GPs and practice staff on frontline turn down swine flu vaccine

I suppose GPs are free to make up their own minds on this; if they want to catch swine flu and risk its complications, need to take a week or two off on sick leave and put the burden of caring for their patients upon their shortstaffed, overworked practice partners then that is their personal decision. Their partners are unlikely to feel very sympathetic however, especially as they will be dumped in it at the busiest time of year. But to read doctors like Liz Miller say that she would not be recommending it to patients is scandalous... Certain types of patient are extremely vulnerable to the more severe complications of this infection than others, and to deny them the opportunity to protect themselves is probably something the GMC would show a keen interest in if they were aware of it. I also hope for Dr Miller's sake that a patient in a high priority group for whom she fails to recommend vaccination does not become seriously unwell with swine flu. I doubt Dr Miller earns enough as a locum to cover the resultant negligence claim, and her medical defence organisation is unlikely to be sympathetic.

Good for them, I agree, safety issues with this vaccine, too much push, not enough science.

I find Peter Flegg's comments a little unkind on Dr Miller! At least locums will not be a burden to their colleagues as they do not have colleagues to burden. As I run the local Non-Principal Group I have heard it has been difficult for this group of GPs to actually obtain the swine flu vaccine (although the majority would decline it in any case). I also mirror Mike Lane's comments however with regard to safety issues around the vaccine and I will not personally be rushing to have the vaccine.

It's easy to see why so many front line health workers have doubts about taking the vaccine themselves. Just look at what we know. The risks of adverse events from the vaccine are low, but they seem to be higher than the chances of needing hospitalisation from swine flu (1-4). The mortality rates are low, and on a par with seasonal flu which most people are happy to run the risk of catching. Of course a few thousand people die of flu every year, but its easy to see how the press get over excited when they can put out headlines such as 'swine flu: thousands will die'. Personally, I have no appetite to be injected with the mercury based preservative thiomersal or the squalene adjuvant, due to concerns about the health risks of both. The low risk of death from swine flu does not seem to be worth the risks of injecting these compounds into so many healthy people. Squalene is not necessary, it simply allows a vaccine to be diluted, this allows more doses to be produced. In the event of a virus with much more significant mortality rates, perhaps this would be justified. With swine flu, it simply looks like profiteering. There have been concerns over the possible side effects of squalene. Oil-water suspensions, including MF59, were associated with the ability to induce lupus autoantibodies in non-autoimmune mice (5). In one study, endogenous squalene was linked to autoimmune arthritis in rats (6). (1) 'the countries of the southern hemisphere that experienced the arrival of the pandemic during their winter seasons had similar rates of hospitalization, with most experiencing rates of 10–24.5/100 000' http://www.who.int/wer/2009/wer8446.pdf (2) 'Rates for countries in the temperate zone of the southern hemisphere ranged from 1.8 to 14.6 deaths/1 000 000 population. However, it is almost certain that estimates of the numbers of deaths significantly underestimate the actual numbers and that the degree of underestimation varied from country to country" http://www.who.int/wer/2009/wer8446.pdf (3) 'Dr. David Butler-Jones says that of the 6.5 million people who have received the H1N1 vaccine, only 36 have had serious adverse reactions.' ie in Canada, a rate of 5.5/ 1 000 000. http://www.google.com/hostednews/canadianpress/article/ALeqM5g7a7zt66_DkJIqDwV8aGvukVufIQ (4) 'More than 85,000 doses of the swine flu vaccine have now been administered in the State and so far 113 adverse reactions to it have been reported, Dr Joan Gilvarry of the Irish Medicines Board said.' ie 132/ 100 000 http://www.irishtimes.com/newspaper/ireland/2009/1113/1224258725797.html (5) Andrew Pollack. Benefit and Doubt in Vaccine Additive, The New York Times, September 21, 2009 (6) MF59 Adjuvant Fact Sheet, Novartis, June 2009.