12/16/2012 08:21 pm ET Updated Feb 15, 2013

A Few Flu Facts

The coming of the colder months heralds different things for different people. Some look forward to hanging stockings and decorating trees, others ringing in the New Year. However, the onset of winter does mean one thing for everyone, regardless of which holiday you celebrate: Flu season is upon us. With the onset of flu season, it is perhaps worth looking into some of the ethical and practical issues that surround the virus.

These days the flu is -- in general -- a relatively banal ailment. It might knock one out of commission for a few days and relegate you to lying in bed slurping down chicken noodle soup. However, with a little rest and nourishment, chances are you will have recovered in no time at all.

Such a rosy scenario was not always the status quo. Historically, some strains of the flu -- or influenza as it's more formally known -- have shown themselves to be incredibly contagious and lethal, given to wiping out large portions of the population. Consider the deadly flu pandemic that occurred in 1918 and -- over the course of three years -- was responsible for the deaths of somewhere around 50 million people worldwide. To put that number into perspective, that is more people than were killed in the Civil War, Vietnam, the Holocaust, the Napoleonic Wars and World War I combined. All told , just under 3 percent of the world's population perished.

In the United States, there has been an ongoing process to combat both the serious and not-so-serious strains of the virus. "Flu shots" are vaccines that were first developed in the 1940s, and their use has gradually become more and more prevalent throughout the population. Currently, the CDC recommends, "everyone 6 months and older should get a flu vaccine each year."

On the surface, such a program seems completely straightforward. Historically, the process of vaccination has been a firmly-embedded principle in medical literature. Many vaccinate children -- and adults -- against all different types of debilitating and horrifying illnesses from mumps, to smallpox, to polio. However, there are several ethical considerations that we must keep in mind when promoting a program of vaccination. These considerations apply especially when we talk about a virus like the flu, which is much more common (and also of course much less severe in most cases) than smallpox or typhoid or any of the other diseases that we typically vaccinate against.

The first issue that is worth looking into is that of perceived security. By developing a vaccine against the flu, there is a perception that we have in some way beaten it and will be protected against becoming infected. This is not always the case. Every year those in charge of developing that year's vaccine choose which strains of the virus to include and which to leave out. This complicated process can essentially be boiled down to a risk analysis; only the most lethal and contagious mutations of the virus need apply. In some sense, this leads to a false perception that because one is vaccinated one is immune to all possible strains of the flu. This is simply false; one is simply protected against the most likely and most dangerous known strains that are included in the vaccine, not the virus in its entirety. Furthermore, this sense of perceived security may make us less likely to engage in preventative behaviors we would normally utilize. Just because you are vaccinated does not mean you shouldn't try and limit your exposure, eat well, wash your hands, and get plenty of rest. In an ideal world, behavioral interventions would work hand-in-hand with vaccines; however, this isn't always the case.

Shifting things around a bit, let's assume that there was massive uptake of the CDC's directive for everyone to be vaccinated, motivated perhaps by fears of another pandemic, similar to that of 1918. In this case, it's possible that we could end up in a situation where there would not be nearly enough vaccines to go around -- particularly if the deadly and virulent strain were late in being identified as a threat (ramping up production of a vaccine for a particular strain takes at least six months). This problem of resource allocation has been a hotly-debated medical ethics issue for years. With limited supply, you face at least one incredibly hard ethical question: Who gets the vaccines, and why do they get them instead of someone else? There have been all types of principled strategies advanced for who should receive resources (vaccines, treatments) in times of crisis (first come first served, evaluating medical histories, treating medical professionals and caregivers before all others, etc.). However, such an issue is incredibly complicated and worthy of its own separate article.

Another relevant resource allocation issue is one of funding. Simply put, public health funding in this country -- or in any country for that matter -- is not infinite. In order to fund certain programs, others will be cut, so we must choose carefully when considering where to invest our limited funds. In essence, we need to determine how to get the biggest bang for our buck -- a question that becomes infinitely more complicated because it involves rating outcomes (quality of life vs. number of people treated, etc.). Are routine seasonal flu vaccines a cost-effective way of preventing the illness? Or are we expending precious funds that would do more good somewhere else?

On the surface, the flu vaccine seems like a no-brainer. History has shown us that influenza can be a devastating and lethal disease worth attempting to control if not eradicate. However, looking more closely, we find that these apparent no-brainers do, in fact, present complicated policy questions that deserve careful consideration.

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