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.

Will Antivaxxers Embrace the HIV Vaccine?

I was reading the latest news about one of the many HIV vaccines in development, and even though the results of the initial phase of testing appear to be very positive, I couldn't help but wonder to myself... how will the antivaxxers spin this to make something as beneficial as a HIV vaccine to be a bad thing?

I understand full well we are a long way away from an actual usable and functional HIV vaccine, but the initial clinical trials suggest that such a vaccine could be right around the corner.  So if we assume a HIV vaccine is within our grasp, and we already know over 33,000 people a year are diagnosed with HIV / AIDS and over 9,000 die from the disease annually, will there be a major push from the antivaxxer community to proclaim the vaccine is more harmful than HIV itself?

Perhaps it is too early to tell.  We don't yet know of any potential side effects of the HIV vaccine so we can't say what harm it may cause.  However if we look to other vaccines as examples of what we might expect it seems highly unlikely that antivaxxers will support such a vaccine even if it is shown to save thousands of lives.

How do we know this?  Simple... just look at something like the HPV vaccine (Gardasil). We know the lifetime risk of developing cervical cancer in the US is 1 in 147 for those women who are unvaccinated while it is only 1 in 400 for those women who are vaccinated.  Knowing the fatality rate of cervical cancer is around 35%, we can use simple math to determine that the HPV vaccine could potentially save approximately 2,500 lives per year in the US alone.  Now antivaxxers are quick to point out that within one year of receiving a Gardasil vaccine there have been at least 68 reported deaths.  Some sources cite slightly higher numbers, some cite lower numbers, but the 68 number is accurate as of June 2011 and came directly from the Vaccine Adverse Event Reporting System (VAERS).  What they fail to tell you however, is that that total includes all deaths... even those which were a result of suicide, car accidents, or unrelated medical conditions.

Now in case you are curious, even if we use the full 68 deaths, and we consider that at that point in time over 35,000,000 doses of the Gardasil vaccine were given it would mean that 68 works out to be 0.0004%.  It is probably also a good time to mention that 0 of those deaths (0.0000000000%) have actually been attributed to Gardasil... and that number doesn't change no matter who has reviewed the data.

However, I'm in generous mood and I'm trying to make a point, so for the sake of discussion, let's just go ahead and assume out of those 68 deaths that the vast majority were a direct result of the vaccine.  For the sake of argument, we will ignore all common sense and logic and simply assume that 50 of those 68 deaths were a direct result of Gardasil.  Now let's also assume that VAERS only captures about 10% of the actual adverse events tied to vaccines, and therefore we need to now extrapolate that 50 deaths to be a total of 500.  So out of 35,000,000 doses of the vaccine given, we are making a wild assumption of 500 deaths.  In case you are curious that works out to be an effective rate of 0.00142%

Do you have any idea how small a number 0.00142 really is? That is roughly one out of 70,000.  That means  if you injected one person each day with Gardasil, you could continue to do so for 192 years before someone might actually die as a result - and that is under the huge assumption that all of these deaths can be directly linked to the vaccine (which we know they cannot).

Great - so the chances of dropping dead within one year of receiving a Gardasil vaccine are 0.00142%.  Fine... I know it is a huge stretch, and we know the numbers are nowhere near that level, but even if we use worse case scenario logic coupled with idiotic assumptions, we still come up with a value which is incredibly small.

So how many lives have been saved by the vaccine during that same period of time?  The Gardasil vaccine was approved by the FDA in June of 2006, so five years later in June 2011 by the time those 35,000,000 doses were distributed, we could have potentially saved 12,500 lives from the vaccine.

So let's be clear - if the vaccine saves 2,500 lives a year (12,500 lives over five years) and if the vaccines results in 500 deaths during that same period, that tells us the end result is a net increase in lives saved.  This means the Gardasil vaccine actually saved at least 12,000 lives.  Yes you can argue the number is larger or smaller, but in the theme of keeping things simple, this is a fairly conservative figure.

So what do antivaxxers say when presented with these numbers?  Do they admit that the net effect of the vaccine is that lives are saved?  No.  Do they admit that even if the vaccine isn't perfect that it is still better than nothing?  Nope.  Instead of looking at the net impact, antivaxxers do what antivaxxers always do when the numbers don't help their cause.  They deny the numbers and claim the math doesn't add up.... or better yet they simply refuse to talk about it.

Now we know it is impossible for even the most diehard antivaxxer to deny basic arithmetic, so instead they simply flatly deny that the vaccine saves any lives.  They even go so far as to claim there is no connection between HPV and cervical cancer.  Yes seriously.  (In case you are wondering, the claim about HPV not causing cervical cancer is flatly untrue and stems from a misunderstanding of the virus.  It is true that not all strains of HPV cause cancer and it is also true that many HPV infections are short-lived and don't result in cervical cancer, but it is widely know that some strains of HPV (namely HPV 16 and HPV 18) do in fact cause more than 99% of all cervical cancers).

So we can see with our own eyes that antivaxxers with do anything and say anything rather than admit a vaccination is actually beneficial.  They will misinterpret data, they will misreport the facts, they will misrepresent scientific studies and even cherry-pick statements out of context.  Even worse, when all else fails... they will just flat out lie.

So if one day we are presented with a HIV vaccine that could potentially save tens of thousands of lives each year, is it possible that antivaxxers would actually embrace the vaccine and admit that it benefits the health of the human race?

Considering many antivaxxers don't even believe that the HIV virus causes AIDS... not bloody likely.

The HPV Vaccine and Promiscuity

Antivaxxers aren't really fond of the Human papillomavirus (HPV) vaccine Gardasil - primarily because it is adiscussed the myths surrounding this vaccine in the past, and I even wrote a blog piece that explained none of the deaths that antivaxxers associate with Gardasil have been proven to actually be a result of the vaccination.
vaccine.  They attribute many medical issues to the vaccine and even go so far as to blame it for numerous deaths.  Of course I have

Rest assured, even in spite of overwhelming evidence surrounding the safety and effectiveness of the Gardasil vaccine, and even though it has been shown to save at least 2,500 lives each year due to the reduced risk of cervical cancer, antivaxxers are unwilling to concede the vaccine might actually be a good thing... because once again it is a vaccine.  

Antivaxxers don't really care if vaccines work because they are predispositioned to believe all vaccines are bad.  In fact, most antivaxxers believe society would be better if nobody was ever vaccinated for anything (because apparently losing hundreds of thousands or even millions of lives each year to diseases like smallpox and polio is better for society).

So since it is so easy to discredit many of the claims made by antivaxxers surrounding Gardasil, and because they have absolutely zero data to support their claims about deaths and serious injury caused by the vaccine, some antivaxxers decided to take a new approach.  One of the more recent claims is that the HPV vaccine is a bad thing because it teaches girls that they can be sexually active with no ramifications.  The premise here is that allowing a girl to get the vaccine would therefore be suggesting to her that it is OK to start having sex.  

Imagine the outcome of teaching girls that sex at a younger age is perfectly fine.  Teen pregnancy rates would rise, the transference of sexually transmitted diseases such as HIV would rise, and the net effect of the vaccine would be more damaging than HPV was in the first place.  Except that isn't happening, and we now have data to prove it.  Technically we had the data before, but a recent study simply analyzed the available data and summarized the findings.  

CBS News: HPV vaccine won't make girls promiscuous, study finds

USA Today: HPV vaccine not tied to increased promiscuity for girls

Psychology Today: HPV Vaccine Doesn't Cause Promiscuity

So with that out of the way, it makes you wonder what excuse antivaxxers will decide to use next.  Time will tell, but the one thing we know for certain is that they won't start admitting that the benefits of the Gardasil vaccine far, far outweigh any risks... because that would be allowing the data and the science to lead them to a conclusion, and we all know antivaxxers aren't very good at allowing the data to tell the story.