Yesterday I got a flu vaccine at work. The coughs and sneezes are beginning to sound like bad muzak around the office, so I figured it was time to give flu season the finger. I've actually never had a flu vaccine before. It just never occurred to me to do so. But now that I work in a corporate office environment, the handwashing signs over the bathroom sink and little pumps of antibacterial hand sanitizer glistening on individual desks are beginning to make sense to me. I don't want these people making me sick. I don't want to make them sick either. I like my coworkers a lot, but I wish we lived in a country that understood the value of a sturdy facemask. I live in Hollywood, a city so image-obsessed that the only time you see somebody wearing one of those is if they've just gotten their nose done.
But I digress. I noticed when I proudly bore the sticker proclaiming to the office masses today that I got my vaccination, a lot of people responded that they "don't do that" or they "don't believe in it." That struck me as funny. It made me wonder why, if a free flu vaccination is offered to you only steps from your desk, you would opt not to partake.
Of the 3,000 respondents in last month's Thompson Reuters-NPR health poll, about one-fourth voiced concerns about the value and safety of vaccines. There are all sorts of myths surrounding general vaccination, and a resurgence of fear-mongering came about following the H1N1 scare of 2009. In future discussions, we can address the long-debunked "vaccines cause autism" scam, propelled by the morally bankrupt Dr. Andrew Wakefield and popularized by the vacuously gullible (I'm being nicer in print than in my own head here) Jenny McCarthy, which caused irreparable damage to public health and set back measles rates to those from the previous decade. We can also get into the other anti-vaccination quackery that lights up my bullshit detector, like "cold weather causes the flu," "influenza is not a serious disease," and "antibiotics can treat the flu if I get it." But I don't want this blog post to take your entire lunchbreak to read. Instead I want to talk about the common response that I hear from well read, intelligent, trustworthy people who opt not to get vaccinated.
"The flu vaccine might make me sick." Nope. Sorry. First of all, the flu vaccine cannot and will not give you the flu. Injectable flu vaccines contain a dead virus. I would rather be exposed to buckets of dead virus in vaccine form than the tiniest sneeze oozing with live virus from somebody sitting across from me at the lunch table. Maybe that's just me, but I hate the flu. Maybe you're a fan? The inhaled influenza vaccine does contain the live virus, but here's the rub: the virus has been attenuated (weakened) and cold-adapted. This means that only your cold nostrils can actually contract the flu. The rest of your warm body cannot. Unless of course, you are a zombie. Then all bets are probably off.
I fear that a lot of people who get a flu vaccine are confusing feeling sick with getting sick. After you get a flu vaccine, your arm should hurt. You might feel a bit crappy for a little while. This is not a sign of illness, its a sign that your immune system is working to fight off what it recognizes as the flu. Once the antibodies bind to the various killed or attenuated viruses within the vaccine, they are marked for destruction by other cell types. Generally speaking, this will induce an immune response every time you are exposed, and it is highly unlikely you will get that particular strain of influenza in the future.
And lets not forget that we get flu shots during a time of year when the flu (and colds, and other infections) are highly prevalent. It can take around two weeks to develop a full immune response to the vaccine, so there is a chance that some people will get sick within that window. Here we are subject to a common psychological bias akin to food aversion. (Remember getting way too drunk that one time in college and puking up a bunch of chili? You couldn't eat chili for six months, could you? It wasn't the chili's fault! It was the Jager! Blame the Jager!)
Now, this is probably starting to sound like a local commercial for the Flu Vaccine Depot out on Route Nobody Cares. The truth is, no medical treatment is risk-free, and vaccination is not a simple discussion. Sure, vaccines are loaded with crap that I wouldn't want to consume in large doeses. But the ingredient list of the flu vaccine isn't arbitrary. Those preservatives are necessary for the vaccine to have a useful shelf-life. Yes, there are trace amounts of thimerosol and aluminum and even human proteins in many of our vaccines. So what? Toxicity depends on dosage. Paracelsus, the father of modern toxicology said that "Almost all substances are toxic under the right conditions." Think about it. Water can be toxic if you pump enough of it into your body.
Also, the reason we are encouraged to get vaccinated each year is that vaccines only protect against a few strains of influenza, and that evil little virus comes back around like a shape-shifting cockroach year after year. We haven't yet mastered the technology or the price-effectiveness to offer fast vaccines to mutating viruses. Although, with amazing developments like Craig Venter's synthetic cells, fast vaccines may be on the horizon, and microevolution may be thwarted by human ingenuity. But for the time being, some years the flu vaccine is more effective than others. That's just the nature of the beast.
I'd rather take my chances. The truth is, even though a new meta-analysis published in The Lancet only two days ago showed an overall efficacy for influenza vaccination hovering around 59% (in adults age 18-65, spread over the last 44 years), I'll take 59% over 0% any day. And not getting a vaccine is 0% effective against the spread of influenza.
By the way, if you are one of those people who opt out of prophylaxis, please do your part by washing your damn hands. And sneeze into your sleeve, not all over your disease-laden paws. Of course, I'm now a lot less worried about your germs making me sick. So, hug me! I'm vaccinated.
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