{"id":3602,"date":"2013-01-11T20:52:44","date_gmt":"2013-01-12T01:52:44","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=3602"},"modified":"2017-09-14T16:24:27","modified_gmt":"2017-09-14T20:24:27","slug":"how-to-make-the-flu-vaccine-more-popular-warts-and-all","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/how-to-make-the-flu-vaccine-more-popular-warts-and-all\/2013\/01\/11\/","title":{"rendered":"How to Make the Flu Vaccine More Popular, Warts and All"},"content":{"rendered":"

In a week that saw both our hospital’s influenza-induced bed crunch make the New York Times<\/a>,<\/em>\u00a0and my son, mother-in-law, and me succumb to this seasonal plague despite our receiving flu shots, I have been highly<\/em> attuned to all things influenza.<\/p>\n

But the focus here will be on that perennial whipping boy of preventive Infectious Diseases, the flu vaccine. Let me get it out of the way that\u00a0I unequivocally believe that it’s our best way of preventing flu, and that I would never skip it.<\/strong>\u00a0Nonetheless, it’s far from perfect, which is why\u00a0in the court of public opinion, it just can’t win.<\/p>\n

Why do most universal flu vaccine campaigns seemed doomed from the outset? Let me list the ways, some of them the fault of the vaccine, some just human nature:<\/p>\n

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  1. It has to be repeated yearly.<\/strong> Like magazine subscriptions renewals, membership dues, car inspections, and taxes, the flu vaccine comes round every year and induces the same feelings of nauseating weariness. Again? You mean I need that shot already? Didn’t I just do it? And will it even work this year? All right, go ahead. <\/em>Medically savvy patients note that we’re not making them repeat any of the other shots yearly, which must imply to them a serious weakness in our vaccine.<\/li>\n
  2. It doesn’t always work.<\/strong> Estimates of flu vaccine effectiveness vary widely, so I like to cite the 70% figure from this study<\/a> rather than the more discouraging\u00a0CDC’s aggregate data of 60%<\/a>. And then\u00a0I add some motivating language such as, “but it works better in some people than others, so let’s be on the optimistic side.” Plus I mention that all doctors and nurses get the vaccine, which though a bit<\/em> of a lie, is at least true about ID docs\/nurses.<\/li>\n
  3. Many people think it works even less well than it does.<\/strong> Flu season just happens to coincide with the seasonal increase in all kinds of other respiratory tract infections, and it’s inevitable that patients with bad colds will blame that on the failure of the flu vaccine. Plus, approximately 32.56% of the population use the term “stomach flu” to describe various short-term gastrointestinal ailments, and regardless of what that term actually means, it’s 100% certain that the flu vaccine does nothing to prevent them. More failure! Even the above-mentioned\u00a0Times<\/em>\u00a0article<\/a> compounds this confusion by starting the piece on influenza, yet including several paragraphs on norovirus — just because, um, it’s sort of related, I guess. (It’s not.)<\/li>\n
  4. “It gives me the flu.”<\/strong>\u00a0I find it truly mystifying why so many people believe that the flu vaccine gives them the flu, but regardless, it’s either the top reason cited by vaccine refuseniks or a close second to, “I never get the flu, so I don’t need it.” My hunch is that people believe the flu vaccine gives them the flu because 1) colds are common and 2) they once got a bad cold (the “flu”) shortly after getting the vaccine. QED.<\/li>\n
  5. It has to be matched each year with the predicted\u00a0circulating influenza viruses. <\/strong>Sometimes the match is a good one (this year it is), sometimes less so. Unfortunately, in the absence of an all-knowing, popular\u00a0Nate Silver<\/a>-like projection guru — someone who updates his\/her predictions on a regular basis for the public to see, and does it in plain language — the process of matching the vaccine to the circulating viruses is not for the faint of heart. (I dare you to read this<\/a>\u00a0all the way through.) This stuff is rough going\u00a0even for most doctors, hence it’s no wonder that the public is skeptical on an annual basis. For the record, this is what’s in this year’s vaccine (in case you want to make one at home):\u00a0an A\/California\/7\/2009 (H1N1)pdm09-like virus,\u00a0an A\/Victoria\/361\/2011 (H3N2)-like virus, and a B\/Wisconsin\/1\/2010-like virus (from the B\/Yamagata lineage of viruses). Piece of cake.<\/li>\n
  6. Weird stuff happens. <\/strong>Just like no vaccine is 100% effective, none is 100% safe either. The sheer volume of flu vaccines given every single year means that bad stuff is numerically more likely to happen with the flu vaccine than with others, at least in adults. Some of these linked events will be little more than anecdotes — do you really think your golf game was worse this week is because you just got a flu shot? — but some will be real, e.g. the 1976 swine flu vaccine and\u00a0Guillain-Barr\u00e9 syndrome<\/a>. These associations are hard to shake, and not a year passes where I’m not asked about the flu vaccine and Guillain-Barr\u00e9, along with much more tenuous (really nonexistent) links such as flares of multiple sclerosis, transplant rejection, arthritis, and inflammatory bowel disease.<\/li>\n<\/ol>\n

    Given the above challenges, what can we do about it?<\/p>\n

    Seems what we need is a truly trustworthy spokesperson for the flu vaccine, someone who will take on what Magic Johnson did for HIV. He or she will calmly recommend the vaccine, reassure people about its safety, acknowledge fears and misconceptions — perhaps even mention that even if the vaccine doesn’t work, it probably makes the breakthrough case of flu milder — how many people know that?<\/p>\n

    So with the help of this nice list of the most Trustworthy Celebrities<\/a>, plus some of my regional\/personal biases, I ask you to help choose our Flu Vaccine Celebrity Spokesperson. <\/strong>I am 100% sure that after hearing of their nomination, they will quickly drop whatever project they are doing and volunteer their time for this important public health effort.<\/p>\n

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    Who should be our national Flu Vaccine Celebrity Spokesperson?<\/strong><\/p>