Swine Flu (H1N1) Experts and Bill Maher on the Vaccine and Managing Your Risk

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, 2009The 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

Follow my writing on Twitter

Read more about the H1N1 virus and vaccine here:


Swine Flu Vaccine: What to DO?

H1N1 Vaccine – Tested In Animals First

Safety Concerns Swirl Around H1N1 Vaccine


Keep Swine Flu Out Of Your House

Swine Flu Symptoms & Prevention

Swine Flu:  The Single Best Way to Prevent Illness

Swine Flu Parties

Swine Flu: Can Cinnamon Fight It?


My Life With Swine Flu

H1N1 A Challenge For Working Mothers

Toxic Pollution And The Swine Flu Vaccine

H1N1 And Your Pets (Really!)



Helen K.
Helen K.4 years ago

I braved the G.B. syndrome risk and got the swine flu vaccine in the mid seventies - and I have never had the flu since!
So, yes it works - much better than you imagine!

Shirley S.
Shirley S.6 years ago

Eat healthy,exercise,plenty of vitamin D,wash hands.take multi vitamin & mineral supplements.This way we will avoid cols & flu.

Lea C.
Lea C.6 years ago

I just noticed that someone mentioned the way the media is playing this like a plague. Governments WANT them to, to keep people under pressure and look for a way to instigate martial law and THAT my dear friends is the truth. They were actually believing that people were going to be scared to death and RUN to every facility to 'fight for this vaccine.' NOT! :>) Even in France, only 20% of the population got the vaccine. They're pushing it because they know they're gonna get 'stuck' with a trainload of the junk...so they're gonna make it look BAD. It's NOT...and it was ordered to be a pandemic by the World Health Organization. They're looking for any way they can for global government and telling people what to do. (snicker) and if people are smart...they won't follow. If the CDC said that they conducted studies and you could prevent Cancer by jumping off a cliff, would you do it??? I doubt it! :>) People ARE waking up, thank goodness. Where this one doctor said that over 1 million people have come down with the swine flu in the U.S, that's just a crazy LIE. According to Dr. Mercola.com and Dr. Carley.com, they're saying that the media is NOT reporting that most of the people they're counting that were tested did NOT have the flu of any type. They continue to count the respiratory infections, ear infections, sinus infections and that's NOT the swine flu. They must really believe people are stupid. Geesshhh!

Lea C.
Lea C.6 years ago

Bill is smart! So am I. they could pay me a few mil & there's NO WAY I would take ANY vaccine! Had enough as a kid, made me sicker than a dog. I had ALL the flus, all the measles, mumps, chicken pox, etc blown way out of proportion by those vaccines. When I had one case of the measles AFTER a vaccine, they were so bad, & my fever was so high, they had to put me on sodium penathol to knock me out. I was in horrible shape. So vaccines? NO! My older cousin had the polio vaccine when it came out and GOT polio. He was in an Iron Lung, (back in the day) for over a year before he finally snapped out of it. Darn near died. So, anyone who gets vaccines are nuts!! A body cannot build any immunity with mercury in it. Cripes...why do people think they STOPPED putting mercury in tooth fillings? Dangerous! Gives off a gas that has been found to contribute to Alzheimer disease. (look up on YouTube or Google Video) When the temperature of mercury increases when drinking something hot, or in teeth when chewing something hard is when it gives off that gas.

I put people who believe that vaccines will help them on the same level as those who believe in the tooth fairy or that fluoride is good for you. (they use fluoride in RAT POISON, folks, under another name). Check this stuff people. I'd always thought fluoride was helpful too, until I ended up with gum disease for NO reason, AND lost 1/2 my teeth to it. Every time I use toothpaste with fluoride I get infected.

Ancil S.
Ancil S.6 years ago

Hi all! I got the "shot" and I feel fine so far.I'm 48,so I guess I fit in the danger zone.I work at the hospital where I live,and figure it would be a good idea being as the hospital was giving out the vaccine for free,and so I can keep from spreading it to patients that I come in contact with.

Regine B.6 years ago

To anyone who wants the opinion of a medical expert on the subject, I recommend to go to http://www.newsmax.com/health/vaccine_swine_flu/2009/07/07/232717.html

It is quite enlightening, as it exposes in great detail what goes in vaccines and what the clinical studies say.

Teresa T.
Teresa T.6 years ago

"The CDC is not claiming that H1N1 is akin to The Plague" That may or may not be true, but the media is playing it like it's the plague. My local newspaper has an article about the flu or the vaccine EVERY SINGLE DAY. Complete overkill. I'm with Bill Maher on this one. People in high risk groups such as those with compromised immune systems (like my sister with MS who gets pneumonia every year), the parents of newborn infants, etc should get a shot. For them the benefits outweight the risks. Not necessarily so for the average healthy person.
Here are two links regarding the flu and vaccinations: http://articles.mercola.com/sites/articles/archive/2009/11/03/What-We-Have-Learned-About-the-Great-Swine-Flu-Pandemic.aspx

Don't just go by what's listed, do some additional research and then decide if you are in the group where the benefits outweight the risks.

Cindy M.
Cindy M.6 years ago

"as for crying wolf...there hasn't been a pandemic flu declared since 1968, so i am not sure what you are referring to there."

I wasn't thinking in terms of CDC declarations; "crying wolf" was more in reference to media frenzy and our getting riled up.

If the number is now 600, that's even more families who are facing great hardship. So I do not wish to minimize their loss.

But, what's the risk to you and me, relatively speaking? I think it's pretty remote. About 800 of every 100,000 Americans dies each year (2.5 million, roughly). And flu is on the hit parade of causes, albeit on the lower end of the list. So sure, it's a risk, but a pretty small one for any given individual.

Thus, take some precautions of you can, but don't worry too much (my advice, to myself, only.)

That's all I'm saying.


Michael C.
Michael C.6 years ago

Marc, 2-49 is not the high risk range. that is the range of those eligible to get the nasal spray vaccine.

High risk is age 0-24, and those with underlying health conditions that put them at higher risk.

priority for vaccination is 6mo-24 years, pregnant women, and age 25-64 with underlying health conditions (and of course anyone who cares for or is in close contact with the high-risk groups).

Michael C.
Michael C.6 years ago

Cindy, as of yesterday's AP article, there were over 600 deaths in the US so far from H1N1 (including over 80 children). Yes that is many less than in a typical flu season, but what you are ignoring is that those deaths have all happened outside of flu season, and the majority of them are in children and young adults. A significant portion of them were completely healthy.

the majority of deaths from the seasonal flu are in elderly individuals and those with otherwise compromised immune systems. (whereas those age 64 and over are at much less risk from the pandemic H1N1 flu)

as for crying wolf...there hasn't been a pandemic flu declared since 1968, so i am not sure what you are referring to there.