Every August I go through a bit of an emotional roller coaster. I am sad to see summer ending, elated to have un-bored kids again, and anxious. It is time to center myself, consider yoga, or become a Buddhist.
It is time for…..the flu vaccine.
For about the next six months, my job will take on an added layer of stress. I will spend hours upon hours educating, explaining, answering, and sometimes down right pleading with patients to get their flu vaccine. Over the coming months, countless patients will listen to my earnest plea and say a polite “No, thank you.” So, this year, instead of banging my head against a brick wall or whimpering in the fetal position, I decided to try to address the five most common reasons my patients decline the flu vaccine.
First, why do I care so much if people get the flu vaccine or not? Put simply, the flu freakin’ terrifies me. No, not in an irrational, phobic–escalator kind of way. More in the oh-man-this-could-be-bad-kind of way.
The current census estimate for the US is just over 310 million.
In 1918 the flu killed an estimated 100 million people worldwide. Most were young and healthy. That is 1/3 of our current population. If that’s not staggering enough, consider this. In 1918, our population was somewhere around 110 million. So, the flu, in one horrific pandemic, wiped out as many people world wide as we had living in our entire country. Please take a moment to digest that.
While there have been other pandemics since, thankfully, none have approached that of 1918. If another flu pandemic happened, our MODERN health care system would be overwhelmed within weeks. Forget no room in the ERs–we already have that. I am talking, not enough Ambu-bags to resuscitate people in respiratory distress, not enough IV fluids or medications to administer even if we had the medical staff–which we wouldn’t. Believe me, usually I am not a doom and destruction kind of girl. But, in the above scenario, the word “apocalyptic” would not be a hyperbole.
Since the early 20th century, scientists, doctors and geneticists have been working feverishly to understand the influenza virus and develop effective vaccines against it. Astonishingly the entire genetic composition of that horrific bug of 1918 is now well documented.
The WHO (World Health Organization)
Imagine thousands of the smartest, highest educated, most selfless scientists, medical engineers, and mathematicians working around the clock to come up with ways to prevent such a pandemic from ever happening again. Imagine them presenting, on a gilded platter, the final life saving potion. Now, imagine me: smart, educated, yet a relative neanderthal* when it comes to brain power, turning my nose up and walking away.
*No, I am not saying that if you don’t get a flu vaccine you are a neanderthal.
Why are people declining the flu vaccine?
Let me point out that, while I consider myself well-respected and trusted by my patients, most years, I am lucky if 30-40% of my practice population gets the flu vaccine.
Here are the top five reasons MY patients report and my counter arguments.
1. “I never get sick.”
Well, lucky you. Unfortunately, you interact with people every single day that do not have your “mental will” against sickness. Not getting the flu vaccine because you don’t get sick is, in the words of one of my fave South Philly girls, a “bitch move.” People do get the flu and get over the flu. But, in the meantime, they could be coughing on a new mom whose baby could die from the flu. Take the “I” out of your answer. Influenza vaccine protects the youngest, oldest, and most vulnerable folks in our community, our society, our country, and the world.
2. “Every time I get the flu vaccine I get sick.”
Ah. Here comes my hate mail. First, if you don’t believe in the power of evidence based medicine please stop reading–nothing I say from this point forward will matter.
For those of you still with me, countless studies have compared the incidence of an acute flu like illness following the administration of the KILLED vaccine with the incidence of a similar illness following a placebo. There is absolutely no statistical difference. Because the LIVE vaccine (indicated for the young and healthy) needs to replicate in the cool environment of the nasal passage, it can cause a relatively minor cold-like syndrome.
Disclaimer: I am not a military expert nor do I pretend to understand the way our service men and women are trained. The following is for illustration only
“So,” you ask. “Why do I get sick EVERY time I get the vaccine–even the killed one?” The answer is that your immune system is doing PRECISELY what we want it to do. It is reacting to that tiny bit of inactivated virus. Some people can have pretty significant reactions like fever, muscle aches etc. Most professionals agree that those patients that get “sick” from the flu vaccine are not actually getting a case of the flu. Rather, they are experiencing an enhanced immune reaction to the antigen (the protein responsible for stimulating the production of antibodies) within the vaccine. These immune reactions can be miserable. We STILL recommend receiving the vaccine. Some would go as far as to argue that if the KILLED vaccine antigen caused such havoc on the immune system, imagine what an actual case of the flu would feel like? It is advisable to choose the timing of your vaccine wisely in these cases (i.e….avoid getting it say the day before your wedding or dream job interview) and perhaps premeditate with ibuprofen or tylenol. Of course, it is important to consult with your physician about such reactions before receiving the vaccine.
Imagine a military training site. Every soldier is given an AK47. It is the same size, weight, and configuration of an actual weapon. However, the deadly bullets have been replaced by paint balls. After weeks using this dummy weapon, a soldier has learned to do battle with a fully loaded one.
The killed flu vaccine has all the components of the live one, minus the most dangerous bits that can cause illness. That model weapon may cause our soldier to have a sore arm and shoulders, but it is not capable of killing. Our killed vaccine will train our immune system to battle the real flu virus should we be exposed to it. You may even see signs of that. But, like that training weapon, about the most dangerous thing it can do is give us a sore arm.
3. “The vaccine doesn’t even work.”
Flu vaccine efficacy is one of the most frustrating and nail biting things in medicine today. Development of the vaccine starts in the midst of the season the year before. Folks way smarter than you and I are analyzing, pooling, predicting, and agonizing. In the end, the strains chosen for the coming year are based on a well thought out guess. Most scenarios place the efficacy of flu vaccine at 70-80%. Last year was a bad year; our vaccine was only about 59% effective. One of the most dangerous things about the flu virus is its mutability. Imagine playing catch with a water balloon. Now imagine coating that balloon in grease. Now imagine dipping your hands in that same grease. That’s about how easy it is to pin down the influenza strains.
One frequently misunderstood point is that even when you get a case of the flu after being vaccinated, your illness is almost always milder than if you were not vaccinated.
4. “Flu vaccine is just a money making scheme for pharmaceutical companies and doctors.”
If you really believe that, shame on you. I am getting ready to pay a $12,000 flu vaccine bill. When you factor in nurse time, supplies, storage, my time to explain, crummy insurance reimbursement etc, we are lucky to make a few dollars on every flu vaccine we administer. I would be better off with a lemonade stand in the parking lot.
5. “The flu vaccine causes Gullian-Barre Syndrome (GBS.)”
GBS is a scary neurologic condition caused by an autoimmune attack of the nerve cells. Most cases resolve completely but it can lead to paralysis or death. Multiple studies have concluded that the incidence of GBS after the flu vaccine is 1:1,000,000. One in one million. Guess what the incidence of getting GBS is after a case of the flu? At least 1:1,000,000 and some studies estimate it to be a lot higher. A French study looked at four hundred cases of GBS occurring over an 8 year period. After all the dust settled, ten out of seventy three cases of otherwise unexplained GBS were associated with a recent influenza infection—not vaccine
I sincerely hope that this year will be a “quiet” flu year. But we just don’t know. By the time the flu season is upon us, we have missed the opportunity to protect our most vulnerable citizens.
My family is always dragged down to my office on flu vaccine delivery day. We line up our kids, tell them to stop whining and give them each their vaccine. Then, I stick my husband and he sticks me. Clearly, I am not uneducated or under the influence of a big bowl of WHO Kool-aid. I simply dread the thought of my kids getting the flu or worse: passing it on to someone who could die from it.