There are a lot of anti-vaccine tropes about the CDC (Centers for Disease Control and Prevention), none of which make a lot of sense. There’s the conspiracy theories that the CDC is bought off by Big Pharma. Or the CDC whistleblower meme that they hid evidence that vaccines cause autism. However, the CDC usually gets the science right, like they did with the recent FluMist vaccine recommendation.
The CDC, a federal government agency made up of scientists, physicians, and public health officers, who come from civilian and military backgrounds, are the first responders to almost any infectious disease outbreak across the world. They are the front line of science against disease.
They use scientific data, gathered through clinical trials or lab experiments, to make public recommendations about diagnosing, treating and preventing diseases. They’re impartial about their recommendations – they go where the data leads them.
So what’s the story behind the FluMist vaccine recommendation, better yet, non-recommendation? It’s not all that complicated, and it’s clear that the CDC got the science right.
CDC FluMist vaccine recommendation
Recently, a CDC advisory committee recommended that FluMist, a quadrivalent nasal spray influenza vaccine, should not be used during the 2016-17 flu season. The CDC’s Advisory Committee on Immunization Practices (ACIP), a panel of 15 immunizations experts that advises the CDC, voted (yes, they vote) that the nasal vaccine did not provide an adequate level of protection against influenza.
The influenza viruses in FluMist are live, attenuated (weakened) which, like all vaccines, stimulates the immune system. There are two versions of FluMist: one a trivalent vaccine, which protects against three strains of flu virus, and the other a quadrivalent, protecting against four strains.
This ACIP vote is based on data showing poor or relatively lower effectiveness of the nasal flu vaccine from 2013 through 2016. However, ACIP continues to recommend annual flu vaccination, with either the inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV), for everyone 6 months and older.
During the hearing, MedImmune shared results from the company’s 2015-16 influenza vaccine effectiveness study, which found the FluMist quadrivalent vaccine to be 46% effective, compared with the flu shot’s 63% effectiveness. However, Dr. Brendan Flannery of the CDC presented data indicating that FluMist had zero effectiveness against one strain of flu.
The ACIP recommendation must be approved by CDC director, Dr. Tom Frieden, MD MPH, before it takes effect. Because the upcoming 2016-17 flu season is about to start, Dr. Frieden probably will make a temporary decision to not recommend FluMist. Further data will be reviewed next year to determine if the recommendation becomes permanent.
The decision must now be approved by the CDC director, Dr. Tom Frieden, and published by the agency before it takes effect, which is expected to be prior to the upcoming flu season. It is an interim decision that could be reversed when the panel reconsiders it next year with additional data.
FluMist, first approved by the FDA in 2003, is manufactured and marketed by MedImmune, a subsidiary of the Big Pharma corporation, AstraZeneca PLC. The FDA has been concerned about the effectiveness of FluMist, working with MedImmune to determine what might be the cause.
Previously, the CDC has shown some preference for FluMist for pediatric patients because, obviously, no needles. They thought that if all things were equal, then uptake of this version of the flu vaccine would be preferred by parents and children. This is still true, but improvements on the vaccine are still necessary.
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What does this all mean?
I know what the anti-vaccination crowd are saying – the FDA and CDC can’t be trusted, because the got this all wrong, and the CDC shouldn’t be pushing the flu vaccine. And there’s even more nonsense one can find.
But here’s the thing – science is not dogmatic. If there is evidence, generated by the scientific method, that says FluMist is not working, then that must be considered. The CDC, seeing the evidence, changed its recommendation about FluMist. The CDC’s disease experts are constantly monitoring data about vaccines, especially with the flu vaccine, since the flu virus mutates frequently.
[infobox icon=”quote-left”]This announcement is actually good news in at least one respect: it shows just how much the committee is staying up to date with the most recent data, continually re-evaluating the evidence, taking it seriously and relying on it to make decisions. This is actually what science working properly looks like—a constant reassessment and course correction as needed when new evidence emerges.[/infobox]
This is how science works – gathering new data, and then reassessing where that evidence points. And, in this case, it pointed to a fairly ineffective vaccine.
I want to reiterate something – the current flu vaccines are still quite effective. In the same report about FluMist, ACIP stated that the effectiveness of flu shots (excluding FluMist) was around 63%. I know that the anti-vaccine folks think that because it’s not perfect, it must be crap, but given the hospitalization and mortality rate from the flu, a 63% chance of being protected from the disease sounds pretty good to this writer.
Annoyingly, Astra-Zeneca announced that they disagreed with the CDC’s analysis of the data. And they are going to distribute the vaccine in other countries. Well, there goes that old trope that the CDC is in the pockets of Big Pharma.
What does this all mean then? The CDC did it’s job and is probably going to recommend that FluMist not be used in the USA. This decision wasn’t based on politics, Big Pharma, or anything else – it was based on scientific evidence.
Let me repeat that – the CDC got the science right. That’s the most important takeaway from this story.