This report on an advisory panel recommendation that all adult smokers be vaccinated for pneumococcal disease is competently done, and accurate as far as it goes. But it doesn’t go far enough.
The report correctly describes the actions of the CDC’s Advisory Committee on Immunization Practices (ACIP). It adequately cites dissension among panel members about the value of immunizing smokers under 40. It usefully reports the general limitations on the vaccine’s effectiveness.
But it ignores the core question the panel’s recommendation raises:
How effective will the recommendation be in preventing serious or fatal pneumococcal disease in the targeted population? How much money will be spent to save a life?
That consideration is often the driver of a public health recommendation. Certainly it’s been considered by the panel members. But it’s not raised here.
The story also reports statistics linking flu to pneumonia to death–without indicating that such links are very unlikely to apply to the targeted population.
The story reports per-dose price: $30 per dose for the most common form of the vaccine.
It might have been useful to do the math: If 50 percent of adult smokers got the recommended vaccine, it would cost about half a billion dollars annually.
The report leaves the most fundamental questions unanswered:
How vulnerable is the targeted population–adult smokers under 65 who have not been diagnosed with asthma or other chronic respiratory diseases–to pneumococcal disease, and especially to potentially deadly forms? And how good is the evidence that the current vaccine can reduce incidence?
This is a situation where the reporter should have sought the "number needed to treat" data: How many adult smokers would have to be vaccinated in order to prevent serious cases of the disease or death?
Further, the report cites the often-published statistic that pneumonia is linked to many of the 36,000. But this link exists almost exclusively in an elderly and immunocompromised population–not among otherwise healthy smokers under 65.
The report should have explicitly called out the minor risks of vaccination, and of the uNPRoven safety for women who are pregnant or who may become pregant.
Mentioning such risks is always important when dealing with a recommendation for a large population.
Given the fact that the report is about an advisory panel recommendation–not publication of new research–the reporter is not required to discuss the evidence underlying the statement.
But see the note below under "Quantification of Benefits of Treatment." This exposes a serious flaw in failing to explore the underlying evidence.
The story for the most part avoids exaggerating the risk of pneumococcal disease and the efficacy of the vaccine in preventing it.
Yet the story cites the often reported annual statistics linking flu, pneumonia and death. These statistics apply mostly to an elderly and immunocompromised population. The vaccine is already recommended for this population. The use of this statistic without questioning its applicability to the population in question falsely supports the case for the recommendation.
The story quotes a CDC epidemiologist and a physician representing a college health group who is skeptical of the recommendation. That’s borderline sufficient for discussion of a new population-wide vaccine recommendation.
We wish AP had sought commentary from an independent specialist in smoking-related disease and/or in pneumonia and other pneumococcal diseases.
As a matter of course, the story should have mentioned other ways adult smokers can reduce the risk of pneumococcal disease, especially in younger smokers where the wisdom of vaccination is questioned by some panel members.
The story implies correctly that pneumococcal vaccine is widely available.
The story correctly parses the facts that this is the first vaccine recommendation aimed at smokers, yet the treatment is currently in wide use.
The CDC has not issued a press release about the advisory committee’s recommendation.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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