In 2006, emerging from a decade of Cochrane reviews of influenza vaccines, I was still trying to work out why these interventions were being pushed so hard despite clear evidence that their effects were, at best, slight. The evidence we had assembled came from randomised controlled trials, and it was consistent across age groups. However, the age group performing slightly better (as expected) were healthy adults. 

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Then I got a phone call from a CDC fella who offered me a grant for 100k USD to look into a vaccine, which he said would be very important. It was so important that I had forgotten which one it was (I took notes and had to look them up to remind me occasionally). 

It was an apparent attempt at despistage, as the French would call it. It was April, and staring at the Roman countryside from my window, I conceived a simple idea. Now that we had a complete suite of Cochrane reviews, how did the policy stack up against good quality evidence? 

I started by asking myself which data should be used for decision-making. While writing the reviews, the answer was clear for someone who had read, extracted and assessed the quality of hundreds of influenza vaccine studies.

Including observational data in the reviews was OK for assessing rare or long-term harms. But, when we got to effectiveness, I wrote in a BMJ editorial, “A meta-analysis of inactivated vaccines in elderly people showed a gradient from no effect against influenza or influenza-like illness to a large effect (up to 60%) in preventing all-cause mortality. These findings are both counterintuitive and implausible, as other causes of death are far more prevalent in elderly people, even in the winter months. It is impossible for a vaccine that does not prevent influenza to prevent its complications, including admission to hospital”.

Most of the observational studies were poorly done, and the impact of confounders was substantial, leading to markedly inflated effects.  The gap between the policy and the evidence has ultimately led to an unjustifiable waste of taxpayers’ money. The most reliable evidence for such a significant programme comes from randomised controlled trials and, even better, from systematic reviews of RCTs. The effects of bias would not be completely obliterated, but they would be exposed and minimised.

Because there was no evidence-based rationale for the influenza vaccine program, one had to be created.

In 1984, the US Advisory Committee on Immunisation Practices (ACIP) first recommended that healthcare workers vaccinate annually against influenza. In  2003, ACIP began regularly updating the rationale for influenza vaccination programmes by targeting selected groups. 

So, what was the US plc trying to achieve by vaccinating those against influenza?  The answer was simple: They were trying to avoid influenza complications such as pneumonia and the ultimate catastrophe: deaths. That's good for them; that’s what they were paid for.

These are the categories they were targeting:

So far, there is a clear rationale and target: ten out of ten for the CDC—hats off.

However, how did the CDC decide which proof is sufficient for a population intervention of that size? In practice and clinical epidemiology, the answer is randomised controlled trials.

In my BMJ article, I reported what the good-quality evidence concluded: no apparent benefits, apart from sporadic case prevention (33 to 99 healthy adults must be vaccinated to avoid one case).

It is hardly an endorsement, as trials did not show or test benefits against transmission or complications. Influenza viruses are unstable; they shift and drift, and infections are self-limiting and benign. Setting up a vast global machinery to go after them does not make sense. That is what the trials showed.

The optimistic and confident tone of the predictions of viral circulation and the impact of inactivated vaccines mirrors much of what we see today. All of which is at odds with the lack of evidence.

This post was written by an old geezer who’s been working on this for three decades and hopes that the content of posts like these will be his legacy.

The following posts explore the establishment's responses, manipulations, and rationale for fleecing taxpayers. 

Readings 

(Open access) Jefferson T. Influenza vaccination: policy versus evidence BMJ  2006;  333 :912 doi:10.1136/bmj.38995.531701.80