Why I Chose the Flu Shot

photo-59Vaccines in general, and especially the flu vaccine, are a hot button these days. I posted on facebook that I’d gotten my annual flu shot and the response was predictably contentious. One guy even ridiculed my appearance. Predictable trolls are predictable.

I used to be anti-vaccine. Especially the flu vaccine. I could be obnoxious about it. Thank goodness it was (mostly) before facebook, or I’d have an online history of anti-vax ‘activism’ to be embarrassed about. In a follow up post, I shared the story of the first time I actually got the real flu:

“I used to wonder why people got so worried about the flu. I’d had it a few times and my healthy adult immune system had fought it off efficiently. Why all the hype about flu season and flu shots? What the heck was the big deal? I was pretty obnoxious about it.

And then the year I was 30 I got the flu for real. And as I crawled down the hall one morning (because I wasn’t able to walk, or even stand up) to ask my husband to take me to the emergency room, I was humbled by the realization that all those flus I had arrogantly told myself my body had fought off were really nothing more than bad colds.”

These days, I get my flu shot every year, and my kids are fully vaccinated. My experience with the real flu is only part of the story. In fact, it’s a very small part of the story.

The real reason I get my annual flu shot has nothing to do with me as an individual, and it has nothing to do with the individuals I may otherwise expose to the virus. I get the flu shot because I am a member of a civilization. A civilization that I benefit from in a multitude of ways. I have an obligation to keep that civilization healthy and productive in any way that I can. Because a healthy, productive civilization is of enormous benefit to me and my family. I am not an island. I am an intrinsic part of this civilization, and my actions matter to the health and productivity of that civilization. .

Let me explain, using an analogy most people are very familiar with: traffic.

Traffic laws are in place to keep traffic moving as efficiently and smoothly as possible, and to keep motorists safe. Traffic laws are not a ‘conspiracy’ to restrict individuals’ freedom. Traffic laws help everyone get where they are going as quickly and safely as possible. The more people that respect traffic laws, the more easily everyone can move from place to place, and the safer we all are. I think almost everyone can agree on that.

Some people don’t understand the big picture that traffic laws represent. They think “I’m just one person, what I do doesn’t matter in the grand scheme of things. I’m just going to break the law here. I’m just one person! What harm can it do?” And it’s true, that on an individual level, one person’s actions have a very small effect. Unfortunately, that one person’s actions can influence other people’s actions. And when other drivers see that person breaking the law, they think “Well, he’s doing it, I might as well too.” And soon, lots of people are breaking the law, and things get more and more chaotic, and bottlenecks happen, and EVERYONE gets slowed down, and the risk of accidents increases for EVERYONE. And as more and more people break the law, breaking the law becomes normalized, and the laws begin to not matter at all, and respect for the laws diminishes, and chaos reigns. Hello traffic jam. Hello accidents.

If everyone would just follow the laws, things may be a little slow, but they’ll be way less slow than the mess that occurs when some people think the laws don’t apply to them.

Vaccines aren’t laws, and they won’t likely ever be. But the ARE recommended by every reputable public health agency. And ultimately, those recommendations aren’t really to protect INDIVIDUALS. Yes, getting vaccinated will greatly reduce your individual risk of contracting a preventable disease, but at the end of the day, vaccines aren’t there to protect YOU. They are to protect the civilization. The more people that comply with vaccine recommendations, the more the civilization is protected from disease. The less chance the disease has of finding a host, and over time the disease dies out. We saw it happen with smallpox and polio. Those diseases are gone. No one has to worry about them any more, not even people who aren’t vaccinated, because enough people followed the recommendations to eradicate the disease on a civilization level. Just as compliance with traffic laws keep everyone moving more quickly and safely. We see some people these days believing that vaccine recommendations don’t apply to them as individuals, that their individual actions don’t matter. The result is that some previously eradicated diseases are making a comeback. Whooping cough, measles. And it’s not always the people who make the decision not to vaccinate that pay the price. Many times, it’s infants who are too young to be vaccinated. Just as the individual who breaks a traffic law may not be the one who gets in an accident or who gets slowed down by traffic. Often it’s people down the line who pay the price of one person’s decision not to obey the law, especially when that one person’s actions contribute to a larger, more systemic pattern of behavior.

Several people linked me to this Cochran Review of the scientific literature on the flu vaccine. They seem to have focused on this specific conclusion as evidence that the flu vaccine is ineffective:

“The preventive effect of parenteral inactivated influenza vaccine on healthy adults is small: at least 40 people would need vaccination to avoid one ILI case (95% confidence interval (CI) 26 to 128) and 71 people would need vaccination to prevent one case of influenza (95% CI 64 to 80).”

What this means is that 40 people need to be vaccinated to prevent one case of ‘influenza like illness’ and 71 need to be vaccinated to prevent 1 laboratory-confirmed case of influenza. Oy, that seems depressing, doesn’t it? Maybe the flu vaccine really IS ineffective?

Lets do some math. If 40 vaccines prevent 1flu-like illness, then 240 million vaccines would prevent 6 million flu-like illnesses. 240 million is equal to 75% of the US population. So, if 75% of the US population gets vaccinated, we collectively prevent 6 million flu like illnesses. If 71 vaccines prevent 1 laboratory confirmed case of flu, then 240 million vaccines will prevent 3.4 million cases of laboratory confirmed flu.

Neither 6 million nor 3.4 million is insignificant, especially to the people who can’t get vaccinated due to allergies or age or previous reaction.

The flu vaccine isn’t ineffective. It simply takes a high level of compliance, on a civilization scale, to realize the enormous benefit. What the Cochran Review actually shows is what public health agencies have been saying for decades: participation is important to protect our society.

The more people that are vaccinated, the more protected our civilization is.

Just as the more people that follow traffic laws, the more quickly and safely we all get where we are going.

I choose to be on the team that is preventing millions of illnesses, just as I choose to be on the team that is keeping traffic moving quickly and safely.

I can get vaccinated, so I do, thereby protecting those who can’t. And contributing to a healthier civilization.

Getting vaccinated isn’t about me. It isn’t even about the people I come in direct contact with. It’s about being a part of a group, and contributing to the welfare of that group in any way I’m able. And in return, I receive numerous benefits: safety, resources, companionship, opportunities, education and more.

I get vaccinated for the same reason I follow traffic laws and pay taxes and return my shopping cart to the corral when I go to the grocery store. A little bit of inconvenience on my part keeps the system running smoothly. And I receive enormous benefit from a smoothly running system.

There were a couple other conclusions from that Cochran Review, including:

– “The administration of seasonal inactivated influenza vaccine is not associated with the onset of multiple sclerosis, optic neuritis (inflammation of the optic nerve of the eye) or immune thrombocytopaenic purpura (a disease that affects blood platelets).” (no indication that the vaccine causes MS or other conditions)

– “Evidence suggests that the administration of both seasonal and 2009 pandemic vaccines during pregnancy has no significant effect on abortion or neonatal death.” (looks safe for unborn fetuses)

I really liked this interview with Eula Biss (author of ‘On Immunity: an Innoculation‘) on this topic. She has an eloquent way of explaining this complicated reality in simple words.

I also appreciate this essay in Scientific American on “The Ethics of Opting Out of Vaccination“.

You can learn more about this year’s flu vaccine here and here.

And because the anti-vax movement is nothing if not predictable, let me state definitively here: I am not a ‘shill’ for ‘Big Pharma’ or ‘Big’ anything. No one is paying me to post this. I do not gain any benefit from this post other than promoting public health, which, as a member of the public, directly benefits me in many ways.










40 thoughts on “Why I Chose the Flu Shot

  1. The community awareness for me is key, and I wish it were more convincing to more people–I wish there were not this layer of entitled well-off Americans who believe they deserve to have every privilege at whatever cost to others, as long as it doesn’t affect them. I had a terrible scare when I was first pregnant with my daughter (more than 20 years now) because the first generation of kids who’d not gotten measles vaccines were starting to infect the populations. All you have to do is try to communicate with a child whose mother was infected with measles (if it was lucky to live, in those days still) to know that you’ve got no right to allow yourself or your child to be a vehicle of such a cruel and damaging cause of birth defects. I was pretty sure I’d had the measles, but had no records, and that was a long ten days to wait for the blood titre results.

    Short version: get vaccinated (and don’t forget tetanus every 10 years).

  2. People forget that millions of people died from the flu during the 1918 pandemic. Flu is still not to be treated lightly in spite of the advances in medicine. Please get vaccinated.

    • And there’s no reason the same level of virulent strain can’t appear again. The numbers on the 1918 epidemic are pretty terrifying.

  3. I don’t get the flu shot because I have MS and it’s recommended that given my Having never had the flu (or a bad cold even), that my immune system should be largely left to its own devices for the time being. At 31, I do wonder if it will be weaker as I age despite my training and my clean diet – but with an auto immune disease like MS, a lot of things are tricky and unpredictable.

    I agree with vaccination to protect our populace. But as of now, my doctors are concerned about my own protection especially since they do not see me as a risk.*

    *the therapy I inject daily to help me battle my disease is already an immuno-suppressant that doctors see my body managing well the way it is.

    Thanks for the post!

  4. Thanks for writing this. Sanity can be hard to come by on the internet. I also got the actual flu once, when I was very, very broke and didn’t have health insurance. My breathing got so bad one night my mother almost took me to the emergency room – hospital bills be damned – and she doesn’t panic easily. At 22 I recovered (slowly, and it screwed up my entire semester in college), but I understood how if I were older and/or not in perfect health the flu could have killed me. Since then I’ve been diligent about my flu shot. I don’t EVER want to experience that again. More importantly, I don’t want to be responsible for inflicting that misery on somebody else. People online are panicking about ebola right now, but it’s far more rational for Americans to be afraid of the flu.

  5. This is an excellent piece. Your analogy using traffic laws is particularly effective in getting your point across (in my opinion). It is also helpful to communicate the real world numbers, and emphasize that it’s important to help protect individuals who are particularly vulnerable.

  6. As a person, who as a child, had every childhood disease out there…thank you! A well reasoned, well thought out statement about vaccines. I would never want any child go have to deal with any of those diseases, just as I would never wish the flu on my worst enemy. I have had “true” flu three times in my life and that was three too many. Sadly I am one of those few who have a reaction to the shot, so can no longer get one.

  7. A very well written and insightful explanation for why to chose to be vaccinated. I like the way you illustrated the effects of following the recommendations vs. ignoring them. If 75% of the nation gets the shot preventing over 3 million cases of flu would be great, that could mean the prevention of another pandemic like the Spanish Flu.

    I’m one of the semi lucky people who have a compromised immune system because of medicines I had to take to fight off RA. I went from flu to pneumonia when I was in my early 30’s. In the fight against the pneumonia, I missed almost 3 months of work, becoming allergic to 5 different antibiotics and damaging one lung before it was cured. That means since since then I have gotten the yearly flu vaccine, every 7 years I get the pneumonia vaccine, and I stay up to date on all the others. Yes that is for my health. But it is also for everyone else’s too.

    There are a lot of people who are allergic to vaccines, a lot of people whose immune systems are compromised enough they cannot take the vaccine, a lot of people who simply don’t have the access to them. If my getting the shot protects one of them, all the better. Good things should be passed on and life is a good thing.

  8. The very first year that flu shots were offered, I got one. The result was that of an extreme horrible sickness that totally floored me. I was so sick that I couldn’t stand it. The irony of it is that I don’t get the flu ever.Now with a compromised heart and blood clots in my lungs, my doc wants me to get a flu shot. I told her, no thank you!

    • That’s unfortunate. And likely a coincidence – you can’t get the flu from the flu shot, as the virus is dead. It’s far more likely you either had already contracted it and hadn’t developed symptoms, or you were exposed to another virus at the site you got the shot from.

      • I got an email from our HR department this morning about the on-site flu shots my company offers this year. I just deleted it because I never get the flu, and I don’t like getting shots or having blood drawn, so I never get the flu shot.

        This post and the comments has convinced me I should not be a baby and just do it. I’m retrieving the file from my email trash and signing up right now!

    • A lot of folks have stories like that and get turned off of the flu shot, but it’s been looked at many times, and for real, when you “get the flu because I had a flu shot,” it’s a coincidence — you would have gotten the flu anyway, you just happened to get the shot a little bit too late.

      It’s a very normal and natural reaction, but it’s unfortunate that it keeps so many people from getting vaccinated.

  9. Actually, while I do like your civilization argument, the flu shots are generally only recommended for children and the elderly because they are the most at risk of actually DYING from the flu. The number of people who are neither a child nor elderly getting the shots is the reason that the shots so frequently run out and the children and elderly who need them may no longer have access.

    • I’m in Denmark, and the gov’t recommends a certain subset of the population receive the flu shot yearly – at no cost to them.

      Anyone else is welcome to request the shot, however it must be paid for out of pocket. If there weren’t sufficient supplies of vaccines for the population, they would be restricted to those individuals most at risk – which isn’t the case.

      I’m willing to wager it isn’t the case in the UK, either.

        • Hi Kaleo, not being a fan of presumptions, I thought I would chip in with the actual situation in the UK. Yes, high risk groups are offered vaccination, and it covers a wide range of conditions. My otherwise very healthy husband is offered it for eczema and my doctor offers it to me, although all I have ever complained about is period pain. Also, all healthcare workers are offered it, and the National Health Service is the biggest employer in the UK. I work for the NHS and everyone from doctors to cooks to admin staff are offered vaccination. If your doctor doesn’t invite you for vaccination you can request it, a lot of people who have had ‘flu would do that. By the way, the critical threshold for vaccination is much higher for diseases like pertussis but you don’t hear people complaining that vaccination is ineffective. I know influenza has a very unstable genome but the vaccine is reformulated each season.

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  11. Thank you for this common sense, reality based approach to the decision of whether or not to get a flu shot. I have now decided to get one tomorrow! I’m near 70 and in good health. I’ve gotten a flu shot in the past (years ago) but in recent years I thought I didn’t need it since I changed my diet and all my health factors were very very good. So I became pretty wishy-washy or complacent about it. Now, thanks to your post, coupled with previous things I’ve read (like the SA article), I’ve been convinced. I tweeted a link to your post so I hope it helps others decide too. Thanks again.

  12. Thank you AS ALWAYS for your super insightful, thought out post! And as always, I will be sharing your story with my friends. I suspect, AS ALWAYS, the science behind my share will be over looked as people are SO HAPPY to hope on non science conspiracy FOLKLORE Bandwagons that it makes me ILL! Like the smart people I know who refuse to wear seat belts and basically cancel out 99% of the brains they have…WTF RIGHT? Either way, Flu Shots for the win, I do it! Almost all insurances pay for it and Walgreens can give it to me as good as a doctor! Speaking of, it’s time for a flu shot! Today at lunch I do believe!! :)

  13. It saddens me that vaccinations are even a topic of debate at all. It is ridiculous to think that one of the single greatest advances in human health (up there with knowledge of hand hygiene and sanitation system infrastructure) is being increasingly resisted due to pseudoscience and, well, stupidity. Great post! I came across your blog the other day and just love it. For someone like me who is into health and fitness but wants to avoid triggers for EDs and body dysmporhia, your approach is a breathe of fresh air. Keep up the great work!

  14. Just your story about crawling down the hallway makes me want to go get a flu shot. Usually I am just too lazy to do it, and that’s no excuse. I work in the school system and I am probably at higher risk due to the extreme volume of snot that I deal with in high school on a daily basis. Ugh. *runs off to pharmacy*

  15. i used to work in a pediatricians office. I had to deal with misconception about immunizations on a daily basis. The number of parents who thought they’d just skip the shots and count on herd immunity was staggering.

    Then we had a shortage of available flu shots, and everyone lost their minds. You would have thought theseshots were Furbies in the 90’s! The lengths that people were willing to go to procure a flu shot was ridiculous. I helped out at a neighboring countries towns flu clinic that year, and saw the same behavior.

    I suppose it would be unethical to intentionally put out word that there was a shortage, to get people to comply.

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  17. Sorry, I will have to be one of the dissenting votes… but I do wish to clarify that I am not anti-vaccine. I just think the hype over the effectiveness of the flu shot is a great sales pitch.

    In the post you wrote “What this means is that 40 people need to be vaccinated to prevent one case of 'influenza like illness' and 71 need to be vaccinated to prevent 1 laboratory-confirmed case of influenza. … Lets do some math. If 40 vaccines prevent 1flu-like illness, then 240 million vaccines would prevent 6 million flu-like illnesses. 240 million is equal to 75% of the US population. So, if 75% of the US population gets vaccinated, we collectively prevent 6 million flu like illnesses. If 71 vaccines prevent 1 laboratory confirmed case of flu, then 240 million vaccines will prevent 3.4 million cases of laboratory confirmed flu.”

    So to restate, if 70% of the population got the vaccine only 6 million flu-like illnesses would be prevented. That is 2.5% prevention of those who got the shot. ONLY 2.5% out of 240 million people. That is a ridiculously LOW amount of protection. And this number is even SMALLER for lab confirmed results.

    The reason is simple. The flu vaccine is a guess made of three or four different expected variants of the flu. It is a GUESS based on what the CDC believes may be prevalent based on observations the previous year.

    The CDC writes on their website “How well the flu vaccine works each year depends in part on how closely related (or 'matched') the viruses in the vaccine are to the flu viruses circulating that year. Vaccine effectiveness also varies depending on how well a vaccinated person responds to the vaccine in terms of making protective antibody, and how successful vaccination programs are at vaccinating people in advance of the season.”

    Getting a flu shot does not prevent you getting the flu unless the strain you are exposed to is one of the ones used that season in the vaccine.

    So in addition to the low percentage effectiveness – which itself is difficult to define since the variables change yearly – you are still a prime target for any virus that is not included in the vaccine. With thousand of influenza subtypes in existence, it is not possible to get them all covered to make a 100% effective vaccine. And that is why the 2.5% figure above, used from the sources of the article, are not too impressive.

    Yes, the flu can be fatal. Yes people with weakened immune systems should have the vaccine – but the rest?

    So protecting yourself starts with good hygiene, good hand washing, good surface cleaning. Your own immune system needs to be in good shape. Good nutrition, adequate sleep, exercise, From health.Harvard.edu comes “Many researchers are trying to explore the effects of a variety of factors ' from foods and herbal supplements to exercise and stress ' on immunity. ”

    And finally, there is the business of flu vaccination, which you can read at http://time.com/money/3342086/flu-shot-deals-drugstores/

    So forgive me if I tend to my immune system, stay nutritionally supercharged, and pass on the shot!

    • I think a lot of the anti-vaccine arguments, like yours, rely on the ‘it’s not perfect so we should just scrap the whole thing’ line of logic.

      Some protection is still better than no protection. Especially for those who are at real risk of death from a flu infection.

    • Some people think only bad things happen to other people. You never realize human frailty until you get sick. I think it’s only when modern medicine saves your life that you can appreciate how amazing and lucky we are to have it.

      • So you know when someone says that their immune system is all they need then I know they’ve just never been sick before. Yes there is a business of saving lives but that doesn’t mean people created a vaccine you don’t need just to get $30 off you. That’s silly.

  18. Your post leaves out the reality of adverse reactions to the vaccine, which are very real. Every year dozens of people die after flu vaccination…just look up which vaccine has the highest compensation from the government for proven serious adverse reactions. I have never had the flu, nor will I risk my own health or that of my children to theoretically protect someone else from a flu-like illness or the flu.
    traffic laws protect everyone and have no risk of side effects…comparing them to a flu shot is kind of ridiculous.

    • Every time you get in a car you’re taking a risk – even if *everyone* followed the traffic laws there would still be accidents. They would just be dramatically less often. Just as if *everyone* got the flu shot, people would still become ill – just dramatically less often. And as for side effects, cars pose risks, just as vaccines do. Brakes could give out. Faulty wiring could cause fires. All sorts of things could go wrong any time you get in a car. And yet, we still do it every day. The analogy is apt, and strong.

    • I am so glad Amber replied to this ignorant comment. User referenced no reliable studies and carries on the woo train of dumb… Cause people die after the flu shot? That statement hurts my head cause it’s full of stupid….

  19. When I see all the dissenting comments I can’t help thinking that none of these people have had “real” flu. We’re talking running a fever for 14 days in a row. Not able to walk. Coming to terms with your imminent death and waiting peacefully for it. Thinking you’re going to choke to death when you start coughing. Not able to leave the couch for days and days.

    I’ve had this twice. I don’t remember how long the first one lasted, but the really bad bout took more than 30 days to completely recover from. I’ll ask about my shot while I’m at the doctor’s office today…

  20. I’m a nurse and get my flu shot every year. Vaccinations is the one area I openly “judge” (not shame, but judge) people’s choice on. I don’t care what you look like, what you wear, what you eat, how your raise your kids—it doesn’t affect me. Choosing not to vaccination CAN and DOES affect me, so please vaccinate. Thousands of people die annually from the flu. If there’s anything we can do to prevent it, we should.

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