Five days after Dr Trotman said the flu vaccine didn’t work in healthy normal people (blog entry 27 July), various news outlets around the world commented on a new study in the 2 August edition of the Lancet, showing that the flu vaccine did nothing to prevent pneumonia in healthy elderly living in the community, aged between 65 and 94 years of age.

Medscape today said that vaccination reduced pneumonia rates by a nonsignificant 8% during the flu season, and increased risk by 4% during season peaks. The study pointed out that all participants had normal immune systems.

Note that word, “nonsignificant”. 

Yet in 2007 we were told in a  New England Medical Journal study, that “vaccination was associated with a statistically significant 7% decrease in risk of hospitalization and a 33% reduction in all-cause mortality risk.”  In this study, the researchers cautioned that their findings may not be applicable to older adults or the "frailest elderly in nursing homes”, who may have impaired immune responses further reducing the effectiveness of influenza vaccination.!

So what’s it to be?  A statistically significant 7% decrease, or a nonsignificant 8% decrease?

Having said this, we are told that, “Despite lingering questions, physicians should still be recommending the flu shot.”  Without the benefits of large randomized trials we are told that, for older frailer elderly, that “there could still be” a 5% or 10% reduction in pneumonia or pneumonia hospitalization.

We are told the lack of benefit, “could be that the flu causes only a small proportion of pneumonias in this population, or that the vaccine is ineffective in reducing influenza infection risk in older people at risk of pneumonia”.  Huh?

Let’s rephrase that another way:

1)  The vaccine is ineffective in reducing influenza infection risk.  Having not read the whole study, I can’t see if they looked at that, but you’d think that if they had found a reduced incidence of the flu in both groups, they would have said so.  Perhaps the pneumonia news was bad enough, so they decided not to discuss the lack of reduction in the flu.

2) It “could” be that the flu only causes a small proportion of pneumonias in this population. 

You mean, they don’t know what causes the most pneumonia in this population? 

Wait up here… isn’t the reason the flu vaccine is recommended for the elderly, because influenza is the main cause of pneumonia in the frail in rest homes?  Are they now saying that flu might not be the main cause of pneumonia?  Did they not study that before the recommendations to shoot up all elderly in sight with a dud vaccine?

I’m sure the flu "experts" will think I just don’t get it, but here’s my problem.  If the flu vaccine doesn’t work in the healthy young, or the healthy old, how then is it suddenly going to work in frail elderly with immune systems far worse than either the healthy young or the healthy old?

After all, a previous study showed that: ”Antibody responses to the influenza vaccine in placebo-controlled randomized controlled trials were only about one-quarter to one-half as strong among older adults as they were in younger adults.”

Obviously the flu vaccine is a dud, so can we toss it out now?

Of course not! 

One of the authors of the 2 August Lancet study, Michael L Jackson, said: "Despite our findings, and even though immune responses are known to decline with age, I still want my grandmother to keep getting the flu vaccine …The flu vaccine is safe. So it seems worth getting, even if it might lower the risk of pneumonia and death only slightly."

Jackson’s co-author heartily agreed, saying that everyone over 65 should still get the useless flu shots every year, while the researchers conduct lots of large scale randomized controlled trials to see whether bigger doses of vaccine, or stronger types would work better.

Life is certainly not boring when you are an influenza vaccine expert, trying to justify your existence.