In defense of flu shots

The assumption has long been that the influenza vaccine works well to prevent flu and that everyone who’s eligible to get vaccinated should do so. Thus it was rather a shock when a new study, published last month in a British medical journal, claimed the vaccine isn’t as effective as we think.

This negative-stained transmission electron micrograph depicts the ultrastructural details of an influenza virus particle, or virion. Photo by Cynthia Goldsmith, U.S. Centers for Disease Control and Prevention.

The study, led by a team from the Center for Infectious Disease Research and Policy at the University of Minnesota, analyzed about 30 previous studies carried out over the past four decades and concluded that the flu vaccine only protects about 59 percent of the population. And during some flu seasons it appeared to have little, if any, effect.

Does this mean we should write off flu shots as a waste of time and money? Not at all. Even 59 percent protection is “better than zero,” the study’s lead author, Michael Osterholm, told the StarTribune of Minneapolis.

If anything, the study underscores the need for development of better flu vaccines, Osterholm said.

Still, it’s not hard to see why many in the public health community have been concerned that some folks will interpret this study as yet another reason to skip being vaccinated.

Despite state and federal efforts to educate the public, there’s still a fair degree of skepticism about flu shots. A series of studies by the RAND Corporation this past year came up with some interesting findings about this:

– During the 2009-10 flu season, an estimated 39 percent of American adults received a flu shot. Among those specifically recommended for the vaccine because they met higher-risk criteria, 45 percent were vaccinated.

– Among those who opted not to get a flu shot, the leading reason was “I don’t need it,” followed by “didn’t get around to it,” general disbelief in flu shots, and worries about side effects or the possibility of getting sick from the vaccine.

The conventional wisdom has been that when people don’t get vaccinated, it’s usually because of a missed opportunity, such as a visit to the doctor’s office or urgent care center during which the flu vaccine could have been offered but wasn’t. The RAND researchers found, however, that even if the number of missed opportunities could be reduced, there would still be a percentage of individuals who say no to the vaccine.

They also found that adults who haven’t previously fit the recommendations for getting a flu shot are less likely to have ever been vaccinated against influenza, less likely to believe vaccines are safe and less likely to follow a doctor’s suggestion to receive a flu shot.

It’s not enough to simply make the vaccine available; the public health community also needs to actively promote it, the RAND researchers concluded:

Stepping up conventional strategies to encourage vaccination, including mail/telephone reminders and physician recommendations, and offering vaccines at more convenient locations, would help. Special efforts may be required to reach the healthy young adults who are now recommended for vaccination but do not visit providers often and may be difficult to reach through standard modes of public health messaging. These efforts could include using new media to deliver public service announcements and making vaccinations available at work. Finally, those most skeptical about vaccination may require one-on-one counseling with health care providers to help them understand that vaccination for flu carries very little risk compared with the risk that going unvaccinated poses to themselves and those around them.

Motivating people to take specific health-related steps is never easy, period. But this study suggests it’s especially important to pay attention to people’s beliefs and attitudes. For better or worse, beliefs and attitudes – even when they might be based on misinformation or incomplete information – do matter when it comes to getting an annual flu shot.

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