“The mark of an effective vaccine is not that it prevents mild illness, but rather that is lowers your chance of severe illness, hospitalization, or death and curbs spread of the illness throughout the community without hurting people along the way.”
What is misinformation? Every side of every debate claims that the other side is spreading misinformation especially when it comes to vaccines, and the side with the loudest voice and the most access to federal agencies and the media always seems to have the upper hand. Doctors tend to follow everything federal agencies (like the CDC) say, or what is written in their favorite newspapers or uttered by their favorite academic physicians, but there is very little critical thinking involved on either side. For adults, this blog will provide you with the most robust data we have regarding adult immunizations, and we’ll do our best to cut through all the misinformation from both sides and just stick to the facts.
Vaccine Deniers vs. Vaccine Zealots: When it comes to vaccines there are the two extreme positions, and both are vitriolic, non-scientific, boisterous, dogmatic, and ultimately very dangerous. Deniers/skeptics claim correctly that very little good data exists regarding the efficacy and safety of most vaccines. Frankly, the data is disturbingly scant with almost no randomized trials demonstrating who, if anyone, benefits from a vaccine; whether it is safe to take multiple vaccines; and if there are salient short- and long-term problems incurred by vaccination. So, on this point they are correct. However, we do have some historical data that they also vigorously dispute, such as the fact that when we instituted smallpox and measles vaccines we saw a marked reduction in deaths from both viruses. This must be considered sufficient, I believe, to support the benefit of those vaccines. But, they are right to insist on some demonstrable evidence of benefit and minimal risk for a vaccine to be considered effective, including age-specific data and data about interactions with other drugs and vaccines. Very few vaccines meet these criteria.
The zealots are far more frightening as they insist that no evidence is needed as long as a drug company, a TV network doctor or other academic doctor in some way affiliated with drug companies, or a federal agency highly affiliated with drug companies (like the CDC) tells people to take the vaccine. In fact, to most vaccine zealots, any evidence that dissuades people from taking a vaccine is immediately considered misinformation. Facts don’t deter zealots from their religiously inspired quest not only to vaccinate themselves but to insist that every person on the planet become vaccinated too. During COVID, such zealots largely won the day, and now they are insisting that people get even more vaccines. This is not science. It is not good medicine. It is a form of religious fundamentalism.
Just a word on the CDC. In my upcoming book Uncared For, I have documented numerous instances in which the CDC has worked with drug companies to promote vaccines and anti-viral medicines that clearly have been proven to be both ineffective and dangerous. Several articles at Cochrane and in medical journals such as BMJ have documented flagrant violations by the CDC of medical ethical principals in which, despite data to the contrary, the CDC has endorsed ineffective medical interventions and made flawed and potentially dangerous proclamations largely based on committees run by former executives of the pharmaceutical industry. In addition, a substantial quantity of CDC funding flows from the CDC-Foundation which is almost entirely funded by the pharmaceutical industry. And thus, relying on CDC recommendations is akin to relying on recommendations by drug companies or by doctors whose work is largely financed by drug companies. To know if a vaccine works, we cannot ask the CDC or academic doctors. We must look at the evidence as derived by randomized studies and by historical experience.
Two salient articles from the BMJ that reveal the CDC's tie to industry and how both industry funding and leadership have tainted its recommendations.
Public Health Benefit of Vaccines. A salient consideration when we discuss vaccines is whether they convey a public health benefit. When vaccinating an entire population is necessary to assure the safety of each individual, then the vaccine has a public health benefit. In other words, if you get a vaccine and you are only protected if everyone else gets that vaccine too, then there is a public health exigency to mandate that vaccine. In this day and age, no vaccine meets that criteria. As we will see, if a vaccine is protective, then it will protect you even if everyone around you doesn’t get it. Thus, despite the preaching of zealots who demand mandates and who shame the unvaccinated, vaccination is largely an individual choice, not one that should be forced on anyone. To mandate a vaccine would be akin to mandating someone to use sunscreen or take cholesterol drugs because you believe that sun screen and cholesterol drugs are effective. At least in this country, health decisions don’t work that way.
The danger of multiple vaccines as we age. Why not just get all the vaccines we can? What’s the downside? As we age our immune system becomes somewhat disabled. It is not nearly as robust as it was in younger years, and it can only fight infections when it is pointed in the right direction and unleashes all of its energy against the culprit infection. This is made worse if we have diseases or conditions that further impair our immune system, such as obesity, diabetes, auto-immune conditions, or are on medicines that impact immune function such as prednisone. When you get a vaccine, it points your immune system in the direction of the bug against which you are being immunized. Thus, after a flu shot, some of your immune system is now busy getting ready to fight flu. Each shot you get takes away some of your immune system’s ability to fight other infections. The more immunizations we get, the weaker our immune system becomes to fight anything other than what we are being immunized against.
As you can see, multiple immunizations must be done with extreme caution in people with compromised immunity, which includes everyone who is elderly. We don’t want to immunize you against something unless we are sure it’s shown to work, it has minimal interactions or side effects, and it is not mixed with many other vaccines. One common problem we confront in geriatrics is something called a prescribing cascade. That occurs when we give you a drug, you get a side effect from the drug, we treat that side effect with another drug which gives you another side effect leading to yet another drug, and soon enough you are on twelve drugs and are sicker than before you saw a doctor. We also can create a vaccination cascade, where we give you too many vaccinations which weakens your immune system leading to more infectious illness which leads to more vaccines which leads to more infections. We saw this during COVID when far too many vaccines led an increase in infections like shingles, pneumonia, and even RSV, prompting calls for more vaccines which leave our elders even more vulnerable to even more infections as their weakened immune system becomes far too busy to fight anything else. Beware of zealots who believe that vaccines are all good and should be poured into the body like water, and beware pharmacies and doctors who say the same and who are paid well the more vaccines you get; our goal would be to give you the most effective vaccines possible as rarely as possible and to give as few vaccines as possible, which reflects the geriatrics mantra that: LESS IS MORE. Now, let’s talk about the most common vaccines.
Influenza: Recommendation is to take a standard dose flu shot annually. The flu shot has been around for decades and has largely been shown to be safe and effective. The mark of an effective vaccine is not that it prevents mild illness, but rather that is lowers your chance of severe illness, hospitalization, or death. Influenza vaccination meets those criteria. Although the vaccine sometimes misses the mark, it can pack a lot of possible variants of flu into one shot without being too immunogenic. In other words, it doesn’t lead to prolonged or intense activation of your immune system, rather instead helping your body to develop antibodies that ware off after a few months. Because of the short-lived nature of the shot, it is advised not to get it too early; anytime after October is optimal. Also, there is no evidence that the so-called high-dose flu shot is more effective in preventing severe illness, hospitalization, or death than the standard dose shot, but it can lead to more side effects. Thus, we don’t recommend the high dose shot even if most doctors and pharmacies tell all elders to get it. There’s just not enough evidence to promote its use.
Pneumovax and Prevnar: Recommendation is to take Pneumovax once a lifetime after age 65 and not to take Prevnar. Bacterial immunizations differ from flu in terms of their ability to lead to longer immune protection. Pneumovax helps prevent infection from pneumococcus bacteria that can cause sinusitis, bronchitis, and pneumonia. It is not a vaccine against pneumonia which can be caused by many bacteria, but rather only against the pneumonia caused by pneumococcus. It usually is not very immunogenic but can persist for a lifetime. Studies show a small benefit in terms of preventing severe disease, hospitalization, and death, mostly by averting blood-borne infections. It is considered safe. A second iteration of pneumovax vaccine called Prevnar is being recommended as a second pneumonia shot, to take in conjunction with Pneumovax. We don’t recommend its use. There has been only one study, it was conducted by the drug company under very scripted circumstances that do not reflect the health conditions of most people. For instance, participants were overall healthy, and they also could not have ever had the Pneumovax vaccine. Even under these conditions, Prevnar did not prevent any serious sequala of pneumococcal infection. And the very fact that the CDC recommends Prevnar be given along with Pneumovax, even as the drug company study deliberately excluded people who had received pneumovax from participating, is very disturbing. I communicated with a vaccine “expert” at the CDC who acknowledge that we have no clinical data to support the combined use of both Pneumovax and Prevnar, but that CDC advised getting both because they cover different strains of the bacteria. Still, that doesn’t mean that both work well together, and given the lack of evidence of efficacy of Prevnar, the small benefit of Pneumovax, and not a single good study showing what happens if people take both of these vaccines together, we strongly advise against getting both shots. Just get pneumovax once after age 65 and for now that’s good enough. If more data comes out we may change our recommendation, but it’s unlikely that the drug company will do any other studies since currently they are selling tens of billions of dollars of Prevnar a year without a sliver of data to support its use, and thus it is doubtful they’d want to do a study that may refute its efficacy.
Shingles: Recommendation is to take the two-part Shingrix vaccine if over age 60 even if you have had prior shingles vaccines. Shingle is reactivated chicken pox—or, as one of my patients described it, long chicken pox—and when it strikes it really hurts. It can form a painful rash on one side of the body and in rare circumstances the searing pain can be life-long. No one knows what activates latent chicken pox or who is prone to prolonged symptoms, so we believe everyone should get this shot, even people not sure if they had chicken pox. It hurts a bit, but is overall safe, and is very effective at preventing severe shingles.
RSV: Recommendation is not to get the RSV vaccine. Respiratory Syncytial Virus (RSV) is primarily a serious respiratory infection in infants. It has historically killed 60-100 million infants annually, but very few in this country. It rarely poses harm to elders and seems to have found its way into the news recently even though it has been around for decades. It is very likely that more elders are getting it now due to being over-immunized, but the CDC and other tainted sources are suggesting that elders get an RSV vaccine. This is the end result of the vaccine cascade we discussed earlier, and it just leads to more immune compromise without any evidence of benefit. Studies are lacking that would tell us if RSV vaccine prevents serious RSV in elders and is safe, and since RSV is not a very common virus in its serious form, it would be medically negligent to recommend this vaccine now. Unless we get more information about the vaccine in elders, especially in combination with other vaccines, or unless RSV become more of a threat, we advise people to stay clear of it.
COVID: Recommendation is to use caution and wait until we know more about the newer COVID vaccines. When COVID vaccine came out at the end of 2020 it was perceived as a medical miracle, and we were told that if enough people received it then society would return to normal, masking would disappear, and the death toll would plummet. None of that occurred; more people died of COVID after the vaccine than before, and in the VEERS data base—which lists reported vaccine reactions—the COVID vaccine and subsequent boosters cause more serious problems than virtually every other type of vaccine combined, with a frighteningly large number of people suffering disability and death. The COVID boosters have been even less effective, with not a single analysis or study demonstrating that the boosters prevented serious illness. In fact, there has been no difference in risk of catching COVID or getting ill from COVID in people who received booster’s vs those who didn’t, but boosters caused side effects in many. Thus, from the standpoint of medical rationality and the Hippocratic Oath—First Do No Harm—it would be negligent to recommend any boosters for COVID, especially as the virus is far less dangerous now than it was 2 years ago. Whether the new annual shot will surmount these problems and both help people avoid serious COVID AND not cause significant side effects is yet to be seen. The COVID shots and booters are very immunogenic and take up a lot of space in our immune system’s capacity for up to many months. Thus at this point, we could not medically, scientifically, or ethically recommend a COVID shot until we know more.
MMR, Pertussis, Tetanus: Recommendation is to not get any childhood vaccines including Measles, Mumps, Rubella, or Pertussis, and not to get the Tetanus shot regularly. Yes, adults can get childhood viruses, but rarely are they serious, nor do we know if any childhood vaccines can avert serious illness in elders. Given that only a dozen cases of such childhood viruses flutter around each year, all in kids and very few being serious, it would be folly to take these vaccines at the expense of your immune system’s integrity. Similarly, Pertussis—Whooping Cough—is not a serious illness in adults, and the only people who should get that shot are people who will be caring for an infant who is less than 2 months old. As for tetanus, having practiced for 30 years I and no one I know have ever seen a case of tetanus; it’s rare and it can be treated with a vaccine after injury, so again there is no reason to take yet another vaccine and harm your immune system for an illness that is largely invisible.
In sum, vaccines are many in number and more are being developed each year. The overall thrust of CDC and “expert” epidemiologic recommendations is to take them all, even at the same time. In elders, this is medically unsound and potentially dangerous. We have given our advice about which vaccines make the most sense, with two caveats. First, don’t take any vaccines together. For our immune system to best develop immunity after a vaccine, we need not to be sick and we can’t have our body fighting two vaccines at the same time. This is why we are always told not to take a flu shot when we’re sick, but now the CDC seems to have discarded science in its rush to assure that drug companies sell as much vaccine as they can. Second, if you have a reaction to a vaccine, don’t take it again; no vaccine is worth it. At best, most vaccines provide small benefit, and when there is risk involved, then we have to use even more caution.
Sometimes in geriatrics we must discard expert advice when that advice contradicts science. Few experts understand the aging body, and most seem to have adapted a take-as-much-medicine-as-you-can mentality. We at PPC believe just the opposite. Our bodies function better on fewer pills and with fewer shots. While some vaccinations seem to help, a flood of vaccinations poured into our bodies is a very bad idea. At our office we only give the standard flu shot; all other vaccines can be given at the pharmacy without a doctor’s order, but beware: they usually want to introduce you a vaccine buffet!