To Vaccinate or Not to Vaccinate? Why Is It a Question?

As Americans we have little memory of days when our loved ones could be snatched away from us by a contagious illness. We watch our friends and relatives go through cancer diagnosis and treatment, and we know a few people with diabetes or some type of autoimmune disease that requires careful management. Perhaps we know of someone who had a bad time with Lyme disease, but for the most part, we seem to feel that the 21st century has brought us immunity from deadly viruses.

It has not.

"People have become complacent," says Margaret Lewin, M.D. F.A.C.P., and medical director of Cinergy Health, a health insurance company that stresses preventive health care. "Today's families are too young to remember the fatalities and disabilities that can result from influenza."

As a result, people are hearing the news about the spread of the H1N1 swine flu virus, and they are not alarmed. In a just-released 60 Minutes/Vanity Fair poll, 4 out 10 Americans report that they are not altering their behavior because of the H1N1 influenza virus. When asked what changes they had made to avoid the swine flu, 44 percent answered, "None--I'll take my chances." Just 2 percent said they would refrain from kissing or hugging friends, and only 8 percent said they would stop shaking hands. Thirty-eight percent did admit to washing their hands more frequently, though the answer they picked was: "Wash hands and use so much sanitizer I should own stock in the company."

Many are also opting not to have their children vaccinated or to receive a vaccination for themselves. A recent story in The New York Times (10-29-09) reported that fewer than half of New York City parents had given permission for their children to be given the vaccine at school.

Dr. Lewin points out that some parents have opted out of vaccinating their children against many things, and she notes that in many cases there have been no repercussions. "They are benefiting from 'herd immunity,'" says Dr. Lewin. If the majority of a school is vaccinated against a particular illness, then the unimmunized will also be protected--unless they travel to a country where a particular disease is more widespread.

In an equally baffling maneuver, New York health workers have temporarily overturned a mandate that would have required them to get influenza vaccinations--both seasonal and H1N1. (Why would health workers--who are almost guaranteed exposure to the virus--resist being protected?)

The CDC estimates that 36,000 Americans die each year as a result of the seasonal flu. Even if the current strain of swine flu kills no more than the seasonal flu, that is still a significant number, particularly when you factor in that the swine flu is most dangerous to the young, those born after 1957. Statistics for deaths in car accidents--perhaps a worry parents tend to focus on more seriously--is expected to be lower for 2009 than the deaths by seasonal flu. (The most recent statistics from the National Highway Traffic Safety Administration shows 16,626 deaths in the U.S. from auto accidents for the first half of 2009. If we double that figure for an annual estimate, that gives us 33,252 deaths in traffic accidents, fewer than the number of people who will die from the seasonal flu.)

Two Guarantees with a Virus
Even with medical progress, there are two guarantees with influenza:
1. The virus mutates--always. It may become milder, or it may become more virulent. There is no way to predict this in advance.
2. Anti-viral medicines (Tamiflu, Relenza) can lessen the symptoms, they do not prevent, reduce the spread of the disease, or cure the illness.

What We Can Learn from 1918
In March of 1918 the flu that spread in U.S. military camps was relatively mild. By that fall when the disease had an opportunity to mutate, many people became ill with a strain that basically caused them to suffocate within a few hours.

In Philadelphia, during the first four months of the outbreak, an astounding 7 percent of the population died from the flu.

Of those who died from the influenza that spread in 1918, 99 percent were under the age of 65.

A scan through some issues of the New York Times from 1918 provide many stories of people "dropping dead." I read of a streetcar conductor who was well enough to start his shift but died before finishing work that day. Another newspaper report described four women who played bridge together one Saturday afternoon. By Sunday afternoon three of them had become ill and died. There is no shortage of similar stories from that time.

By 1920 the virus was finally slowing down, but estimates are that the Spanish flu, as it was known, had killed 20-40 million people worldwide.

Why the Resistance to Protecting Ourselves?
Other than the federal government, there is no one running any "get vaccinated" campaign to guard against a far more lethal risk that what we face when we get into an automobile. (Where is the vaccination campaign being organized by Mothers in Favor of Getting Children Vaccinated?) Have we become so distrusting of government that we are unwilling to participate in something that will protect us?

Adults sometimes refer to the 1976 swine flu fiasco as the reason why they are disbelievers. Science does not bear out the bad rap received by that vaccine. Here's what happened:

After the 1918 pandemic, the government did not want to be caught off guard, so when epidemiologists warned about a particular flu strain that spread quickly and was anticipated to spread widely during the winter of 1976-77, the U.S. government tried to prepare for a nationwide vaccination program against what was also called "swine flu."

The CDC mustered all its resources to obtain enough vaccine and enlisted volunteer health workers throughout the country to administer the vaccinations rapidly. Forty million doses of vaccine were administered and there were 532 incidents of the debilitating Guillain-Barre syndrome among those who were vaccinated. At the time it was feared that the vaccine was causing this reaction in some people, and since the flu never actually materialized, the vaccine program was halted.

Today scientists feel that the connection between the vaccination and the development of Guillain-Barre syndrome may have been overblown. "Statistically, we know that a certain number of people are going to encounter various health problems, with or without receiving a vaccine," says Dr. Lewin, who points out that one measure the government is taking this time is preparing some baseline statistics as to what health occurrences are statistically probable anyway. This should help counter people's concerns that certain issues occurred as a result of getting a vaccine.

The government is closely monitoring the situation, and a spokesperson for the National Vaccine Program stated on CBS' 60 Minutes (11/01/09) that of the 10 million doses of the swine flu vaccine that have currently been administered, there have been no notable problems. To watch the 60 Minutes piece:

When flu kills more Americans each year than die in traffic accidents, and our country has a 65-year record of creating safe flu vaccines, there is no reasonable explanation for resisting getting vaccinated. (For those who are concerned about the mercury preservative in vaccinations, there is a mercury-free version of the vaccine available for children.) For more information on the vaccine:

Rejecting flu shots is a lot like riding in a car without fastening your seatbelt. You know seatbelts save lives but you decide nothing will happen to you "this time." Anyone who has recently been ill with this strain of the flu would advise you to think again.