The Profit of Vaccinations

The New York Times recently published an article about the flu season which shows that the levels of deaths have officially crossed over into "epidemic" territory.  The full article can be found here:  Flu Season Deaths Reach Epidemic Level but May Be at Peak, C.D.C. Says

This is a well balanced article speaking about the impact of the flu as well as explaining that the flu vaccine isn't nearly as effective as some other vaccines like those for the norovirus (aka: the "stomach flu" or gastroenteritis) or pertussis (aka: whooping cough).  Part of this is obviously due to how quickly flu viruses mutate, but another aspect that could be partly responsible is the simple fact that on any given year only around a third of the population bothers to actually get a vaccine.  This means there is a much greater chance that the virus can spread among those who have no protection from the vaccine, as well as among those who the vaccine wasn't effective.

Clearly there are failures in the system and improvements must be made.  Not only do we need better vaccines, but we need to do a better job informing the public as to the benefits.  The good news is we appear to be making progress on both of these fronts, and the percentage of those who receive flu vaccines is on the rise each year.  There are also new vaccines in development that hope to address some of the problems with the current targeted vaccines although progress is slow, and funding is difficult to obtain.

This latter point is one which I wanted to speak about, because all too often we hear antivaxxers complain that vaccines are merely a profit mechanism for pharmaceutical companies and that there is no true benefit.  As the article explains it could take as much as $1 Billion to actually bring a vaccine to market, which at first glance seems like an insurmountable figure.  If a new vaccine was to be developed which either prevented the flu or even merely significantly reduced the chances of contracting a flu virus and if the usage of that vaccine was on par with vaccines for MMR or Hib, chances are we would see a vaccine acceptance rate somewhere above 90%.

So let's be conservative and use a vaccination rate of only 80% for the "one-time" flu vaccine.  We know not everyone would bother to be vaccinated the first year, but after a few years when people realized they no longer need an annual flu vaccine, they would probably be more willing to get the single vaccine, and since many other vaccines have rates well above 90%, I don't think 80% is that unbelievable.

So if we focus on the United States alone, we know there are around 312,000,000 (312M) people who could potentially be vaccinated.  80% of this is around 250,000,000 people who would likely receive a flu vaccine.  So let's assume the cost of this vaccine is $35.  The current wholesale costs of single year flu vaccines is closer to $10, but a one-time vaccine is likely to be incrementally higher due to the complexity.  For example an adult vaccine for MMR costs around $35 while the vaccine for varicella is over $60.  A childhood vaccine for Hib may be only $12 while rotavirus can be over $70, so it isn't hard to a flu vaccine could cost at least $35 wholesale - at least for the first few years after release.

Ok, so now we have 250,000,000 potential customers each of which will spend $35 for a grand total of $8,750,000,000 ($8.75B).  Even if we assume only a 50% vaccination rate (156M) and an even lower cost of $25 per vaccine, the total is still $3,900,000,000 ($3.9B).

Of course the $1B it takes to bring a vaccine to market does not include the costs to produce, distribute, and market the vaccine, so it isn't as if there will be billions in profit the first year, but the flip side of this equation is that we are only factoring in the population of the US.  Chances are once the vaccine was available it could be submitted for approval in numerous other nations with the potential to sell hundreds of millions of doses to those nations.

The moral of this story is, there would be a lot of money to be made from a one-time flu vaccine, yet to date we haven't seen anything available.  Since antivaxxers seem to feel vaccine manufacturers are only interested in profits, how can they explain that not a single manufacturer has unleashed such a vaccine on the public?  It shouldn't matter if the vaccine is effective or not, because as any good antivaxxer will tell you vaccines don't actually work (and yes I'm being sarcastic).  Antivaxxers are even willing to claim publicly that the polio vaccine and the smallpox vaccine did nothing to prevent those diseases (suggesting the diseases just magically disappeared on their own apparently), and they feel that vaccines are generally ineffective.

These same antivaxxers will tell you that the MMR vaccine does far more harm that good and that there is no evidence that viruses like the Measles have been controlled by the vaccine in any way.  They will also claim that the HPV vaccines don't work at all and that it is merely a method for the manufacturers to collect millions upon millions from insurance companies and the unsuspecting public.

You see this is one of those situations where antivaxxers want to have it both ways.  One one hand they claim vaccine manufacturers are simply in it for the money and that the vaccines themselves don't actually work.  On the other hand, they can't explain why the market hasn't delivered something like a one-time flu vaccine which would quite obviously be a gigantic windfall for the pharmaceutical companies.

So which is it antivaxxers?

It would seem to be the fact we don't have a one-time vaccine for the flu only proves that the system works.  We have clinical trials and data which shows us the effectiveness of vaccines, and if a vaccine is found to be ineffective it wouldn't be approved.  We have a system of checks and balances in place to ensure the public is protected and that vaccines are not only effective but that they are safe.  We have a system which rewards responsibility, and one which puts the safety and health of the public as the priority far head of profit.

We aren't talking about a nutritional supplement or a vitamin that can be sold by anyone trying to make a buck.  Vaccines are subjected to rigorous safety and effectiveness testing which can take years to complete and which requires verifiable proof of efficacy before that vaccine is ever approved for use.  Can we say the same thing about the various supplements and pills sold on antivaxxer websites?

Sort of makes you wonder what type of clinical trial or testing was done on something like the miracle "brain repair" pills sold by a well known anti-vaxxer.  I think we all know the answer, and it rhymes with none.

If vaccines were really all about profit and if the health of the public was an afterthought as so many antivaxxers have suggested, I have no doubt we would have a half dozen one-time flu vaccines on the market this very moment.  Yet we don't - and I've yet to see an antivaxxer who can explain this without contradicting themselves.

What's The Harm In Avoiding Vaccines?

We often read about anti-vaccinationists who cite a random child they claim is "vaccine damaged" as evidence enough that we shouldn't attempt to vaccinate children.  We also read tear-jerking stories from various individuals about how a child received a vaccination and within days or weeks (or in some cases months) they started running a fever and shortly thereafter started regressing in their development and eventually were diagnosed with autism or some other neurological disorder.

It doesn't seem to matter that there is never any conclusive proof to link vaccines to these disorders because most antivaxers believe personal observation by parents or family members or random bloggers is superior to peer-reviewed science performed by trained physicians, clinicians, researchers, and scientists. 

Essentially the antivaxers would have us believe that the risk of giving a child a vaccination is far, far greater than the risk of going without said vaccination.  This belief essentially ignores all common sense and requires a selective rewrite of history in order for us to ignore the massive outbreaks of polio or smallpox previous generations had to deal with.  We also need to ignore the thousands of children who used to suffer from various diseases such as the measles, pertussis, mumps, rubella and several other preventable diseases along with those who were permanently injured or even those who died after contacting one of these diseases.

Nevertheless antivaxers seem convinced vaccines are dangerous and there is no justification for using them... ever. In fact we often hear antivaxers suggest that the diseases and viruses that vaccines protect against aren't really a problem at all.  We even see stories from antivaxers where they have bragged about having "pox parties" where they expose their children to others who have chicken pox, and in extreme cases there have even been published reports of parents ordering lollipops from infected children which they then give to their own kids in the hopes they will actually contract chicken pox. 

I wish I could make this stuff up, but sadly this is the reality.  Meanwhile, even though we have mountains of evidence and research showing the overwhelming effectiveness of vaccines, and even though we no longer need to worry about diseases such as smallpox or polio specifically because they were eradicated via vaccination programs, we still do not have so much as a single peer-reviewed study which has been able to link vaccines with a neurological disorder such as autism.  Not a single study.

In fact, we know thousands upon thousands of children needlessly suffer from vaccine-preventable diseases each and every year.  In some cases this may be because a child has an existing medical condition which prevents them from receiving a vaccine.  In some cases it could be due to to a vaccine not being effective in that child (no vaccine is 100% effective in every human just as no medication is effective in every human).  However in our current environment, most children who suffer from vaccine-preventable disease seem to be unvaccinated (due to their parents' unwarranted fears and actions based upon emotion rather than scientific fact), or they contract the disease from an unvaccinated child.

In effect, antivaxers promote the idea that vaccines are dangerous not because of what does happen or because of what has happened, but because they fear what might happen.  They ignore the millions of lives saved by vaccines and the millions more who didn't suffer with a preventable disease all due to their illogical belief that the rare condition that they "maybe sort of think might have something to do with vaccines" should take precedence over the numerous diseases we know are prevented by those very same vaccines.

I dare ask - are these people capable of performing basic arithmetic operations?  Even if we were to believe that vaccines might result in autism... even if we ignore accepted science and just assume that the majority of all cases of autism are due to vaccines, have they ever compared the risk of contracting a vaccine-preventable disease to the risk of being diagnosed with autism?  Have they also considered that in many cases those who contract vaccine-preventable diseases can suffer lasting effects which could include permanent disability or even death? 

Keep in mind we are ignoring accepted science here, so we need to ignore the fact that there is no evidence linking vaccines and autism and we need to ignore the fact that even the very strong anti-vaccine Generation Rescue non-scientific and heavily biased phone survey found there is not a statistically significant difference in the rate of autism between unvaccinated children and vaccinated children.  Even with all of this ignored, what is the logic behind the belief that the risk of autism somehow trumps the risk of death?

Surely critical thinking skills or common sense have no place in this discussion.  After all, what possibly could be the harm from NOT vaccinating a child?  Well if you have ever wondered what the answer to that question might be, you may find this website interesting:  What's The Harm. 

Of course it should be noted this website does not serve as a comprehensive list by any means.  The website is not updated on a regular basis and it is only a few select examples of the harm that anti-vaccine views have created, but it does serve as a reminder of why vaccines are so important.

You know what else is important?  The number 57,628.  That is how many cases of polio were reported in 1952.  Of those cases, 3,145 people died and 21,269 were left with varying degrees of paralysis.  All of this occurred in one single year prior to the development of the polio vaccine.

Of course if you are a vaccine conspiracy theorist like Lowell Hubbs, you tend to believe polio just magically disappeared from the planet and that it had nothing to do with vaccines.  In fact Hubbs still believes sugar consumption is to blame for polio, so he isn't exactly an expert on the subject.  But I digress...

Another important number is 400,000.  That is how many Europeans died annually from smallpox towards the end of the 18th century.  It is also estimated that as many as 10% of all children born in Sweden in the 17th century died from smallpox, and the estimates for Russia were one out of every seven children would die from the disease.

1813.  That is the year the US Congress passed a law (aptly named the Vaccine Act of 1813) to ensure the safe and legitimate smallpox vaccine would be available to the public.  By the late 1800s, smallpox was effectively eliminated within the US due to the vaccine.

50,000,000.  That is the estimated number of cases of smallpox that occurred worldwide as recently as the early 1950s.  Look at that number again.... fifty million cases!
 
So how about the number 25.  That seems to be a rather important number as well, because it is the percentage of people who died from smallpox after being infected.  Yes that is 25% or put another way one out of every four people who contracted smallpox would die from the disease.  In the early 1950s, this would be approximately 12,500,000 dead humans each year all because of one preventable disease.  That is greater than the populations of New York City and Los Angeles combined, and it was happening year after year.

Yet we no longer need to fear smallpox because of one thing... a vaccine.  Perhaps the most significant vaccine ever developed by man, and one which has saved millions upon millions of lives, which leads us to yet another important number...

1979.  That is the year that smallpox was certified as being eradicated from our planet.  There have been no cases reported since, and the disease is no longer a threat.  Again, this is all due to the availability of a vaccine.

I could obviously go on with numerous other vaccines and explain how many lives have been saved or how much suffering has been prevented, but the point here is that when a parent believes they are doing their child a favor by not vaccinating them from numerous preventable diseases, they are quite simply ignoring history.  They are gambling with their child's life, and they are ignoring science, logic, and reason. 

Thus even if we ignore the lack of science linking vaccines and autism and even if we give in to emotional pleas and pretend that parents who decide against vaccination are just doing what they feel is best for their children, what does this leave us with?  We know autism isn't a fatal disease so what this tells us is that parents would rather put their children at risk of contracting a fatal disease than even allow the slightest risk that they may suffer with a neurological disorder... surely that can't be right can it?

Are these antivaxer parents really that disconnected from reality?  Are they really unable to pick up a history book and take five minutes to learn about how preventable diseases like polio, smallpox, rubella, measles, varicella, and many many more have led to so many deaths?  Are they just ignorant of history and the science behind vaccines?

I really can't say why some parents decide against vaccines, but when I look at the facts it really comes down to either blatant ignorance, laziness in not bothering to do the research or examine history, or possibly the worst excuse of all... selfishness.  As sad as it may seem, there are a certain number of parents out there that have such a fear against having to raise a developmentally disabled child, that they would rather avoid life saving vaccines in the off chance they might find themselves with a "broken" child. 

Keep this in mind the next time some antivaxer brags about how they refuse to allow their children to be vaccinated - because aside from the fact they are scientifically and historically illiterate, instead of protecting their children, they are effectively telling them they would rather see them dead than allow them to be diagnosed with autism.

Disgusting?  You bet.

Vaccinating for Whooping Cough: Life Saving Advice

An article published a few days ago discusses how there has been a trend of whooping cough in the Seattle area.  The original article can be found here.

One key fact pointed out is how the Seattle area has a rate of 136 infections for every 100,000 infants whereas among the entire US the rate is 97 infections for every 100,000 infants.  A report published in the Archives of Pediatrics and Adolescent Medicine included a retrospective analysis of infected infants in the Seattle area from 2002 through 2007 and they found the primary cause was exposure from a family member who was not fully vaccinated and thus could spread the disease to others.

As the article states, in the study of the babies who came down with whooping cough, "the researchers found that nearly half the people who lived or worked with the babies were eligible to receive a vaccine that would have protected them". 

The article also mentions that whooping cough (which is also known as pertussis) "causes uncontrollable, violent coughing, infects 30 to 50 million people a year globally and kills about 300,000, mostly children in developing countries".

So ask yourself - how many children would die in the US each year if Mr. Hubbs had his way and all vaccinations were eliminated?  Would 20 dead children be considered acceptable?  How about 100?  Would 1000 dead children be ok as long as the antivaxxers like Mr. Hubbs were happy?

That may seem like it is dramatization, however the article states that the problem with whooping cough infections "may be getting worse because some parents have been reluctant to vaccinate their children -- and the more unimmunized people there are in a community, the more likely there are to be outbreaks. One recent whooping cough outbreak in California has affected more than 6,400 people and killed at least 10 infants".

Obviously even with widespread vaccine usage there is no guarantee that every infant will be protected because no vaccine has 100% success rate in preventing the spread of a disease, but obviously the risk would be much less if more adults received the recommended vaccinations to prevent passing the disease onto the infants.  The reality is most infants who contract pertussis are not old enough to have received the full schedule of vaccinations and therefore rely upon the adults around them being vaccinated in order to reduce the risk of spreading the disease.

Obviously an antivaxxer such as Mr. Hubbs would say those babies would be better off without anyone being vaccinated, but that begs the question... are we really willing to deal with the ramifications of an unprotected populace simply to appease some antivaxxers who seem to believe vaccinations cause autism even when they don't have one single peer-reviewed scientific study to support that belief?  How many more children must suffer the complications of a disease like whooping cough - or worse, how many more children must die before antivaxxers realize how harmful their opinions really are?

It is clear there are those people on this earth who really have a sincere desire to protect children and those are the doctors and nurses and support staff who are out there doing their best to ensure each and every child is protected via vaccinations.  Then there are those people like Mr. Hubbs as his fellow antivaxxer friends who proclaim to care about children, but in reality do everything in their power to ensure those children continue to suffer from preventable disease all in the name of avoiding what they perceive as harmful.

Thankfully the antivaxxer movement has been losing ground the past few years and vaccination rates are on the rise. There is still work to be done, but luckily the situation seems to be improving year after year.