Archive for the vaccines Category

Taking a Shot At a Shot (Or Why The Flu Shot Sucks)

Posted in flu shot, vaccines with tags , , , , , , , , , on January 28, 2015 by sometimesafoggynotion

To start off, I’m not opposed to the flu shot and get it every year (having had the flu before, I learned my lesson the hard way), but some people do oppose it. And I’ve seen where others label anyone who is critical of the flu shot as an “anti-vaxxer” – but that’s not necessarily true. It is not only possible but very common for people to oppose the flu shot yet still support all other vaccines, in which case, I think it is completely wrong to call them anti-vaxxers.

I’ll illustrate this with an example via a personal story to back up that people like this do exist.

I have a lot of friends on Facebook from different social circles I’m in. One of those social circles is the Unitarian Universalist Congregation of Atlanta (usually called UUCA for short). A few years ago, I noticed that a friend from this group started posting a lot of Facebook status updates about eating natural organic food. She seemed like she was basically becoming a naturopath (something that can be either good or bad from case-to-case, so I tend to avoid being too critical of it). Then one day, she posted a link to a terrible write-up on some blog (I wish I had saved the link, but I don’t have it anymore) that said a lot of misinformation about the flu shot (for example, the blog claimed that the flu shot has antifreeze and dangerous mercury in it, etc., etc. – the typical misinformation found too easily online).

I posted a comment to her posting basically begging her to not spread these awful lies. She then personally messaged me about my comment and we had a private discussion. And the discussion had the following exchange word-for-word in it:

me: “And being anti-vax is dangerous. Fewer people are getting their kids immunized due to the myths being spread around, so diseases once virtually conquered are returning, like Whooping Cough, due to the lack of mass immunity.”

her: “I’m not anti-vax. I’m anti flu-shot.”

That’s an exact quote (including the misplaced hyphen). She was not opposed to any vaccine other than the flu shot.

Later on I reflected on what she said about not being anti-vax, just anti-flu shot and realized I was wrong and made a hasty generalization mistake in calling her an anti-vaxxer and should have been simply critical of the misinformation she posted about the flu shot. I haven’t encountered her personally since then, but if I did I would apologize for calling her an anti-vaxxer.

Now, if you are getting hot under the collar still convincing that being anti-flu shot is just as bad as being against any other vaccine and are about to jump down to the comment section to give me a piece of your mind, just bear with me a bit more and read on as I provide what I think is a reasonable basis for being anti-flu shot.

First, I’m going to list a number of unnamed vaccines and their overall effectiveness and duration:

Vaccine (A): greater than 95% effective, lasting a lifetime

Vaccine (B): greater than 90% effective, lasting at least 10 years

Vaccine (C): greater than 90% effective, lasting at least 15 years

Vaccine (D): greater than 99% effective, lasting at least 18 years

Vaccine (E): greater than 96% effective, lasting at least 13 years

Vaccine (F): between 23% and at best 66% effective, lasting just a few months

Look at these numbers and guess which one is the flu vaccine?

[Jeopardy music goes here]

If you guessed “Vaccine (F)” is the flu vaccine (and hopefully phrased it in the form of a question), you are correct! And calling it “Vaccine (F)” is appropriate because compared to those other vaccines, I would give it a grade of “F” for Failing to measure up. (BTW, Vaccine (A) is the Measles vaccine, Vaccine (B) is the Mumps vaccine, Vaccine (C) is the Rubella vaccine, Vaccine (D) is the Polio vaccine, and Vaccine (E) is the Tetanus vaccine.)  Simply look at the CDC’s recommended vaccine schedule for adults ( LINK: http://www.cdc.gov/vaccines/schedules/hcp/imz/adult-shell.html ) and just add up the number of doses for any other vaccine and the number of doses for just influenza for a person from the age 19 until the age 65. Most vaccines for a person over that age range would need just 1, 2, or 3 doses total. Tetanus, Diphtheria, and Pertussis would need a booster every 10 years, so 5 doses total over that timespan. But the current flu shot means 47 doses over that span of time from age 19 until 65, far more than any other vaccine and more total doses than all the other vaccine doses combined.  The pie chart below shows that over 63% of the vaccine doses recommended over this span of time are just the flu shot (the slice in dark blue).

SAFN_Vaccination-doses

Face it, when it comes to vaccines, the flu vaccine is the runt of the litter. It’s the 80-pound weakling that can’t keep up with the other vaccines and maybe should be picked on and criticized (don’t worry, it’s just a shot so can’t hurt its feelings). In fact, I don’t think it should be called the “flu vaccine” and should just be called the “flu shot” because it simply doesn’t deserve being ranked alongside other vaccines that are truly great breakthroughs in medical science. Instead, the flu shot is really just a not-so-great placeholder until we get a real flu vaccine that is over 90% effective and just one shot lasts for a decade or more.

The main problem with creating an effective flu vaccine is that there are multiple strains of the influenza virus that are always rapidly evolving, which makes formulating an effective vaccine much more challenging than creating one for other, more stable viruses. The current method of trying to guess which strains will be prevalent in the next flu season is rather flawed which is why the effectiveness can vary so greatly. To make a very effective flu vaccine would require basing it on the parts of the influenza virus that do not change. (BTW, research for this “universal flu vaccine” is actually underway now and reportedly making good progress – LINK: http://www.medicalnewstoday.com/articles/288082.php )

And if you are going with the argument that the flu shot saves lives and start quoting stats about the number of deaths due to the flu, just note that according to Dr. Sanjay Gupta, “Most of the people who die have underlying illnesses or a weakened immune system.” In other words, they were already sickly to start with, so perfectly healthy adults rarely die of just the flu (assuming that guy knows what the hell he’s talking about). The official death rate of Influenza type A virus is less than 0.1% of people who catch the flu and factoring in the flu shot’s typically low effectiveness, there’s no easy way to even be sure having had the shot would have saved anyone who died. True, it makes sense that someone in one of the high risks groups for possibly developing flu-related complications (ex. pregnant women, children under 5, and adults over 65) should probably get the flu shot. And I remember one year (the 2000-2001 season) in which the flu shot was in such short supply that everyone was told to not get it unless we were in one of these high risk groups.  The fact is most people are not in these high risk groups and the overwhelming majority of which would recover from a bout of the flu on their own without any lasting effects.

As for the vaccination goal of “Herd Immunity” or the situation in which so many people have been vaccinated that even unvaccinated people are essentially safe from the virus. It’s a real possibility with other vaccines, but with the flu shot, it’s at best hypothetical and, realistically, it’s practically impossible. Yes, hypothetically speaking, on a year in which the flu shot has a higher than average overall effectiveness level (say 66%, which is the highest overall effectiveness I’ve ever seen listed for it) and also with a high percentage of people (say over 80%) getting the flu shot, then it would potentially achieve herd immunity. But this will not happen with the annual flu shot. Just never ever happen. Why not? Because of its duration. Other vaccines achieve their herd immunity from the cumulative effect of people getting that particular vaccine over many, many years – something that just doesn’t apply to the flu shot because for it, everyone in that 80% would all have to get the flu shot in the exact same flu season  (which is really within about 6 months of each other, so just half-a-year by the calendar) due to the flu shot’s short duration. To get 80% of the people having the flu shot in a single flu season would require over 250 million people in the U.S. getting the flu shot during that exact same flu season. Dream on, but that’s just not going to happen. The flu shot manufacturers don’t even make 250 million doses of the flu shot in a single year. So herd immunity in the occasional years where the overall effectiveness is over 60% just doesn’t happen due to the short duration of the flu shot’s effectiveness. Only whenever the “universal flu vaccine” is widely available will herd immunity be realistically possible for the flu.

My personal experience is, outside of people in the medical industry or in the scientifically-oriented crowd, most people do not get the flu shot every year. Just ask about a dozen or so random people if they got the flu shot and I would guess less than half got it this year or even last year.

And the most common views of people who don’t get the flu shot include one or more of the following:

  • they claim that they had a bad reaction to the flu shot in the past
  • they claim that they never get the flu and hence do not need the flu shot (although the reason why they claim this can vary)
  • they claim that the shot has toxins in it (this is where there is some crossover with actual anti-vaxxers, but this claim alone does not necessarily make them anti-vaxxers)
  • they claim that it doesn’t work (citing either its short effectiveness duration or claiming that in the past they once got the flu shot and still caught the flu)
  • they hate getting shots and are afraid of the nasal spray version containing live flu viruses

Of course, some of those are terrible reasons to give but the fact remains that no vaccine is completely safe, so getting any vaccine is always a risks vs. benefits issue. Yes, there can be bad reactions to a shot, but they are rare and seldom are as bad as contracting the virus they are trying to prevent. However, for the flu shot, the risks vs. benefits argument is weaker than for any other vaccine. The risks are annual shots (which means at least 10x as many shots as a different vaccine over the same timespan) that may cause a bad reaction on some years vs. the benefits being a so-so level of protection against a not-so-scary illness that the vast majority of people recover completely from on their own in about 2 or 3 weeks without ever needing to see a doctor.  So the risks are arguably a lot higher and the benefits lower than any other vaccine out there.

Now I have had the flu on a few occasions. One bout of flu back in 1997 was so bad and I felt so miserable for a few days that back then I thought that I might need to go the hospital. But I improved (if you’ve never had the flu, the worst parts only last a few days with the rest of the time being a lot like a bad cold) and when it was over, I decided to get the flu shot from then on. The other times I caught the flu were either early in the season before the shots were available to me or when I procrastinated too long in getting the shot, but only one other time (2009) was the flu as bad as what I had in 1997. If you are wondering how I figured that I had the flu instead of a bad cold, every time I had a high fever with chills and bad aches & pains in addition to the symptoms most common to both, I presumed it was the flu and not a cold (so it’s possible I was mistaken sometimes and just had a bad cold, but I definitely had the flu in 1997 and 2009).

And catching the flu was the only reason that convinced me to start getting the flu shot. If I was one of those people who never get sick with the flu, I probably wouldn’t get the flu shot at all. The only bad reaction I have to the flu shot is my arm is sore and basically useless for the rest of the day, which usually causes me to plan out when to get the shot, but nothing worse than that. However, if I had some of the bad reactions I’ve heard people say they got from the shot, I’m not sure if I would continue getting the flu shot.

A final point to make about anti-flu shot people is when there’s an outbreak of a virus like Measles or Whooping Cough, notice how the outbreak is blamed (correctly) on anti-vaxxers. But when there’s a lot of flu going around, no one is blaming the anti-vaxxers – which is also being done correctly because given how herd immunity is practically impossible with the flu shot, in any realistic scenario, there still would be a lot of flu going around. So call people who are against the flu shot but support other vaccines a name like “anti-flu shotters” but don’t call them anti-vaxxers because there is a clear difference between the two viewpoints.  Anti-flu shotters oppose only the flu shot with arguably good reason, while anti-vaxxers additionally oppose all other vaccines with no good reason.

I think it’s a social and civil duty for everyone to get vaccinated, including making sure to get booster shots for any disease that returns and causes another outbreak. But I do not include the flu shot with that duty and think that getting the flu shot is just a personal choice issue. Get the flu shot if you want or don’t get it – I really don’t care. Now I personally get the flu shot every year because I think some protection against the flu is better than no protection, but I don’t judge anyone who doesn’t get the flu shot. I have this view because my overall point, plain and simple, is that the flu shot sucks… but catching the flu sucks even more.

(P.S. and at this time you can unleash your furious anger in the comment section below)

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