Blaming the flu vaccine for the COVID-19 outbreak: The latest antivaccine misinformation

I have to hand it to antivaxxers. If there’s one thing about them, they’re consistent. Whenever there’s an outbreak of infectious disease, they make and spread conspiracy theories designed to support their antivaccine views. Yes, it might be happening now with the new coronavirus outbreak in China, but it happened during the horrific measles outbreak in Samoa last year that killed dozens of children, mostly unvaccinated, and sickened thousands. (Antivaccine leader Robert F. Kennedy, Jr. even wrote a letter to the Prime Minister of Samoa warning him that it was shedding from the MMR vaccine that had caused the outbreak. Interesting how antivaxxers never mention that the outbreak started when MMR vaccine uptake was very low and didn’t break until the government had achieved >90% vaccine uptake.) Similarly, there were a great many conspiracy theories about the Disneyland measles outbreak in early 2015, in particular that the government was hiding its “true cause” (MMR viral shedding, of course) and had instigated it as a tool to usher in “forced vaccination.” Earlier, there were more conspiracy theories during the H1N1 influenza pandemic 10 years ago than I can even remember. I’m sure there were conspiracy theories during the SARS outbreak 17 years ago, but I wasn’t paying as close attention then as I do now to these issues.

Coronavirus
Coronaviruses

The outbreak doesn’t even have to be of a vaccine-preventable disease to produce antivaccine conspiracy theories. For example, the ongoing coronavirus outbreak in China has spawned the latest batch of conspiracy theories. (Note added March 23: the virus is now called SARS-CoV-2, for SARS coronavirus-2, and the disease caused by it is called COVID-19, for coronavirus disease 2019.) The one I’m most amused by (sort of) is an attempt by the merry band of antivaccine propagandists over at that wretched hive of scum and antivax villainy, Age of Autism to blame the coronavirus outbreak on the flu vaccine. You heard that right. Because of course antivaxxers would find a way to blame an outbreak of a disease that is not vaccine-preventable (yet) on the influenza vaccine.

First, here’s some background about coronaviruses and the outbreak. The strain of coronavirus causing the Wuhan outbreak has been dubbed 2019-nCoV (novel coronavirus first identified in December 2019). As of yesterday when I wrote this, there had been reported 6,165 confirmed cases of 2019-nCoV infection, of which 6,067 were within mainland China, with 133 deaths. 2019-nCoV is related to the SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome) strains of coronavirus that can also cause severe disease. By way of background, the major SARS outbreak began in China in 2002 and resulted in thousands of cases of disease and 774 confirmed deaths. The MERS outbreak began in 2012 on the Arabian Peninsula and resulted in a 30-40% case fatality rate, which is staggeringly deadly, given modern supportive medical care. Other strains of coronavirus are less deadly, with a total of seven strains of coronavirus known to infect humans. The four strains other than the deadly MERS, SARS, and the Wuhan strain (now dubbed 2019-nCoV, for novel coronavirus 2019), basically cause generally mild upper respiratory tract infections. Coronaviruses can also cause a number of diseases in farm animals and domesticated pets, some of which can be serious, and it is suspected that 2019-nCoV might have originated in animals and “jumped species” to humans, mainly because the first infected individuals identified were workers at the Huanan Seafood Market.

Of course, this is not the first conspiracy theory that’s popped up in the wake of the Wuhan coronavirus outbreak (named after Wuhan, China, where the outbreak was first detected). China is having a hard time quashing rumors and conspiracy theories about the outbreak, such as that it’s biological warfare, that vinegar root can prevent infection, and more. Likely you’ve heard the conspiracy theory that Bill Gates created this strain of coronavirus. This conspiracy theory appears to have originated with a QAnon YouTuber named Jordan Sather:

The crux of Sather’s conspiracy hinges on a 2015 patent filed by the Pirbright Institute in Surrey, England, which covers the development of a weakened form of a coronavirus that could potentially be used as a vaccine to prevent respiratory diseases in birds and other animals. This is a standard way that vaccines are made, for everything from the flu vaccine to the polio vaccine.

“The assignee of this patent was the government-funded Pirbright Institute out of the UK,” Sather tweeted. “Was the release of this disease planned? Is the media being used to incite fear around it? Is the Cabal desperate for money, so they’re tapping their Big Pharma reserves?”

One of the many, many issues with Sather’s theory is that the Pirbright does not currently work with any strains of the coronavirus that affect humans — its patent covers the avian coronavirus, which only affects birds. (Scientists have suggested that snakes or mammals could be the source of the outbreak — not birds.)

Also, QAnon believers are advocating using Miracle Mineral Solution (a.k.a. MMS a.k.a. bleach) to prevent and treat coronavirus infection, because of course they are.

Meanwhile, the usual suspects (e.g., Mike Adams and others) are predicting the end of humanity, as Steve Novella notes. Other conspiracy theories include the claim that the coronavirus was released by shadowy forces in order to impose 5G on an unsuspecting populace. (Don’t ask me how.) Others claim that it’s a pretext for the “New World Order” to impose martial law and start filling the camps. You get the idea. Still others claim that it’s a manufactured bioweapon stolen by Chinese spies from Canada.

Let’s look at what the propagandists at AoA are claiming in an uncredited post. (I’d leave my name off dreck like this too, not that I’d ever write it in the first place.) As is frequently the case, antivaxxers have latched on to a real phenomenon that gives their claim a tiny grain of plausibility and then run with it. This idea appears to be inspired by a recent series of articles pointing out that, right now, influenza is a far greater threat to the US than 2019-nCoV, noting:

Although the CDC considers this coronavirus (whose scientific name is 2019-nCoV) to be a serious public-health concern, the agency said in a statement Friday that “the immediate health risk from 2019-nCoV to the general American public is considered low at this time.”

A graver health risk for Americans — not just right now, but every year — is the flu.

Since October, up to 20,000 people in the US have died of influenza. The coronavirus, meanwhile, has infected more than 4,600 people worldwide and killed 107.

“When we think about the relative danger of this new coronavirus and influenza, there’s just no comparison,” William Schaffner, a vaccine expert at Vanderbilt University Medical Center, told Kaiser Health News (KHN). “Coronavirus will be a blip on the horizon in comparison. The risk is trivial.”

There is merit to this argument. Even though the case fatality rate of influenza is much lower than that of the strain of coronavirus causing the current outbreak, millions of people in the US alone have already caught the flu, and the worst could be still to come for this season. Also, since there is as yet no vaccine for coronavirus but there is for influenza, there is more that can be done to prevent the flu than just washing one’s hands a lot and trying to stay away from people with signs of respiratory infection.

But where does the flu vaccine come in? It starts with this observation by the anonymous AoA scribe:

Honestly, just reading up on both influenza and coronavirus brings up some interesting reading. For starters, it appears in China, that this year, there were twice as many flu shots being given:

China Daily | Updated: 2019-10-31

The supply of flu vaccines in China this year will be twice as large as last year to ensure demand is met, the top health authority said on Wednesday, adding it is well prepared for the arrival of flu season.
More flu vaccines this year could be a clue?

Reading the rest of the article, I highly doubt it:

He Qinghua, deputy director of National Health Commission’s Disease Prevention and Control Bureau, said at a news conference that about 28 million doses of flu vaccines will enter the domestic market this winter and next spring, which is peak flu season in most parts of China-more than double the number available during the last flu season.

And:

As of Wednesday, about 860,000 doses of flu vaccine had been used, and it is expected 1.5 million doses will be given to residents in Beijing by the end of November, he said. “We will do our best in flu prevention and control between mid-December and early February, the peak season of the flu in Beijing,” he said.

This is China! Its population is 1.4 billion! The population of Beijing alone is over 21 million! If anything the supply of flu vaccine seems grossly inadequate for the need. Antivaxxers are nothing if not fantastic at confusing correlation with causation.

But how? you ask. How could increased uptake of the flu vaccine cause a coronavirus outbreak? Well, let’s follow antivaxxer “logic,” such as it is:

There does seems to be connections to flu shots and acute respiratory infections, like coronavirus:

Increased Risk of Noninfluenza Respiratory Virus Infections Associated With Receipt of Inactivated Influenza Vaccine

We investigated the incidence of acute upper respiratory tract infections (URTIs) associated with virologically confirmed respiratory virus infections in a randomized controlled trial of influenza vaccination.,,,TIV ( trivalent inactivated influenza vaccine ) recipients had higher risk of confirmed noninfluenza respiratory virus infection (RR, 3.46; 95% CI, 1.19–10.1)….c Including positive detections of coronavirus, human metapneumovirus, parainfluenza, respiratory syncytial virus (RSV)…we were able to observe a statistically significant increased risk of confirmed noninfluenza respiratory virus infection among TIV recipients..

May I say that this particular antivaxxer is very annoying in stringing together passages from the study in such a haphazard way, unable even to use ellipses properly? I thought of cleaning up the text for your benefit, but decided just to do a straight cut and paste, so that you could see the text in all its glory. (Also, I’m too lazy.)

In this study, investigators examined the risk of influenza and other acute respiratory illnesses in a randomized controlled trial of trivalent inactivated influenza vaccine (TIV) versus placebo and reported that TIV recipients had an increased risk of confirmed non-influenza viral upper respiratory infections. The relative risk was 4.40, but the 95% confidence interval was huge (1.3-14.8), which doesn’t give me a heck of a lot of confidence in the result of this study. At least whoever it is didn’t cherry pick this particular table from this paper, as another one did:

Yes, coronavirus strains were basically in a “wastebasket” category of assorted other upper respiratory viruses. I note that the difference was not statistically significant between placebo and TIV.

However, antivaxxers are nothing if not expert cherry pickers; so:

That was 2012. Six years later, this study came out:

Assessment of temporally-related acute respiratory illness following influenza vaccination

Conclusion Among children, there was an increase in the hazard of ARI (acute respiratory infection) caused by non-influenza respiratory pathogens post-influenza vaccination compared to unvaccinated children during the same period. Potential mechanisms for this association warrant further investigation. Future research could investigate whether medical decision-making surrounding influenza vaccination may be improved by acknowledging patient experiences, counseling regarding different types of ARI, and correcting the misperception that all ARI occurring after vaccination are caused by influenza.
The conclusion, after saying that indeed those who are vaccinated DO get more acute pathogen-creating illness, like CORONAVIRUS, that should make us all wonder if there are any connections here. The acknowledging that patients DO get ill after flu shots from these other viruses (VIRAL INTERFERENCE) is priceless yet disturbing. Basically patients have been made to feel like they were wrong for decades. I am sure deaths too, have been involved but to correctly blame it on the vaccine has been taboo. Mutating bacteria and viruses are possible for sure and vaccines can also be responsible for that

Um, no. Not exactly. Is viral interference a thing? The very study cited by this antivaxxer notes that the evidence is conflicting, with two large vaccine safety studies having failed to find an increased risk of non-influenza viral ARI after flu vaccination. The idea is that various viruses “interfere” with each other’s ability to cause infection, possibly through nonspecific immunity to one virus inhibiting other viruses, possibly by other mechanisms, meaning that if you eliminate one viral source of infection of ARI (e.g., the flu) then other viruses will fill in the gap to cause more infections.

I note that this was a cohort subanalysis of the community-based study, Mobile Surveillance of Acute Respiratory Infections and Influenza-Like Illness in the Community (MoSAIC), which follows 250 households a year for ARI (acute respiratory infection) surveillance. Cases of ARI were ascertained by twice-weekly text messages to household to identify members with ARI symptoms. Nasal swabs were obtained from ill participants and analyzed for respiratory pathogens using multiplex PCR. The primary outcome measure was the hazard ratio of laboratory-confirmed ARI in individuals post-vaccination compared to other time periods during three influenza seasons. And, yes, the investigators found an increased risk of ARI in those who had had the flu vaccine, with:

The hazard of non-influenza respiratory pathogens was higher during the same period (HR 1.65, 95% CI [1.14, 2.38]); when stratified by age the hazard remained higher for children (HR 1·71, 95% CI [1.16, 2.53]) but not for adults (HR 0.88, 95% CI [0.21, 3.69]).

First, one notes that that’s a much smaller hazard ratio than the first cited study, also with a fairly wide 95% confidence interval. Again, it might indicate something going on, but it’s hardly slam-dunk evidence. Again, the numbers are small, and it’s not clear that all confounding factors have been accounted for.

Not surprisingly, our AoA “scientist” gives it one more try:

We can end here, with a recent study, freshly out and pertinent:

Vaccine. 2020 Jan 10;38(2):350-354. doi: 10.1016/j.vaccine.2019.10.005. Epub 2019 Oct 10. Influenza vaccination and respiratory virus interference among Department of Defense personnel during the 2017-2018 influenza season.

Receiving influenza vaccination may increase the risk of other respiratory viruses, a phenomenon known as virus interference. … Vaccine derived virus interference was significantly associated with coronavirus and human metapneumovirus…..

We will read that this Coronavirus is from “bats, pigs and small mammals”, Biowarfare labs , yet you can bet vaccines will be dismissed in a heartbeat.

That’s some fine cherry picking and quote mining there, pardner! I’ll show you what i mean. Let’s look at a more full reading of the abstract:

We compared vaccination status of 2880 people with non-influenza respiratory viruses to 3240 people with pan-negative results. Comparing accinated to non-vaccinated patients, the adjusted odds ratio for non-flu viruses was 0.97 (95% confidence interval (CI): 0.86, 1.09; p = 0.60). Additionally, the vaccination status of 3349 cases of influenza were compared to three different control groups: all controls (N = 6120), non-influenza positive controls (N = 2880), and pan-negative controls (N = 3240). The adjusted ORs for the comparisons among the three control groups did not vary much (range: 0.46–0.51).

And:

Receipt of influenza vaccination was not associated with virus interference among our population. Examining virus interference by specific respiratory viruses showed mixed results. Vaccine derived virus interference was significantly associated with coronavirus and human metapneumovirus; however, significant protection with vaccination was associated not only with most influenza viruses, but also parainfluenza, RSV, and non-influenza virus coinfections.

Let me repeat that: Receipt of influenza vaccination was not associated with virus interference among our population. In other words, this is a negative study. The authors did not observe virus interference.

Then, in the conclusion:

The overall results of the study showed little to no evidence supporting the association of virus interference and influenza vaccination. Individual respiratory virus results were mixed, and some rebutted virus interference.

I also note that the odds ratio of having coronavirus in those vaccinated against the flu compared to those who were not was only 1.36 (95% confidence interval 1.14-1.63). That’s not very impressive at all.

Here’s what we’re probably seeing: Noise. With the odds ratio of influenza virus significantly decreased (the odds ratios range from 0.39 to 0.88, depending on the specific influenza strain), the rest of the various viruses detected fluctuated around an odds ratio of 1.0 (no difference). Indeed, most of the non-influenza viruses tested for (6/8) demonstrated odds ratios lower than 1.0 (range: 0.67-1.51). Only coronavirus and human metapneumovirus showed odds ratios of more than 1.0 (1.36 and 1.51, respectively), with the rest all lower than 1.0. Moreover, the odds ratio of having no pathogen detected in the group receiving the flu vaccine was 1.59 (95% CI 1.44-1.75), meaning that those who had the flu vaccine were 59% more likely not to have any respiratory virus detectable at all.

I love it when an antivaxxer cites a negative study to support a claim. It smells like…cluelessness.

I also love the inconsistency of this new trope. After all, what is it that antivaxxers keep claiming year after year? It’s that the flu vaccine doesn’t work. Yet removal of virus interference by the flu vaccine couldn’t cause increased susceptibility to other respiratory viruses unless the flu vaccine were effective and reduced the chance of infection with the influenza virus. (I know, I know. Consistency was never a thing among antivaxxers.)

But don’t take my word for it. Dr. Vincent Iannelli has also pointed out that most virus interference studies don’t support the conclusion that the influenza vaccine makes you more susceptible to other respiratory viruses, as has the CDC:

There was one study (published in 2012) that suggested that influenza vaccination might make people more susceptible to other respiratory infections. After that study was published, many experts looked into this issue further and conducted additional studies to see if the findings could be replicated. No other studies have found this effect. For example, this article [99 KB, 5 pages] in Clinical Infectious Diseases (published in 2013). It’s not clear why this finding was detected in the one study, but the preponderance of evidence suggests that this is not a common or regular occurrence and that influenza vaccination does not, in fact, make people more susceptible to other respiratory infections.

In the end, what we have here is a classic case of antivaccine “logic” applied to science. Take an observation that fits in with your preconceived beliefs (e.g., that China, which is the source of a large new coronavirus outbreak, ordered twice as many doses of flu vaccine for this season compared to last season). Look for a plausible-sounding phenomenon (virus interference) to link the observation (more flu vaccination in China) with the emergence of something awful (2019-nCoV), no matter how tenuous the link or how questionable the evidence is for the phenomenon. Then run with the conspiracy theory. Never mind how weak the links are in your chain of “logic.”

The problem is that this particular conspiracy theory will sound plausible to those without a lot of background in infectious disease, and it will take a lot of explaining to shoot it down, if we can even ever shoot it down. After all, if there’s one thing about antivaccine tropes, it’s that they never die. Ever. They always rise again.