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.

HuffPo: Anti-Vaccine Vitriol: Seeking Reason

Dr. David Katz recently published a piece on The Huffington Post in response to some of the anti-vaccination nonsense that gets posted on the HuffPo website on a regular basis.  The amazing thing is HuffPo is known to  be somewhat of a safe haven for antivaxxers, so to witness them being called out for their tactics and lunacy is nothing short of amazing.

I'd love to cite some specific passages from his article, but the truth is if I cited only the parts of the article which make sense and which make very valid points, I'd end up posting the entire piece.  Therefore I encourage you to read the entire article in its entirety over at the HuffPo website.  You can find the article at this link:  Anti-Vaccine Vitriol: Seeking Reason.

Well ok, I do have to list one of my personal favorite quotes that Dr. Katz wrote: "In other words, if you want to offer advice against vaccination that reasonable people can take seriously, try being reasonable".

I dare say the phrase "reasonable antivaxxer" is an oxymoron, but perhaps one day I'll actually come across one.  It is difficult to imagine a world where a reasonable person tosses aside all logic and common sense while ignoring mountains of scientific evidence and historical records, but perhaps there are varying levels of reason.

Of course even after reading the article, the antivaxxers once again come out in full force in the comments section.  Sadly it seems most of them were unable to complete the entire article before posting because many of their comments are using the very tactics discussed in the article itself almost as if they antivaxxers were so enraged after the first paragraph or two they skipped the remainder to cut and paste more anti-vaccine nonsense.

One comment that caught my eye was from an antivaxxer who complained of a lack of "[d]ouble-blind, randomized controlled studies" showing the efficacy of flu vaccinations.  Not only did this particular antivaxxer clearly not read or understand Dr. Katz's article, but she also appears to be very confused about ethically questionable studies.

We of course have discussed this issue in the past, and frankly anyone of average intelligence should understand the moral issues with trying to perform such a study, but even more troubling is how these antivaxxers presume it is possible to prove a negative in the first place.  I just have to wonder if someone did perform a double-blind randomized controlled study on a flu vaccine and those individuals who did not receive the vaccine were six times more likely to contract the flu - would antivaxxers actually suggest the vaccine was functioning as designed?  I think we all know the answer, and that answer is "no", because they would simply claim there was bias, or they would challenge the funding source for the study, or they would make claims about how correlation does not equal causation (even though they are guilty of confusing the two on a continual basis).

The truth is, even if the results did come out as expected it wouldn't change perceptions or the minds of the anti-vaccination crowd, so what benefit would such an unethical study provide, and at what costs?  What if one of the test subjects contracted the flu and died as a result of complications?  What if those study participants who didn't receive the vaccine contracted the flu and spread it to dozens or possibly even hundreds of others?

You see when someone doesn't receive a vaccine, it isn't only them who is impacted.  Potentially it is everyone around them.  It is anyone and everyone who comes into contact with that person which is precisely why I have no problem with calling someone who willfully skips their vaccinations out of ignorance to be nothing short of selfish.  If you want to kill yourself I have zero problem with it, but when you put the lives of others in danger due to your selfishness, then I have a problem with your actions.

We have seen the ramifications of scientific ignorance when antivaxxers refuse to allow their children to receive vaccines, and in some cases it has lead to outbreaks of vaccine preventable diseases such as the measles or pertussis... with the end result being hospitalizations, prolonged illness, and in a few select cases even death.

Therefore antivaxxers can continue to protest that no double-blind randomized and controlled studies on the efficacy of the flu vaccine have been performed, but it won't change anything and is merely a distraction.  As much as we might love to see such a study, it won't be happening anytime soon not only because of the ethical issues, but because anytime a study is performed and the treatment has such profound effects, the study will be interrupted.  It is simply inhumane to continue a study when a sample group shows such a significant benefit over the control group, and any long-term study of a vaccine is most certainly going to show this disparity thus we must look elsewhere for the necessary data.

Granted it isn't like we can't look at actual historical data to know if something works.... say for instance the fact that the CDC reported the incidence of invasive Hib disease dropped from 40-100 per 100,000 children down to 1.3 per 100,000 due to routine usage of the Hib vaccine from 1980 to 1990. Surely that is merely a coincidence.

Then again, Australia found the same thing... which results in this chart showing how the Hib vaccine resulted in over a 90% drop in reported cases in 12 years and actually eliminated all fatalities within 7 years.

It still must just be a coincidence right?  I mean we can't use this type of data because it isn't part of a double-blind randomized and controlled study... so it must be garbage.

Then again, there have never been double-blind randomized and controlled studies proving the efficacy of parachutes either, and there won't be anytime soon.  Does that mean we shouldn't trust the efficacy of parachutes?  Of course not, because we already know they save lives.  We already have more than enough evidence to know that parachutes are a great idea, and we know what the alternative is.  To suggest we need a double-blind study to determine whether parachutes work or not would be unethical (and obviously idiotic), but when you think about it, vaccines are no different.


So the next time an antivaxxer asks for a double-blind study aka: a "vax vs. unvaxxed" study showing the efficacy of vaccines, just ask them if they are willing to participate in a double-blind study for parachutes.  Sure that seems incredibly stupid, but so does the idea of passing on a vaccine because of scientific ignorance or fear.

Now if you need an example that is more in tune with vaccine, simply look no further than shoulder-mounted three point safety belts in automobiles.  We know the usage of such devices has resulted in many lives saved, and we know what the statistics are prior to their usage much in the way we know what the rates of disease were prior to vaccines being developed.  So should automobile manufacturers be required to perform double-blind studies on seat belts prior to installing them in vehicles?  Should they be required to report any findings of shoulder injury or broken arms due to the seat belts even though those same people may have died without the seat belt?

Our world isn't always so black and white, and sometimes the data is impossible to obtain via a perfectly controlled scientific study.  In some cases we need to look at the other sources of evidence such as infection rates or historical data.  It may not always be as clean and concise as a chart listing infection rates of X vs. Y, but unless you are willing to jump out of a plane without a parachute you really have no business complaining about a lack of double-blind studies.

Need Another Reason to Get a Flu Shot?

If reducing the risk of suffering from the flu this winter isn't quite enough to convince you to get a flu shot, consider this:  according to two studies presented at the Canadian Cardiovascular Congress, it turns out getting a flu shot can actually decrease the risk of a heart attack by as much as 50%!

So not only can you avoid the flu, you might actually save your life.  Sort of makes you wonder how antivaxxers will spin this to make it look like a bad thing... because saving lives isn't exactly the type of side effect they like to talk about.

Is this the kind of thing that should be reported to VAERS?

Read more here:  The Shot That Prevents Heart Attacks (via Yahoo Health)