This post by Peter Selley flags a growing menace.
Denmark has a tradition of public trust. Some say it stems from the rapid introduction of Jenner’s smallpox vaccination in the early 1800s. In just seven years, smallpox was eradicated from Copenhagen. Fast forward two centuries, half a million adults are taking part in a trial of Pfizer’s Abrysvo RSV vaccine – DAN-RSV. RSV can cause occasionally severe chest infections in the young and the old – with no problems in between.
The Gold Standard for a clinical trial is that it should be a randomized controlled trial (RCT). DAN-RSV is an “investigator-sponsored, pragmatic, open-label, individually randomized clinical trial”.
Something’s Rotten…
Of course it was not “investigator-sponsored”. According to the study protocol, Pfizer coughed up $22m to reward the Danish researchers. And donated 345,000 free vaccines for use in the trial.
This vaccine’s main ingredient is the PreF protein of the RSV-A and RSV-B Respiratory Syncytial Viruses, in equal amounts.
Vaccines against RSV have already been extensively promoted to paediatricians and respiratory physicians. But Pfizer have identified a gap in the market. Cardiology. An awareness campaign was needed for heart specialists, whose patients have an unmet need for Abrysvo. This trial would put RSV on cardiologists’ horizons.
This ongoing massive trial and some of its first outcomes were briefly covered last year in Ground Control to RSV – RSVP and in the comments.
The study started in winter 2024, originally comparing outcomes in >130,000 adults aged >60, half of whom were given the RSVpreF vaccine. Why Denmark? Individual-level “raw” participant data stemming from Danish health registries cannot be shared?
The results have been presented at the European Society of Cardiology (ESC) Congresses in 2025 and 2026. They were published behind a paywall by the NEJM to coincide with the congresses. [Pfizer of course can afford, if it wants to, to make any published journal article open-access – i.e. free for all to read. But it chose not to. The results may explain why. The Danish team has kindly uploaded one of the NEJM articles.]
ESC is an annual beanfeast, this year attracting nearly 34,000 healthcare professionals and more than 230 journalists to a four-day event in Munich “sponsored” by the pharmaceutical industry to the tune of £14m including £400,000 from Pfizer.
ESC is where international cardiac guidelines are drawn up.
DAN-RSV 2025
The volunteers were randomised to two groups, which were claimed to be well matched, but the (unvaccinated) control group had 20% more Serious Adverse Events (SAEs) in the first six weeks. Could the vaccine have protected recipients from injury- and cancer-related serious adverse events – SAEs?
An interim analysis in August 2025 suggested that among adults 60 years of age or older, the vaccine reduced the incidence of hospitalisation for RSV-related respiratory tract disease as compared to control. While hospital admission with confirmed RSV was reduced, there was no overall benefit in terms of mortality. There were more deaths in the vaccinated group.
But RSV vaccine trials concentrate on the effect on RSV rather than overall outcomes and an analysis published in JAMA showed vaccine efficiency of 9.9% for reducing all-cause cardiorespiratory hospitalisations.
Unfortunately, however, RSV hospitalisation rates during the 2024/2025 season weren’t going to have people racing out to get the vaccine – 21 admissions in over 131,000 participants.
Scandi Noir
Pfizer took some desperate steps. It altered the protocol. The planned sample size was increased for the next season from 130,000 to 690,000 participants. They did this by reducing the age limit from 60 to 18 – people under 60 rarely get significant RSV. They opened recruitment to participants from Galicia in Spain. And the end-date for the trial has been postponed to August 2028 – pushing a definitive publication into the long grass.
Federico Martinón-Torres – a pediatrician? – was pulled in to coordinate the Spanish end. He is from Santiago de Compostela and has multiple close links to Pharma – especially Sanofi the manufacturer of nirsevimab, an RSV monoclonal antibody for immunising babies.
DAN-RSV 2026
Two sets of results were presented at the recent Munich ESC congress, and simultaneously published in a new paywalled journal called NEJM-Evidence.
The first was another interim analysis which included data from the extra (Spanish and younger) participants. The second was a report on the “durability” of the vaccine in the original smaller cohort of Danes.
Pfizer will have been overjoyed with their decision to include participants from Galicia as, remarkably, last winter there were no cases of RSV in the 24,599 vaccinated Spanish participants, compared with 8 in the 24,686 unvaccinated controls. In Denmark a quarter of the RSV cases were in the vaccinated group.
The take-home message for ESC delegates was that the vaccine reduced the incidence of RSV-related respiratory hospitalisations from 0.55 to 0.16 events per 1000 person-years. This corresponds to a vaccine effectiveness of 70.3%. Must be good.
The use of “events per 1000 person-years” is misleading. The numbers of events in the two groups were 19/255,574 and 64/255,961 which gives a conventional Absolute Rate Reduction (ARR) of 0.018%. By comparison Pfizer’s BNT162b2 covid vaccine claimed an ARR of 0.7%. With Abrysvo, 5691 people would need to be vaccinated to prevent one RSV-related hospitalisation. The only people likely to profit from this are Pfizer.
Flatliner
This image from NEJM Evidence demonstrates the cumulative incidence of hospitalisation for RSV-related respiratory tract disease in the two groups.
In the case of all-cause respiratory hospitalisations, there were 11.16 events per 1000 person-years in the RSVpreF vaccine group and 12.01 events in the no-vaccine group, corresponding to a vaccine effectiveness of just 7.1%
Five vaccine recipients developed Guillain–Barré syndrome, a serious rapid-onset neurological problem, in the first six weeks after vaccination.
Six of the 57 “authors” of the paper are Pfizer employees who “made substantial contributions to the conceptualization and design of the study”.
The second report was a follow-up of the original Danish cohort, vaccinated in winter 2024-25. The results below show vaccine efficacy has decreased by a third (from 83.3% to 56.2%). More vaccinated Danes died than their unvaccinated compatriots.
Outrageous Fortune?
RSV is increasingly recognized as a contributor to adverse cardiorespiratory outcomes in high-risk adults, yet awareness and integration of RSV prevention into clinical practice remain limited.
Pfizer have plans to turn this around – RSV Cardiovascular Care.
Projects may include one or more of the following, but are not limited to:
- Agenda educational session at a live cardiology conference
- Independent CME symposia or educational series alongside major cardiology congresses, such as:American College of Cardiology (ACC), American Heart Association (AHA), other key national cardiology meetings
- Peer-to-peer education
- Online articles, newsletter articles, training courses, webinars
- Videos, podcasts, infographics, animations Peer-to-peer educational forums
- Enduring materials linked to congress-based education (e.g., recordings, toolkits, digital resources)
Target Audience
- Cardiologists (general cardiology, heart failure, preventive cardiology, interventional cardiology, electrophysiology)
- Cardiovascular advanced practice providers (NPs, PAs)
- Primary care physicians with a cardiovascular focus
- Pharmacists and other healthcare professionals involved in adult vaccination and cardiovascular care
Two highly respected Drug Information Bulletins Prescrire (France} and MedCheck (Japan) have recommended against RSV vaccination of older folk.
But RSV vaccines are being incorporated into vaccination schedules in many countries. In the UK Abrysvo is recommended for everyone over 75, plus all adult residents in care homes for older adults and people aged 65 to 74 years who are immunosuppressed or who have chronic respiratory disease.
Pfizer are bound to suggest that the solution for declining vaccine efficiency from one RSV season to the next will be annual Abrysvo shots – as with flu shots.
Despite the evidence, it is probably just a matter of time before patients with or at risk of heart disease will be conscripted. A recent high powered British Journal of General Practice article entitled Missingness makes the case for an ABCV of cardiac prevention.
It cites all the saints of sensible medicine from a more innocent era, like Julian Tudor Hart and his inverse care law – that the people least in need to monitoring are those who turn up regularly to the medical clinic and those most in need are those doctors never get to see.
An ABC of cardiac prevention has been around for decades and is easily guessed – B is for blood pressure, C for cholesterol. A for Atrial Fibrillation. But what on earth is V? It’s mentioned in the paper as though it too is as obvious as the A, B and C. It will apparently need a reach out to men and to deprived communities.
V is RSV vaccination, which the authors of the paper portray as now accepted cardiological wisdom.
To be or not to be jabbed: that’s the question:
Whether ’tis nobler in the mind to suffer
The slings and jabs of outrageous fortune,
Or to take arms against a sea of troubles,
And by opposing end them?
Another exceptional post from Peter Selley..
Scandi Noir
But RSV vaccines are being incorporated into vaccination schedules in many countries. In the UK Abrysvo is recommended for everyone over 75, plus all adult residents in care homes for older adults and people aged 65 to 74 years who are immunosuppressed or who have chronic respiratory disease.’
Quite a long time before my seventy-fifth, a letter arrived with an appointment made, day and time, to come and get my RSV Vaccination. They don’t make it easy. You can’t contact your surgery to cancel, you have to dig deep to find a contact to reply to. I sent an email requesting that they cancel the appointment and received a standard reply. A no-reply email which didn’t say they had cancelled. A couple of weeks later, it was confirmed that I had cancelled.
I rarely see a doctor and have no reason to think I have any health issues of any kind. Pressure to take an RSV Vaccine is not a good policy. I had enough problems with Paroxetine messing with my heart, which thankfully resolved after a few very scary months and doctors messing that up.
‘This trial would put RSV on cardiologists’ horizons.’
‘as it made the case for an ABCV of cardiac prevention. But what on earth is V?’
Thank you Peter. Very helpful as repeat ‘invitations’ for vaccination accumulate.
Tim, ask them to remove your name from the ‘invitations list’ – it works! I don’t get pestered about any of them any more. I was warned that my medical record would show a “refusal” – which sounds rather more like a gymkhana pony than a person voicing preference but there we go!
Thanks Mary.
The European Society of Cardiology (ESC) has become a self-appointed massive Guidelines Factory, and deserves a closer look.
In 2024 two Danish investigative journalists, Rikke Dyrberg and Jacob Mikkelsen, outed former cardiology Professor Kim Fox, of Imperial College, London. Fox had drawn up guidelines for heart failure management whilst president of ESC and at the same time receiving payments totalling £50m from French drug company Servier. Their programme was televised in Denmark in 2024. Servier manufactures ivabradine, a drug marketed as a treatment for heart failure.
BMJ has recently picked up the story.
https://www.bmj.com/content/394/bmj-2026-100440
After the broadcast, according to BMJ ESC decided that Kim Fox had committed severe misconduct by drawing up guidelines while receiving money from Servier. ESC stripped him of their gold medal—the society’s highest honour.
This is hypocrisy. Pharma-sponsored ESC itself continues to draw up clinical guidelines at its annual congresses.
David alerted me to the ABCV of heart disease prevention. The ESC “official” recommendation that all patients with heart disease should be Vaccinated against influenza, covid, RSV, pneumococcus, herpes zoster and HPV is based on unimpressive evidence.
https://academic.oup.com/eurheartj/article/46/36/3518/8177060
Thanks for the update, Peter..
European cardiologists, meanwhile, are ruing the damage to their credibility, now that years of rumour and suspicion have been found to have substance. For Martin, the ESC has not done enough to restore public trust, and the recent revelations risk damaging the doctor-patient relationship while also leaving the volunteers who run the society feeling betrayed. He urged action. “The ESC board might be seen as tacitly complicit unless there is a thorough public investigation,” he said. “Many questions remain.”
The government has allocated 35.9 million Danish kroner (approximately $5.2 million) for the vaccine initiative in 2026, with an annual budget increase to 40.2 million kroner ($5.8 million) from 2027 onward.
https://thedanishdream.com/free-rsv-vaccine-in-denmark-new-initiative-to-support-mothers/
In the UK, some challenges were observed in achieving widespread adoption during the vaccine’s first season.
The government’s commitment to free RSV vaccine in Denmark marks a significant step in preventive pediatric healthcare. If successful, the program could serve as a model for other countries seeking to reduce the impact of respiratory illnesses on infants and their families.
‘The European Society of Cardiology (ESC) has become a self-appointed massive Guidelines Factory, and deserves a closer look” and ‘is based on unimpressive evidence.’
Good stuff, Peter
No surprise Pfizer are targeting the biggest volume RSV comorbidity – CVD and cardiologists – they need the incremental business to make the billions roll in from these relatively cheap vaccinations (Grok estimates bulk discounted prices between £137 – £172 a shot).
Novo Nordisk are playing the same game with semaglutide. The Select trial – which I’ve not Interrogated with Selley-Healy forensic scrutiny – don’t have the scientific cogs – recruited patients who were obese (BMI 27 upwards – 27 -<30 is not actually obese, it’s overweight – details, details) with established cardiovascular disease but not diabetes, unlike the core target.
Apparently, a cardiovascular end-point event occurred in 569 out of 8803 patients in the semaglutide group versus 701 of the 8801 in the placebo group. Statistical wizardry notwithstanding, this doesn't seem too great to me – the lay-mortal.
Especially since 1461 patients (16.6%) in the semaglutide group bailed out of the trial because of adverse events compared with 8.2% or 718 in the placebo group. What happened to the bailers and how would this affect the overall results?
It’s a bit like the Danish ‘investigator-sponsored, pragmatic, open-label, individually randomized clinical trial – eh? – Peter has been scrutinising. Looking at the table of second season results and the big numbers that are actually what health systems care about – hospitalisation – hopsitalisatiuon for any lower tract respiratory disease 582 versus 578 placebo there’s nothing in it – though as Peter noted more patients are dying in the Abrysvo group and a few unlucky ones have developed GBS.
I had a quick look at the publicity around results of the RSV vaccine roll out in Scotland – focusing on 75-79 year olds. To put it in perspective, there are apparently 178,000 people in that age group in Scotland. Before the vaccine roll out, 848 cases of RSV were recorded in all over 75s ,not just that tight cohort, of whom 438 needed hospitalisation.
PHS were delighted to report that over 70% of 75-79s had taken up the RSV vaccine -and quoted 'a 62% reduction in RSV-related hospitalisations among those in the older adults eligibility age group following the vaccine’s introduction'. I asked AI to crunch a few numbers and this, in fact, amounted to around 150 less hospitalisations – with no information about GBS or death.
https://publichealthscotland.scot/news/2025/july/uk-wide-report-highlights-success-of-scotland-s-rsv-vaccination-programme/
Of course no-one wishes hospitalisation on anyone. But, again putting these apparent results in perspective, a survey by Age Scotland reported that 39% of 65+ folk cannot comfortably afford their heating bills and/or are living in fuel poverty.
Healthcare records for Scotland show the prevalence of polypharmacy 4–9 medications) is 28.6% for those aged 60–69, rising to 51.8% for adults aged 80 and over. As we all know polypharmacy in ‘the aged’ is a risk factor for death and hospitalisation in the long and short term.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11790100/
If it were me, I’d be spending public funds supporting the ‘aged’ to heat their homes and reduce the unnecessary drug burden, rather than jabbing them to keep 150-ish out of hospital.
Having reached the ‘danger-zone’, in Scotland, my post today brought another.
You’re now invited to book your free flu and COVID-19 vaccines. What follows is a persuasive litany of reasons for me not to go to hospital. Scan the QR Code. Is this clever, there are thousands of elderly who wouldn’t know a QR Code from a frog on a horse’s hoof.
I tend to think positive not negative, about my health. Vaccines do not enter my life chances or choices. I am a low weight, eat loads of spinach, feed my brain. They don’t even call them boosters any more, they call them COVID-19 vaccines. My brain is fed with remarkable narratives by Senator Ron Johnson in Wisconsin who is rousing against COVID vaccines.
They are singling out the older generation in bullying terms. I know enough of the older generation who take fright and head off to get themselves jabbed for everything going. They are not witness to what we see, here, and there, and, everywhere.
This post is by Peter Selley, – a doctor and RSV research trail blazer.
https://rxisk.org/for-every-matter-under-heaven-there-is-a-season/
This older generation also, generally, still put great store in their doctors.
To carry on Mary’s gymkhana skit, they have the bit between their teeth, and are not letting go.
Annie
I think you’ve offered a twentieth century view of an older generation. All the evidence is that it’s older women who are most concerned about polypharmacy and getting off stuff or not getting on more stuff. And older men have generally been much less inclined to take stuff.
Older people re rejecting what they are being sold – youngsters who are medicating crazily these days are becoming the main problem
D.
From listening to people in my local community – a good social cross section – my impression is similar to yours – that rebellion against autopilot drugging by the system is mostly coming from older people.
I think part of it is the obvious debilitating effects of the drugs they’re routinely bunged on by primary care – statins and anti-hypertensives. They can track not feeling well – muscle pain, weakness, giddiness etc – to these pills – and resist.
https://media.nhsbsa.nhs.uk/press-releases/805e4375-d08c-4468-a239-b29e27398040/england-s-top-10-dispensed-medicines-revealed-in-latest-prescription-cost-analysis
The older folk who are most at risk are those who are actually ill. I was talking to an HCP who worked in stroke rehab yesterday –‘ they’re on so many pills they don’t know which end is up, let alone which pills they’re taking’. As you’ve said, the risk is the number of ‘partialists’ on the person’s case, The rony is that nurses and physios are seeing ‘problematic polypharamacy’ clearly – those who create the problem, doctors, seem to have no clue.
The young appear to be a lost cause.. Will they even produce enough offspring for there to be a next generational backlash? Another high profile, tragedy the other day we will all have registered – Presley Gerber, son of supermodel Cindy Crawford and jealously and unkindly labelled a nepo-babe, died at 27 of a suspected overdose in a rehab facility. The poor guy was overwhelmed by the number of drugs he’d been prescribed over the years by FIFTEEN (scream) psychiatrists:
‘I’d like doctors to be like, “Take this three times a day.” But every psychiatrist I’ve had – and I’ve had 15 – are like, ‘Here’s 20 medications and take this if you feel like this, take this as needed.’
https://www.dailymail.com/news/article-16147249/Presley-Gerber-son-supermodel-Cindy-Crawford-death.html
A rather pertinent general comment on X yesterday:
‘Someone asked if I was ready for the fall and it took me a second to realize they meant autumn and not the total collapse of society.’