Preventive Medicine Column
Dr. David L. Katz
The CDC has noted an early and nasty start to the flu season. It’s a bit soon to say, but the virus and the outbreak pattern at this point seem to resemble those of the 2003-2004 flu season, in which nearly 50,000 Americans died. At least two children have already died of flu complications this fall.
This is not the sort of stuff a public health physician can ignore. So, I recently noted on LinkedIn and Twitter that I’ve been vaccinated- as I am every year- and recommend this year’s vaccine, which appears to match the prevailing viral strain quite well, to everyone else. I promptly got comments back from naysayers, including at least one self-identified microbiologist, who noted he never got vaccinated, and had ‘never gotten the flu.’
I believe him. But this is like that proverbial ‘Uncle Joe’ everyone knows, who smoked 3 packs a day and lived to be 119. It could happen- but I wouldn’t bet the farm on it. Uncle Joe is that rare character who somehow comes away from a train crash with a minor flesh wound. The rest of us are mortal.
But there is something more fundamentally wrong with the “I’ve never gotten the flu, and therefore don’t need to be vaccinated” stance than the Uncle Joe fallacy. Let’s face it- those who were ultimately beneficiaries of small pox or polio immunization never had small pox or polio, either. If they ever had, it would have been too late for those vaccines to do them any good.
The trouble with serious illness is that one time can be one time too many.
Familiarity breeds contempt, or at least complacency, and perhaps the annual return of influenza has induced that response. Perhaps that’s why we seem to be dismissive of this germ, and overlook what a serious illness it can be.
But that tendency is at our peril. The single greatest infectious disease calamity in all of human history was not plague, or typhus, or smallpox- it was the 1918 flu pandemic, which killed as many as 50 million. Those who don’t respect the flu just aren’t paying attention.
That said, I do understand the reasons for reticence about immunization in general, and flu immunization in particular.
For any vaccine to do us any good, we need to get it while feeling fine. This is quite different from, say, an operation that is much more dangerous — but easily justified by the obviously hemorrhaging bullet hole, plugged up gall bladder or occluded arteries. Convinced as I am of the benefits of immunization, I feel a momentary hesitation each year myself.
There is also some doubt about the effectiveness of the flu vaccine. It is certainly far from perfect, and the elderly — who most need protection — may need two inoculations to get it. But leaving aside some of the subtleties that complicate measuring vaccine effectiveness in real-world settings, and applying even a low level estimate of overall vaccine effectiveness, routine flu vaccination produces a decisive overall benefit compared to just taking our chances with the flu.
We should also recognize that when it comes to contagion, not one of us is an island. While true that the elderly most need protection and benefit least from vaccination, there is another way to protect our older loved ones: vaccinate ourselves and our children. People who can’t get the flu can’t transmit the flu to those most vulnerable to it and its complications.
Whatever your doubts about the influenza vaccine, it is an established fact that immunization is many times — many times — safer than the flu itself. That does not mean flu is a plague, nor that the vaccine is perfectly safe. Nothing in medicine and little in life is perfectly safe. Harm from the flu vaccine is possible, but a highly remote risk. For what it may be worth to make this personal, I readily accept that risk every year not only for myself, but for my beloved wife and children as well. I put the arms of the people I love most on the planet where my mouth is on this topic.
So, I am unimpressed and unpersuaded by those who argue against flu vaccination because they have avoided the flu without it.
You presumably know the expression “fool me once, shame on you, fool me twice- shame on me.” Influenza unashamedly kills tens of thousands of us ever year. Being fooled by it once could be one time too many.
Dr. David L. Katz; www.davidkatzmd.com