Vaccines figure prominently in Time's "Year in Medicine"

The December 1 issue of Time magazine included several stories on health and medicine, including a feature titled "The Year in Medicine: From A to Z". Of the 33 items listed (some letters had multiple entries, others were skipped), three were related to vaccination:

• A -- "Autism: Debate Rages over a Rare Case". Reviews the Hannah Poling case; the links among vaccines, mitochondrial dysfunction, and autism; and the implications for the overall vaccine-autism debate.

• G -- "Gardasil: Vaccine Battle". Discusses the reports earlier this year about serious side-effects, including deaths, linked to Gardasil. As the item notes, governmental officials are working to assure the public of the vaccine's safety, including through this CDC website.

• H -- "HIV: The Hunt for the Elusive Vaccine Goes On--and On". Details the ongoing failures of HIV vaccine clinical trials and current plans for smaller-scale testing of novel ideas.
  

Seasonal flu: Examining school-based vaccination; Debating health-care worker mandates

A few recent items related to seasonal influenza vaccination:

-- Lisa Schnirring at CIDRAP News published an interesting story last week examining the potential use of school-based flu vaccination efforts in order to increase coverage in the under-18 population for whom vaccination is now recommended by the ACIP. Optimism for these in-school vaccination programs seems to be in short supply given the various pressures -- funding, staffing, and performance -- faced by school districts around the country.

-- Each flu season, the amount of attention grows regarding the astonishingly-low influenza vaccination rates among health-care workers grows. Two recent papers join the discussion about the use of mandates to boost coverage in this group:

• "Requiring Influenza Vaccination for Health Care Workers" (American Journal of Public Health, online pre-publication -- subscription required); Reviews the ethical arguments for and against mandating vaccination, concluding that a program providing small incentives for compliance and requiring active refusal is ethically superior to mandated vaccination.
  

• "The Ethics of Mandatory Vaccination against Influenza for Health Care Workers" (Vaccine, Vol. 26, No. 44, 5562-5566 -- subscription required); Focuses primarily on the ethics of mandatory vaccination for those working in long-term care facilities, and concludes that mandates are only justifiable if voluntary programs fail to achieve 50% coverage among health-care workers.
  

Positive results for Gardasil trial in males

News came from Merck last week that results from its clinical trial of Gardasil in males showed the vaccine's efficacy in preventing HPV-related genital warts and other lesions. No serious safety concerns were found. Here's coverage from the Associated Press and the Merck press release detailing the (as yet unpublished) results which were presented at this European conference last week.

The trial included nearly 4,000 males between the ages of 16 and 26. The vaccine was 90% effective at preventing external genital lesions, the most common of which are genital warts.

Dr. Bernadine Healy, in the news earlier this year for comments seen as supporting a possible link between vaccines and autism, was pleased by these research results about Gardasil, writing about the many benefits of vaccinating males against HPV.

These findings will be part of Merck's eventual application to the FDA to license the vaccine for use in males in addition to females, a decision that has been widely expected for some time.

More interesting, however, will be the decision faced by the Advisory Committee on Immunization Practices regarding its recommendation for Gardasil in males. In particular, it remains to be seen if the direct protection provided against genital warts in males will be sufficient to recommend broad use of the vaccine, and/or what role the indirect benefits of male vaccination (i.e., aiding in the prevention of HPV-related disease in women) will play in the ACIP's recommendation.

No timetable has been set for these actions, but they are sure to be in the news in 2009.

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One other item related to HPV vaccines: The November 15 supplement to the journal Cancer is titled, "Assessing the Burden of HPV-Associated Cancers in the United States". It has a number of papers examining the burden of cervical cancer and other HPV-related conditions as well as several papers on the potential impact of HPV vaccination programs. Very interesting reading.

St. Pete Times story reviews vaccine-autism debate

The November 23 edition of the St. Petersburg Times has a very good feature reviewing the enduring controversy over vaccine safety and alleged links to autism. Written by Lisa Greene, the story, "Debate rages over need for vaccines," interviews prominent voices on both sides of the issue, including proponents of current vaccine policy such as Paul Offit and Amy Pisani, and critics including J.B. Handley and Vicky Debold.

Among other topics addressed in the story is the challenges faced by Autism Speaks in representing its diverse constituencies of autism advocates -- many of whom reject links between autism and vaccines. The piece also explores how media coverage by journalists may contribute to ongoing public confusion over the safety of vaccines.

Greene writes, "This is no longer principally a debate about science. The real question is whether Americans still believe in science — or at least, in the nation's scientists."

Also accompanying the story is a collection of graphs and figures about the history of vaccination efforts and autism trends.

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Speaking of Paul Offit, his new book, "Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cure," has attracted considerable attention this fall, including a profile on NBC's "Today" and a story in Newsweek, among many others. The overwhelmingly-favorable coverage of Offit, his book, and his arguments has triggered online rebuttals from leading critics of U.S. vaccine policy, including Barbara Loe Fisher and J.B. Handley, who refers to Offit as a 'lying jerk.'

Journal roundup: Assessing parental doubts; Cost-effectiveness models in vaccine policy-making

As we do periodically, here are some papers of note published recently in the medical literature. (All require a subscription in order to view the full text.)

• "Parents with Doubts about Vaccines: Which Vaccines and Reasons Why" (Pediatrics, Vol. 122, No. 4, 718-725); A survey of nearly 4,000 parents aimed at understanding the factors contributing to doubts over vaccinating their children or decisions to delay or reject vaccines. The authors note the impact of vaccine safety concerns -- some specific, others general -- on parents with doubts about vaccines and the role of information from physicians in causing parents to change their minds and proceed with vaccination.

• "The Role of Economic Information in Decision-making by the Advisory Committee on Immunization Practices" (Vaccine, Vol. 26, Iss. 42, 5389-5392); A survey of ACIP members' views regarding the use and importance of economic data -- principally cost-effectiveness analyses -- in the development of ACIP recommendations. (While published this fall, the study interviewed the 2006 ACIP membership. This summer, guidelines regarding presentations of economic data were issued by CDC, attempting to address suggestions raised in this survey and elsewhere regarding the standardization of economic presentations.)

• "Funding of Drugs: Do Vaccines Warrant a Different Approach?" (Lancet Infectious Diseases, Vol. 8, No. 11, 727-733); Another paper on the impact of population-level economic analyses on vaccine policy. The authors detail some of the unique characteristics of vaccines and vaccination programs (compared to pharmaceuticals) that make cost-effectiveness analyses more complicated for vaccine policy-makers. Includes examinations of several specific vaccines and the challenges they raise for economic analyses of their impact across populations.

New content now available at VaccineEthics.org

A variety of new materials are now available at VaccineEthics.org:

• Several new Issue Briefs have been added, examining risk and benefit in vaccine policy, vaccine research related to neglected tropical diseases, bioterrorism vaccines, and the vaccine industry.
  
• A new primary-source based curriculum unit is also available, examining key moments in the history of the Salk polio vaccine through documents from the Eisenhower presidential library.
  
• Finally, our bibliography has been updated with over 150 new references, bringing the total number of entries to more than 1,000.

As always, your feedback about the site is welcomed and appreciated.