Family docs slam anti-pneumonia vaccine drive

Some senior family physicians in Israel are opposing the effort to vaccinate the entire population of elderly Israelis against pneumonia as a waste of resources.

Senior officials at the Israel Association of Family Physicians have in recent weeks voiced unusual criticism against a sweeping move to vaccinate the entire Israeli population over age 65 against pneumonia in addition to vaccinations against the seasonal flu. The criticism comes against the backdrop of a newly published article analyzing studies involving more than 100,000 individuals and arguing pneumonia vaccinations are ineffective.

The doctors opposing the pneumonia vaccination plan have told the management of Israel's health maintenance organizations that judging family doctors on their meeting such widespread vaccination goals should also be abandoned.

In an article that appeared in January in the Canadian Medical Association Journal, 22 studies were surveyed on the effectiveness of pneumonia vaccinations. A Swiss study, for example, determined there is little evidence that such vaccinations provide protection against pneumonia. The death rate among those patients who were vaccinated was similar to those who were not. It showed that only 4 percent of chronically ill patients avoided contracting pneumonia as a result of the vaccine.

The findings have not, however, led to a change in directives in the United States, Europe and Israel, where the aim is to have the entire population over 65 receive a one-time pneumonia vaccination and for the chronically ill to be vaccinated every five years.

The critics of the policy at the Israel Association of Family Physicians have voiced particular disapproval over the performance of doctors being measured by the extent to which they meet goals involving vaccination of patients at a reduced price.

Amnon Lahad, who is a senior physician with the association and the chief of family medicine at the Hebrew University Faculty of Medicine, said that "recently it has been concluded that pneumonia vaccinations don't give complete protection or close to complete protection, and it is also a vaccination that is not effective long term. It's true that around the world it is still being recommended, but when the facts are examined, the vaccine has more successful public relations than the vaccination itself. I would not say never to vaccinate, but there is no basis for making this vaccination the flagship of preventative medicine in Israel."

The chairman of the Israel Association of Family Physicians, Dr. Shomo Vinker, said the HMOs "are seeking to aggressively and sweepingly increase the number of those vaccinated for pneumonia. It's true there is no research pointing to risks from this vaccination, but every vaccine has side effects, and we don't want to expose people to a vaccine if it is not effective for them." Vinker added that despite the new evidence, the association is not considering a recommendation that target population groups not be vaccinated.

Some senior sources at the Association of Family Physicians also criticized the growing trend on the part of young adults here to seek pneumonia vaccinations to avoid complications from swine flu. There are doctors who lightly write such prescriptions for young adults, a source said, although it has not been proven effective against swine flu.

Swine flu death

A 50-year-old man with a history of other health problems died yesterday of swine flu, the 24th reported swine flu death in the country.

The Clalit HMO provides free pneumonia vaccinations to its members even if they are not in a specific high-risk target population, on the assumption that only such groups would request the vaccine.

The chairman of the Israeli pulmonologist association said there are articles in support and against vaccinations, but doctors in Israel must consider the position of the Health Ministry, which has called for continued vaccinations against pneumonia among target populations. "We cannot judge ourselves and decide to vaccinate in accordance with the articles, because then every physician would be acting on his own opinion and there would be complete chaos. In this instance, the directives of the Health Ministry must be followed," he said.

A 2008 study of more than 100,000 people found the pneumonia vaccine effective, and the Center for Disease Control in the United States has actually broadened its recommendation as to who should get the vaccine to include all smokers between 19 and 64 years of age.

The Health Ministry said it is aware of the new study, which was accompanied by an editorial in the same journal saying the study's results are not unequivocal, that most studies show the vaccine to be effective and that the current policy regarding the vaccine should not change.

The Clalit HMO, which has made intensive efforts to provide the pneumonia vaccination over the past two years, has seen a 12.5 percent drop in the number of days spent in the hospital among the nearly 40,000 patients vaccinated.