I thought I'd try to come back to Nick's original questions and make sure they weren't lost in the ensuing vax/antivax furore
Appreciate this may be an incendiary topic, but I am sincerely interested to know the opinions of others.
On my Google feed this morning was this article
www.bbc.co.uk/news/articles/cx2ed29v415o regarding a new vaccine which has been developed and is now available on the NHS with the intention of it being offered to pregnant women and those ages 75-79 to protect against respiratory syncytial virus (RSV).
Some basic internet searching reveals RSV is attributed to circa 83 deaths per year in children and 8000 deaths per year among the 'elderly'
(no definition of what elderly is specifically) in the UK. Some context - that is roughly 0.012% of the national population.
The jab on offer has been developed by Pfizer and is said to "reduces the risk of severe RSV lung infection by around 70 per cent in the first six months of life" and "around 80 per cent protection for older adults against more severe forms of RSV over two years." (no detail on what is categorised as
severe) it is also "expected to prevent many cases of the virus each year, and even prevent
some deaths".
RSV's common symptoms are:
- a runny or blocked nose
- a cough
- sneezing
- tiredness
- a high temperature – signs include your back or chest feeling hotter than usual, sweatiness and shivering (chills)
Mortality rates for the 'elderly' are between 38% for those who are hospitalised and 3% for those who remain in the community.
So my initial thoughts which I would encourage others opinion on are as follows
1) This seems to be a relatively low yield 'win' from a medical standpoint. Not to say that any death isn't inherently sad particularly to those close to the deceased.
Answered already, but the decisions about vaccination programs always consider the benefits (health, mortality, NHS burden etc) against the risks (side effects, inherent procedure risks eg injection site infection) and costs (patient convenience and cost, NHS cost) - the benefits conflate efficacy, eg will be lower for a less effective vaccine. Totally fine to question all of them, but how to answer your question without actually doing the work of an epidemiologist? As a society we tend to entrust such specialist analysis to regulated public bodies such as NICE, JCVI, NHS etc, and ultimately to the imperfect-but-best-we-have system of peer-reviewed science that backs them.
2) We (humans) appear to be creating a new 'vaccine' that is offered out to various sections of the population in a time period that I cannot logically believe is sufficient to know the long term implications of them.
If RSV is your sole example of this, I dispute the point. RSV vaccine research has gone on for decades, and there are many vaccinated individuals in the population so there is longitudinal data for them. There is also fairly good data for the cost of RSV-infected people to the NHS, and for the cost of vaccination. The vaccine delivery (physical and chemical) components are pretty standard afaik so there will be adequate safety data for them. There will also be good data for the same variables from other vaccination programs, which I presume allows a decent comparison eg of how RSV vaccination would compare to measles vaccination, etc. I don't have those comparisons to hand but see above.
3) Given 2) If an illness presents as mild symptoms in the majority of cases and has a relatively low rate of severity in even the venerable populations, is mass vaccination the most effective and ethical treatment or should the medical community and society in general be looking at others?
Is vaccinating for herd immunity a good thing? I don't know of any alternatives (do you have any in mind?) but I guess the answer depends on the severity of the disease (= the benefit of herd immunity) vs the cost (to me and society) of vaccination. Both hard to weigh, firstly because we don't have all of the data or the skills to turn it into a prediction, and secondly because of the inherent noise in such a prediction. So it's back to those regulated public bodies for recommendations.
4) The cynic in me worries this is opportunistic pharmaceutical companies riding the PR campaign of Covid and bringing drugs to market with the primary focus of profit rather than public health, I assume this is a new drug under patent but prior to its approval RSV was being treated by some other (cheaper?) means.
Drug companies are (at least partly) motivated by profit, but capitalism does work, so we roll with it. The filter which is designed to ensure societal benefit is those public bodes again.
If by 'treated' you mean 'vaccinated against' then no - the only approved vaccination route prior to today was monoclonal antibodies. This is like feeding Africa with food parcels - it works but you need to keep delivering them ad infinitum, which is a pita. Regular vaccination is like feeding Africa by facilitating agriculturee - it gives your body all it needs to fight future disease without further intervention (this analogy is not very stretchy but you get the point -
wikipedia has more.).
If by 'treated' you mean treated, then the other means is well-understood, and may involve hospitalisation or death. It's not cheaper to individuals or society.
Why do you make that assumption btw? Why assume that the NHS, NICE, JCVI etc would accept a newer, costlier drug over an equivalent cheaper one? As mentioned already, cost is a
paramount consideration.
I would point out that I have never considered myself 'antivax'. Indeed my children all received their recommended vaccinations and I have always received mine. However, I do feel the term vaccination has changed particularly during and since the pandemic when after having one dose yielded limited results the goal posts started to move and terms like 'fully vaccinated' started appearing in the lexicon. And I do have to concede this perceived change in the terminology and seeming desire to depend on vaccines as a solution to all illnesses has increased my distrust of the medical establishment.
To me, 'fully vaccinated' means 'has had all the vaccinations needed against this disease'. Why might more than one be needed? Two reasons - evolving pathogen and waning immunity. And maybe a third - the first vaccine wasn't as good as we hoped.
Pathogens evolve - new strains emerge - which may necessitate new vaccines. Seasonal flu is an example, and of course covid is another (see below).
Waning immunity has been well-described for decades. It's not 100% understood (certainly not by me!) but reflect on the need for tetanus boosters - why do you think that is? It's because over time an immunised person's response to a tetanus challenge gets weaker, to the point where they are not adequately protected against disease. Booster shots of the vaccine boost immunity back up. It's not a new thing.
There are probably some examples, but I'm not aware of any modern vaccine being less effective than predicted, except sometimes those for seasonal flu where they are tracking a moving target, and maybe the covid vaccines where, similarly, it was hard to predict whether the strain being targeted today would be the strain causing most disease by the time the vaccine rolled out. I say 'maybe' the covid vaccines, because I don't think the emergence of new strains would have surprised any scientist, and therefore any predictions of vaccine efficacy would have had that caveat - just not in the headline figure.
This brings me to the other new thing which is the public focus on immunology and epidemiology, which naturally leads to a new need for effective communication of the science - probably that's a good thing long-term.
On the 'seeming desire to depend on vaccines as a solution to all illnesses', I guess I have two thoughts. 1) Would you rather get a disease and be treated, or be immunised in advance? Within reason I think immunisation is better, but obviously it will never be universally true, or unanimously accepted. 2) Yep, there are more vaccines now than there used to be - Hooray! Would I rather go back to a world with polio in it, to save my kids a vaccine shot? Nope. Would I rather not face a winter of seasonal illnesses? Yep. Would I prefer my elderly relatives to have not succumbed to a respiratory pathogen (if you live long enough, 'pneumonia' will likely feature on your death certificate). Yep. Do I want to spend my life in clinics being injected and possibly feeling rubbish for a bit after? Nope. I guess this raises the need to understand your vaccinations to decide if you want them. Luckily, they are not compulsory.
I appreciate by posting this I am likely to be derided as an antivax sporter of a tinfoil hat, but I'm posting as I am interested in the opinion of others as I do not hold mine so dear that I am not willing to entertain differing ones.
PS. To the moderators - If Mr Biden has been putting pressure on you to remove certain content from your platform as it doesn't support the agreed narrative supported by the powers that be, I apologise and will not hold it against you if you delete my post encouraging discourse.