Why force flu vaccinations if the evidence is so poor?

The Lancet investigated flu vaccine effects with the following two interesting studies:

1.  Simonsen et al. showed that as rates of flu vaccination in the elderly rose in the US from 15% to 65%, there was no corresponding decrease in elder deaths from flu!

2.  Carman et al. found that: 

Vaccination of health-care workers was associated with a substantial decrease in mortality among patients. However, virological surveillance showed no associated decrease in non-fatal influenza infection in patients.

In facilities where more healthcare workers got vaccinated (voluntarily), Carman found the overall death rate in patients was lower. However, the patients in those facilities did not have less flu!  So the difference in death rates can't be blamed on flu, and the only explanation is confounding.

Although there are many published papers about the attitudes and beliefs of healthcare workers with respect to flu shots, no reliable data exist to support the usefulness of healthcare worker shots on patient outcomes.  So what is really going on here?

Without being a fly on the wall in the halls of federal medicine, I can only speculate.  Here are some ideas about what might be driving the vehemence of flu vaccine mandates.  Do you have any other ideas?

1.  Deliberately shifting the culture of medical professionalism to a culture of obedience:  get the shot or else wear a mask (even though the data show that it does no good unless you are coughing or sneezing) or be fired.

2.  Mission Creep.  You begin by mandating shots for healthcare workers and then expand the mandate to the entire population.  Fifteen years ago flu shots were only for those over 65, but CDC slowly expanded the recommendations to now include the entire US population over 6 months of age.  The NY Times says CDC wants 80% of Americans vaccinated yearly by 2020.  (Less than 50% are now.)

3.  Creating scapegoats (unvaccinated health workers) for the sorry state of US healthcare and US life expectancy -- we are #38.

4.  Forcibly expanding pharma's flu vaccine market.

5.  Creating a market for specific, well-connected companies just entering the flu vaccine field, such as Emergent Biosolutions, the anthrax manufacturer, which will now be making pandemic flu vaccines.  This is the result of a recent $220 million contract with DHHS’ Biomedical Advanced Research and Development Authority, and is in addition to its anthrax vaccine contracts. 

Flu shots (and especially pandemic flu shots) are tested less than all other vaccines before use, due to the brief interval between deciding on their composition and administering them.  One must therefore rely on the reputation of the manufacturer  to gauge product quality.  Emergent Biosolutions has a track record of shoddy manufacture.  This is another reason to avoid future flu shots.

6.  Paving the way for more vaccine mandates as the hundreds of vaccines in development enter the market.  Mandatory flu vaccines may serve as a trial balloon to see how the US public responds to vaccine mandates for grownups.

7.  Completing the replacement of medical science by medical marketing.