Atlantic examines flu vaccine, antiviral skepticism

As countries around the world roll out H1N1 (swine flu) virus vaccine campaigns, the Atlantic examines, "[W]hat if everything we think we know about fighting influenza is wrong?"

"The U.S. government - with the support of leaders in the public-health and medical communities - has put its faith in the power of vaccines and antiviral drugs to limit the spread and lethality of swine flu," the authors write. "Yet some top flu researchers are deeply skeptical of both flu vaccines and antivirals. … [T]hese experts caution that our defenses may be flawed, and quite possibly useless against a truly lethal flu. And that unless we are willing to ask fundamental questions about the science behind flu vaccines and antiviral drugs, we could find ourselves, in a bad epidemic …"

The article traces the history of vaccine use in the U.S., and examines the evidence that suggests, unlike vaccines for whooping cough and polio, which reduce death rates for the diseases, the data on the protective effects of influenza vaccines are less well-defined. The authors also examine the use of antivirals in response to the H1N1 virus, writing, "As with vaccines, the scientific evidence for Tamiflu and Relenza is thin at best," with studies suggesting a host of adverse side effects from the use of these drugs.

The article continues: "This is the curious state of debate about the government's two main weapons in the fight against pandemic flu. At first, government officials declare that both vaccines and drugs are effective. When faced with contrary evidence, the adherents acknowledge that the science is not as crisp as they might wish." The only way to determine "the efficacy (or lack thereof) of vaccine and antivirals during flu season" would be through "well-constructed, randomized" clinical trials, the authors write.

"In the absence of such evidence, we are left with two possibilities," according to the authors. "One is that flu vaccine is in fact highly beneficial, or at least helpful. … The other possibility, of course, is that we're relying heavily on vaccines and antivirals that simply don't work, or don't work as well as we believe. And as a result, we may be neglecting other, proven measures that could minimize the death rate during pandemics. … By being afraid to do the proper studies now, we may be condemning ourselves to using treatments based on illusion and faith rather than sound science" (Brownlee/Lenzer, 11/09).