"But experts who track the health promotion industry say "public health" messages urging Canadians
to receive the influenza vaccination for health reasons, in fact reflect the agenda of the vaccine
producers, which is to sell more vaccine."
Flu shot campaign criticized as biased: Experts charge vaccine makers pump product in messages The
Ottawa Citizen Sunday, December 21, 2003 Page: A1 / FRONT Section: News Byline: Sarah Staples
Source: The Ottawa Citizen
The only national, federally endorsed campaign to encourage Canadians to get a flu shot is under
fire from critics who say it is biased in favour of the vaccine manufacturers that fund it.
The Canadian Coalition for Influenza, a "coalition of national organizations committed to the
promotion of immunization" organizes an annual promotional campaign designed "to increase
immunization rates by promoting the benefits of influenza immunization for all ages," according to
its website, www.influenza.cpha.ca .
Health Canada is contributing $50,000 this year to pay for print advertisements, mass mailings of
posters and pamphlets to public health authorities, informational "resource kits" for 5,000
pharmacies, "scientific evaluation of information," advice to first nations reserves and the
website, among other initiatives.
Non-profit agencies such as the Canadian Lung Association, the Canadian Medical Association, and the
Canadian Public Health Association, which acts as secretariat, are members of the coalition, as are
the country's two major influenza vaccine producers, Shire Biologics and Aventis Pasteur.
But experts who track the health promotion industry say "public health" messages urging to Canadians
to receive the influenza vaccination for health reasons, in fact reflect the agenda of the vaccine
producers, which is to sell more vaccine.
"You know what they say: 'don't ask your barber if you need a haircut,' " said Alan Cassels, a drug
policy researcher at the University of Victoria. "They have a product, they think it's wonderful and
they think everyone should take it. That reflects on the coalition they're funding."
A spokeswoman for Shire said the Laval, Que., company has a responsibility to educate consumers
about its products, and about the serious respiratory disease that kills an estimated 1,500 to 2,000
Canadians a year a year.
"We're not there to say this is the one you should get, (but) to say to people, 'here are the facts,
and the advantages (of a flu shot) and you should ask your doctor'," said Michele Roy. "We just want
to get information that is really important out there; that is the spirit of the coalition."
Ms. Roy would not disclose how much funding the campaign receives from Shire, saying the money
flows through an "unrestricted educational grant" that guarantees an arm's-length relationship
to the company.
Shire has supplied more than 7.2 million doses of vaccine this year to various levels of government.
A call to Aventis Pasteur was not returned.
Mt. Cassels, who studies the impact of pharmaceutical advertising and promotion on the media, said
that, despite a wealth of studies suggesting vaccination reduces individual incidences of flu,
there is little evidence to assert the efficacy or cost-effectiveness of mass immunization
campaigns.
Surveys consistently reveal drug companies to be unpopular among consumers, who view them as
untrustworthy; conversely, providing "no strings attached" funding to a non-profit organization or
charity enables companies to indirectly promote their interests, without patients realizing they are
being marketed to, the researcher said.
"If you can wrap up your message to appear like a public health message, then you've hit the gold
mine. If you're a vaccine manufacturer, you're laughing all the way to the bank because the Public
Health Association is doing all your work for you.
"It gives the veneer of not directing how the money is spent. But for those (non-profit)
organizations, there are huge unspoken strings attached," Mr. Cassels explained.
"Unrestricted educational grants" are an example of a broader trend toward disguising marketing
activities as education, said Barbara Mintzes, a professor with the Centre for Health Services and
Policy Research, University of British Columbia.
Direct advertising of prescription drugs to consumers is mostly illegal in Canada, prompting a
notable increase in funding to patient groups and health charities in recent years, said Ms.
Mintzes, who has written extensively on pharmaceutical marketing techniques: "The impression is that
it's getting worse."
The flu coalition website contains lists of references to journal articles and a brief question-and-
answer section, but few specific details on side effects of the influenza vaccine, which are known
in rare cases to include Guillain-Barre syndrome, a neurological disorder; serious autoimmune
diseases; and vaccine-associated symptoms such as wheezing, cough and flu-like symptoms.
The website doesn't mention a recent Health Canada report that concluded up to 80 per cent of
flu germs circulating this year are from a strain of the virus, A/Fujian, not covered by this
year's vaccine.
Inquiries about the content of the website were referred to the National Advisory Committee on
Immunization, or NACI, a federal panel that every year issues an official health advisory about the
upcoming flu season.
Affiliated with NACI is the Canadian Association for Immunization Research and Evaluation, an
organization representing Canadian vaccine researchers. Chairman Dr. David Scheifele, director of
the Vaccine Evaluation Centre at the B.C. Children's Hospital in Vancouver, said CAIRE members
receive most of the project funding from the vaccine industry.
"There are lots of safeguards and increasingly, as universities get more sophisticated in their
dealings with industry, post-'Olivieri', there's a lot more care and caution," said Dr. Scheifele,
referring to
Mu. Nancy Olivieri, a scientist from Toronto's Hospital for Sick Children who in 1998 was threatened
with legal action by a corporate sponsor, when her clinical testing of an experimental drug
turned up unexpected health risks.
NACI is recommending vaccination for the frail elderly; children and adults with weakened immune
systems; and those with certain pre-existing medical conditions. NACI doesn't specifically recommend
vaccination to healthy adults, but lists health and economic benefits as reasons why everyone should
be "encouraged" to get the flu shot.
The coalition website's question-and-answer page, in contrast, asks the pointed question: "Why
should healthy adults be vaccinated?"
"They're making it sound like it's a public health message, like (a flu shot) is something you may
want to consider, when the subtext is everyone should be worried about getting the flu, and should
vaccinate themselves whether they're healthy, sick, old, whatever," said Mr. Cassels.
"Basically, the science doesn't measure up to the hype."
One metanalysis, published in the medical journal Vaccine in 2000, concluded the vaccine was just
24-per-cent effective in preventing the disease, though it prompted an immune reaction in 70 per
cent of recipients.
The flu vaccine caused local adverse reactions in 69 per cent of patients, and systemic reactions in
26 per cent, according to the study.