'Dire' CDC warnings hiked flu shot demand

By MARK BENJAMIN  |  Oct. 15, 2004 at 12:50 PM
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WASHINGTON, Oct. 15 (UPI) -- A top spokesman from the Centers for Disease Control and Prevention last April told doctors that emphasizing "alarm" and "dire outcomes" from the flu increased demand for flu shots, according to an outline of his presentation reviewed by United Press International.

That official -- outlining for doctors what he called a "recipe" for increasing demand -- said that "heightened concern, anxiety and worry" drove demand for flu shots. The presentation reminded doctors that the flu arrives "in cities and communities with significant media outlets," including newspapers and television stations.

Glen Nowak, now the CDC's acting director of media relations, delivered the presentation at an April meeting of the American Medical Association. It includes a section titled, "'Recipe' that Fosters Higher Interest and Demand for Influenza Vaccine," according to presentation materials. The recipe includes "framing of the flu season in terms that motivate behavior (e.g., as 'very severe,' 'more severe than last or past years,' 'deadly')."

Nowak, who was at that time the CDC's associate director of communications for the National Immunization Program, told UPI Wednesday that he was analyzing factors that increased demand during the 2003-2004 flu season, not coaching scare tactics to increase demand for flu vaccine.

"Recipe is in quotation marks" in the presentation, Nowak said. "People wanted to know what was learned in the 2003-2004 vaccination season. It is a look backward as to how demand was created." Nowak said flu shots are an important part of preventing flu, which can be deadly. CDC officials have expressed concern at low rates of vaccination among some risk groups.

The recipe is in a section of the presentation titled "Getting Ready for 2004-2005: Lessons (Re-) Learned [Including the Seven-Step Recipe for Generating Interest in, and Demand for, Flu (or any other) Vaccination]."

A vaccine safety advocate said the CDC's rhetoric does not match the risk from flu.

"We have known for several years that the CDC is employing behaviorists and communications specialists to instill fear and anxiety in the public about infectious diseases in order to promote mass vaccination. But the rhetoric about flu risks has been especially over the top," said Barbara Loe Fisher, president of the National Vaccine Information Center, which does not take money from vaccine manufacturers.

"The public is not being well-served by federal health officials who use deceptive propaganda techniques to panic people into standing in lines to get flu vaccine rather than tell them the real truth about flu risks as well as vaccine risks."

An unexpected shortfall in vaccines this year -- combined with strong demand for the vaccines -- has left scores of the elderly waiting in line for flu vaccinations. British health authorities Oct. 5 shut down Chiron Corp.'s flu vaccine plant in Liverpool, barring nearly 50 million doses from the U.S. market. Press reports cite concern over contamination.

When discussing flu shots, the CDC's director has said that boosting vaccine manufacturers' profits would improve reliable vaccine supplies. "There have been many evaluations of why our vaccine manufacturing capability is becoming increasingly limited," CDC Director Julie Gerberding said at an Oct. 12 press conference. "One of the major reasons is that the manufacturers are leaving the market. Obviously, if there was a profit to be made, they would be in the market."

A presentation on flu vaccines by manufacturer Aventis Pasteur at the same conference last April says: "Demand for influenza vaccine drives increased supply. Steady, predictable annual increases in demand will ensure increased capacity to meet immunization goals."

The CDC last flu season targeted for flu vaccinations people over age 65 and people with certain chronic medical conditions. This year, the CDC also recommended that children under age 2 get vaccinated. Nowak's presentation last April also discusses people in age groups 18-49.

Twice in Nowak's presentation he cites the threat to children, noting that "visible/tangible examples of the seriousness of the illness (e.g., pictures of children)" was part of the recipe that increased demand for flu shots.

The CDC received reports of 152 flu deaths among children during the 2003-2004 flu season. It says it is unclear whether that number is high or low. "The answer to this question is not known," a CDC statement says. "Because the number of influenza deaths in children has not been tracked before, it's not possible to compare the number of deaths in children this year with previous years."

Each year, the CDC tries to anticipate the strain of flu that will hit the United States and provides a seed virus to manufacturers. Last year, the vaccine did not match the flu virus. In January, the CDC released a fact sheet stating that in an initial study, "the 2003-2004 influenza vaccine was not effective or had a very low effectiveness against 'influenza-like illness'" in one group of health care workers. The CDC said that study does not prove that the vaccine was totally ineffective.

In his CDC presentation on increasing demand for flu shots, Nowak used as a good example a statement by the Mayo Clinic's Dr. Greg Poland about the risk of flu last season. In an article headlined, "Mayo Clinic official predicts worst flu season in 30 years," Poland told USA Today last November, "This will probably be the worst flu season we've had in several decades. My guess is that we'll be in the 50,000 to 70,000 deaths this year due to this strain."

The CDC said that states are not required to report deaths from flu, but that a data analysis indicated that the percentage of people who died from pneumonia or flu last year "was higher than the epidemic threshold for nine consecutive weeks."

The CDC's "Questions and Answers" about the flu, available on its Web site, says that "flu seasons are unpredictable...Before a flu season begins, it is not possible to accurately predict the features of any season."

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