vaccination program since the anti-polio campaign of the ‘50s. But the program is off to a slow start. The media is abuzz with questions over the shortage of vaccines and the effectiveness of the Obama administration’s response to the pandemic.

The Center for Disease Control, or CDC, estimates swine flu is now widespread across forty-eight states in the country and has led to the deaths of 114 children since the spring. CDC Director Dr. Thomas Frieden called swine flu a, quote, "young person’s flu" at a news conference Friday and said health authorities are releasing the country’s entire stock of children’s Tamiflu antivirals.

Well, my next guest is asking a very different set of questions about how the US should be dealing with swine flu. Shannon Brownlee is an award-winning journalist, author, senior research fellow at the New America Foundation. Her latest article in The Atlantic magazine, co-authored with Jeanne Lenzer, is called "Does the Vaccine Matter?" Shannon Brownlee is also author of the bestselling Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer. She joins me now from Washington, DC.

Welcome to Democracy Now! Well, why don’t you answer that question, the title of your piece: "Does the Vaccine Matter," Shannon Brownlee?


It depends on what we’re talking about. So let’s make a distinction here between seasonal flu, which is the flu that we get — we see every winter, and pandemic flu or swine flu, what we’re seeing right now. For seasonal flu, we have a vaccine program, a public health campaign, that aims to get the people who are most at risk from seasonal flu vaccinated. So, we aim our campaign at the elderly, we aim our campaign at people who have — who are immune-compromised, who are ill with other things, who are more vulnerable. And it looks like that these people getting vaccinated is not producing the effect that we want, which is to reduce mortality in these groups. So, does the vaccine matter in the way that we’re using it? It’s not clear.


Well, explain the politics of who makes the vaccine that is being offered now, though there certainly isn’t enough of it all over the country.


The politics, I don’t — of who makes the vaccine, I don’t see as being that, that big an issue in this swine flu pandemic. There was not a whole lot of time to be able to manufacture millions and millions and millions of doses.

Now, certainly we probably should have more companies manufacturing vaccine. Having only a few companies manufacture it means that it’s hard for them to gear up. It also means that if one of them has a bad production line and has to shut down, it reduces the amount of vaccine that’s available. The issue with swine flu vaccine is not only that it’s hard to make enough of it in a short enough time to have an effect, but also, is it really doing what we want it to do in this particular pandemic?


The swine flu vaccine, the way they’re making it now, how does — explain the whole process.


Oh, I’m not a vaccine expert, but the process is exactly the same for swine flu vaccine as it is for seasonal flu vaccine: You have to grow the virus in eggs; then you have to extract the virus; you kill the virus, or you have an attenuated virus, which is what the nasal vaccine is — it’s a live virus that’s been weakened; and then you put it into your vaccine ampoules; then you deliver it around the country. So, it’s a pretty similar process for the swine flu vaccine and for seasonal flu vaccine.

And this is not about the safety of flu vaccine. A lot of people are worried about the safety of all vaccines. This is not about, should your children be vaccinated against whooping cough or measles? I have a fourteen-year-old; he’s had all his vaccinations. This is a very different question from childhood vaccines. And we were not looking at the safety of flu vaccine. It looks like a pretty darn safe vaccine.


But the issue of the testing of the vaccine. Go into more detail about how it is tested.


Well, you test it in a small number of people, if you’re in a hurry, like we were with swine flu. For seasonal flu vaccine, I really don’t know what the testing is. But that’s really not what we’re concerned with, which is the safety of the flu vaccine. There’s nothing to suggest that flu vaccine is really a dangerous vaccine.


But in terms of effectiveness, when you talk about cohort studies, the placebo-controlled studies, etc.?


Right. That is what we were most concerned with in the Atlantic Monthly article — in the Atlantic article. The magazine has a new name.

The effectiveness of the vaccine is what we’re questioning. And it looks like when you give young, healthy people flu vaccine, they’re able to mount a very good immune response, and they can then resist getting the flu. But when you give vaccine to people who are elderly, who have, say, diabetes or have cancer, are taking chemotherapy — there are any number of people who have compromised immune systems — they may not be mounting a very good immune response. So they get the vaccine, but it isn’t really protecting them.

And that’s where the question arises, is how effective is flu vaccine? Because in seasonal flu, we’re trying to aim our efforts at giving it to the people who are most vulnerable from dying from flu, and they may not be able to mount enough of an immune response to be able to resist flu, even when they get vaccine. So are we wasting a lot of money and a lot of effort in trying to get the vulnerable to get vaccinated, when it may not be doing them any good at all or may do very, very marginal good?


The historic parallel, Shannon Brownlee, that you raise, like treatments for breast cancer, irregular heartbeats?


Well, this has to do with the sociology of medicine and the history of medicine. Medicine, from the time that doctors were bleeding people, putting leeches on people, in the belief that if they bled out the bad blood the person would get better, medicine has a — believes in whatever treatment is the prevailing notion at the time. And the thing that distinguishes what doctors did, say, in the seventeenth century of bleeding people and now is that we actually have science, and we actually try to test whether or not a treatment actually works.

So, what we are calling for in the flu vaccine situation is that we do some of the studies that would really show who it’s effective for, how many people you have to vaccinate to stop transmission. And right now, there’s enormous resistance to doing those kinds of trials, which would require that you have half the people get vaccine and half get a dummy shot, a placebo. And the argument is that it would be unethical to give people a placebo shot, because then they wouldn’t be getting the benefits from flu vaccine, when the evidence suggests that there isn’t a lot of benefit from the flu vaccine in these — in certain populations.

And we’ve seen this happen before in medicine, where a treatment or a test seems to work, everybody starts to believe that it works, and then there’s resistance to really testing it, to finding out if it really does work.


Who is Dr. Tom Jefferson, who you write about?


Tom Jefferson is the head of the Vaccine[s] Field, which is sort of the department of studying vaccines at the Cochrane Collaboration. And this is a very, very important group. It’s a network of physicians, statisticians, other kinds of scientists, virologists, microbiologists, around the world who look at the scientific literature. And they have a set of rules that they use for assessing the merits of any particular study. And they look at all the studies that they can, and they come out with an answer, which says, “We have lots of evidence that says this works. We don’t have very good evidence to show that that works.”

So, Tom Jefferson has been studying the vaccine literature for a long time. And his group, the Cochrane Collaboration, is one of the groups that found that vaccine may not work as well as we think it does for the groups that we aim it at: the elderly and the immune-compromised.


Shannon Brownlee, just heard that they’re releasing all the children’s Tamiflu so that kids can get this, with over a hundred children who have died this year, they believe, of swine flu. What about the effectiveness of Tamiflu?


Well, let’s talk about that in a second. But let’s go back to this issue of a hundred children have died this year. The death of any child is a tragedy. I can’t imagine losing my own child. But 114 children have died this year, and last year, during seasonal flu season, 115 children died. So, we are certainly seeing deaths in children, and we are certainly seeing more deaths during swine flu among younger people compared to what we usually see in seasonal flu, which is deaths among the elderly. But that doesn’t necessarily mean that lots and lots and lots of children are dying compared to a seasonal flu year. So it’s important to keep that in perspective.

As for Tamiflu, Tamiflu and Relenza are the two antiviral drugs that still work against this kind of flu, this kind of virus. And they don’t work very well. On average, they will help a basically healthy child or healthy adult reduce the length of their flu symptoms by about a day. If they — if you take it before you’re exposed to the flu, there’s some evidence that it may prevent you from getting the flu. So, these are not terribly effective drugs. And we’ve spent billions and billions of dollars in stockpiling these drugs.


The Tamiflu, talk about a name from the past, the former Defense Secretary Don Rumsfeld, who you mention in your Atlantic piece.


Yes. The way we began building up our stockpile of Tamiflu began shortly after 9/11, when there was worry that we might be vulnerable to some sort of a biological attack. And so, the Bush administration and the Congress authorized the stockpiling of Tamiflu and Relenza, these two antiviral drugs, not only for the civilian population, but also for the military.

And at that time, Donald Rumsfeld was the Secretary of Defense. He was also the former chairman of the board of one of the companies that manufactured Tamiflu — manufactured or held the patent, I can’t remember exactly which. And the decision was made under his watch. And it’s not clear whether or not he was involved in this decision, but he stood to gain financially, personally, from the stock that he held in this company.


How investigated has this been, his conflict of interest here?


It was investigated at the time. A couple of places, other places, other magazines looked at it. I believe Fortune or Forbes looked at it. I can’t remember which. And it was looked at. And so, it was yet another event that was reported, and then everybody’s moved on.


How dangerous is it to go to the emergency room, Shannon Brownlee?


This is exactly where you shouldn’t go if you aren’t really sick. If you really want to get the flu, go to the emergency room. And one of the worries, and one of the things that’s actually happening, is that people who are not really sick are flooding into emergency rooms. And one of the things that they’re looking for is the drugs. They’re looking for Tamiflu.

And one of the things that is happening is that when you crowd emergency rooms with people who aren’t all that sick and don’t really need to be hospitalized, you — it means that people who really do need help are not going to get their help. There’s very good evidence that people die when emergency rooms are crowded.


We’re talking to Shannon Brownlee, who is an award-winning medical journalist. She’s senior research fellow at the New America Foundation. Her latest piece in The Atlantic magazine is called "Does the Vaccine Matter?" Her book is called Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer.

The question of how prepared is the United States to deal with a pandemic. The issue — “Whether this season’s swine flu turns out to be deadly or mild, most experts agree that it’s only a matter of time before we’re hit by a truly devastating flu pandemic — one that might kill more people worldwide than have died of the plague and AIDS combined. In the US, the main lines of defense are pharmaceutical — vaccines and antiviral drugs to limit the spread of flu and prevent people from dying from it.”

Talk about what you see as what could be a global pandemic.


If we had — this swine flu does not look to be that pandemic, because it is a relatively mild flu. In fact, the CDC suspects that many people are actually being infected with swine flu and don’t even know it. They are asymptomatic. So, this is not that really bad flu that people are very worried about.

If and when that flu does hit, there are many questions. One is, could we produce enough vaccine to really stop transmission, to really halt transmission or slow it down? Number, two, who should you vaccinate first in order to reduce that transmission? Who’s going to be most vulnerable to dying from that flu, and how can you halt the transmission?

There’s some thinking that if you vaccinate healthy people first and they mount a really good immune response, you — in effect, you keep them from passing the flu on to other people. So, one group of people that we probably really should be vaccinating in seasonal flu or in a pandemic is hospital workers and nursing home workers. And what’s interesting is that only about half of them get vaccinated in any year.

Why aren’t they getting vaccinated? Some of them don’t think the vaccine works. It’s kind of a pain in the neck. Sometimes the vaccine itself causes a few little symptoms. So there are any number of reasons why people are not getting vaccinated who ought to be, who could protect the people who are the most vulnerable. We may need to change our campaigns. We may need to really push vaccine in those — on those people. And so, these are the kinds of questions that we have to answer.

And then there are the non-pharmacological methods of trying to stop transmission: basic public health. In this vaccine — in this pandemic, we are not closing schools, we’re not closing public meeting places, there is not that much disruption of regular sort of commerce and existence. But in the event of a real pandemic, we would have to resort to many, many different kinds of measures.


Shannon Brownlee, I want to thank you for being with us, award-winning medical journalist, senior research fellow, New America Foundation. Her latest piece appears in The Atlantic Monthly; it’s called "Does the Vaccine Matter?" Her book, Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer.

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