The comedian Bill Maher sent a Tweet to his 59,001 Twitter followers, “If u get a swine flu shot ur an idiot” (Sept 26). 140 characters wasn’t enough to explain his logic, but the message is clear enough and echoes public skepticism in the United States about vaccines, pharmaceutical companies and government programs.
The CDC, on the other hand, has jumped to action, calling the spread of the virus a pandemic and initiating a series of dramatic steps to slow its spread, track its impact, and prepare for a mass immunization campaign.
In fact, if Maher, who is 52, takes his own advice, skipping the vaccine, he is not likely to suffer grave consequences from a bout of H1N1, provided he is otherwise in good health.
Still, the small risk of death from the flu can be avoided by getting vaccinated. It’s a little bit like wearing a seat belt. It doesn’t look like you will need it for any particular day, but someone is going to be at risk of a fatal accident each day, and seat belts significantly lower that risk.
The simplest thinking about whether to get the shot is something like, “What are the odds that I am going to die of the flu?” For some, like Maher, “not likely” is enough, and the rest of the story about Swine Flu (H1N1) looks like hype.
Here’s why it’s not that simple:
1. Medical experts are concerned about the increased risk of severe complications and death in pregnant women, fetuses, infants, children and persons with preexisting illness. The virus has only been tracked since April 2009, and there is not enough data available for doctors to quantify the risks, but deaths in the United States attributable to H1N1 have occurred in otherwise healthy pregnant women. All common flu strains are responsible for some deaths and severe complications, but doctors are concerned that pregnant women may be at increased risk.
Pregnant women can get the “Inactivated flu shot vaccine” (there are two versions of vaccine becoming available this month, but the other, the “Live, Attenuated nasal spray vaccine” is not for pregnant women). Obstetricians are recommending this vaccine and it is being provided for free starting in mid-October.
Similarly, the CDC is recommending that healthy children from six months to 24 years of age, those who live with infants, health care professionals, as well as people with vulnerable immune systems, who are between the ages of 25 and 64, get vaccinated quickly.
2. Some people who are not in the most vulnerable categories may have other reasons to get vaccinated, as the CDC recommends. For example, if you live with an infant less than six months of age, getting vaccinated yourself may help your infant avoid getting sick. The vaccine has not been approved for infants less than six months of age. So they will remain vulnerable to H1N1 until they reach six months and are vaccinated. But if family members and people living with a young infant are vaccinated, then they will not become contagious themselves, lowering the risk of infection of the infant.
3. In a typical year, 30,000+ Americans die from the flu and its complications. The Swine flu numbers may be higher, if infection rates are higher, as predicted, and depending on how many people get vacinated. But there is also a small risk that the lethality of H1N1 will change. The virus could mutate such that instead of death and complications being rare, they could be more common. At that moment, the fast availability of the vaccine could be crucial to avoid catastrophe. The risk is small, but so was the risk of failure from the levees in New Orleans.
Recent observations of little flu activity in places where the flu spread fastest in the spring, such as New York City, suggest that the population may already be building up substantial immunity to the virus. If this proves true, it will diminish further concerns over the overall number of people expected to become ill and could change the calculation on whether to get a vaccine, depending in part on whether you live in an area that has already experienced an H1N1 outbreak.
The government risks embarrassent expending public resources, to protect against risk, when a calamity does not ocurr. But criticism that H1N1 is all hype is misplaced. The CDC is not claiming that H1N1 is akin to The Plague. It is taking prudent steps to protect citizens and to be informed and prepared as the virus spreads. Every life counts.
I seem to remember Bill Marher having a lot to say about the Bush administration’s failure to protect citizens during Huricane Katrina. But who would have expected a once-in century Hurricane, eh Bill?
Evaluating risk is tricky business. When you get in your car today, ask yourself if you are going to get into an accident. Then ask yourself whether you should wear your seat belt, despite your previous answer.
There is some fear of vaccines, and there have been rare mishaps with vaccines in the past. However, medical professionals have a great deal of experience with flu vaccines and incidents are rare — far more rare than the number of deaths that will occur in those who do not get the vaccine. There are claims that elements in some vaccines, including H1N1 vaccines, are harmful. (Some H1N1 vaccines are available without Thimerosal, some are not). However, there is no scientific evidence to support such claims. On the other hand, there is abundent evidence that H1N1 and other flues cause a substantial number of deaths and that vaccines are effective protection against these flues.
The CDC tear sheets on each type of H1N1 vaccine are excellent and include clear details on priority populations and the side effects. To see them, click here and scroll down to the box that says “Materials for Distribution.” They download in pdf form.
UPDATE October 14, 2009: CNN AC360 Dr. Sanjay Gupta briefly discusses some of the rumors about the H1N1 virus. (PODCAST about 24 minutes into the broadcast.)
UPDATE October 16, 2009: NPR’s October 12, 2009 podcast of Talk of the Nation, available on Itunes and NPR’s website has an interview with Dr. Anthony Fauci, National Institute of Allergies and Infectious Diseases, discusses Swine flu vulnerabilities. Click and scroll down to Tips For Staying Healthy During Flu Season.
UPDATE OCTOBER 24, 2009: The vaccine is likely to be in short supply as production is slower than hoped.
UPDATE November 5, 2009: Distribution success stories: Texas
UPDATE November 15, 2009: New statistics and a new blog — Click here.
Marc Seltzer blogs at Marc Seltzer’s Perspective: Strategic Insights, not Simplistic Attacks
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