Fewer Flying F’s for Fighting Flu’s

Dear Doctor Ninja,

Are flu shots part of the anti-vaccination movement? After my social media post yesterday about my 5 year old and I getting our flu shots, I’ve heard from pro-vaxxers, anti-vaxxers, and people who give flu shots separate consideration from vaccines. What’s the story?

P. Rick

To answer your first question: Yes. Flu shots are vaccines and therefore would not be supported by people taking an anti-vaccination stand.

But what is the story?

Throughout modern history, there have been outbreaks of viruses. The symptoms we think of as the flu are caused by many different viruses. The outbreak of 1918, in a time before we even knew influenza was caused by a virus, it’s estimated that 500 millions people caught the spreading strain (thought to be the H1N1 strain) and that 50 million people died from it.

Since the flu is caused by viruses, there are very few treatments to cure it once you have it. Anti-viral medications help, but usually only shorten how long you have symptoms and sometimes make the symptoms less.

Since so many different viruses cause the flu, a flu vaccine can’t protect you from all of them. Every year, public health scientists and doctors (for instance, at the CDC in the USA) look at the information about what flu viruses have been circulating the most. They then make an educated prediction about which viruses will be the most common in the up-coming flu season, which usually runs Fall to Winter and vaccines to those predicted viruses are produced. Since it takes 6 months to mass-produce a vaccine, they have to commit to the prediction by February or March before the fall (September/October) in the Northern hemisphere, and September or March before the fall (February/March) in the Southern hemisphere.

As the saying goes, “It’s always twelve o’clock somewhere,” which means it’s also flu season twice a year globally. Since each flu season runs for almost 6 months, that means it’s almost always flu season somewhere too.

The most common question posed about the flu vaccine is usually, “Why did I still get the flu even though I got a vaccine?”

First off, you can’t tell you’ve been protected against things you can’t see. So while you might have gotten the flu last year, it’s difficult to tell which virus you got and whether you were _also_ infected with one of the viruses that were in the vaccine last year where you didn’t get symptoms.

Secondly, since you can’t be vaccinated against _all_ flu viruses, you can still get “a flu”, just not from the viruses you had a vaccination for.

Thirdly, there are some viruses that are difficult to make vaccines for. When these types of viruses are the predicted viruses, even if the prediction is right, it can be difficult to make an effective vaccine against them because of limitations on vaccine creation and production technology.

Lastly, sometimes, the prediction is off. You’re vaccinated and protected, but not against the viruses that are the most common in your area of the world.

So the reason why some people give flu vaccines a different consideration from other vaccines is this uncertainty. There aren’t a lot of different kinds of germs that cause tetanus. There’s not much guesswork in creating a tetanus vaccine. Therefore, if you were properly vaccinated against tetanus, it would be nearly impossible for you to get lockjaw if you were exposed to the tetanus bacteria.

So why get a flu vaccine at all?

When the weatherperson tells you it’s going to rain, you bring an umbrella because you don’t want to get wet. Even if it doesn’t rain, you’re ready. And sometimes, even though you have an umbrella, it rains sideways, so you still get wet. Or, it hails golfball-sized hail, and the umbrella isn’t really that useful.

One reason to get the flu vaccine is to protect yourself against the predicted viruses that cause the flu. And if you’re in a category of health where getting the flu is potentially a disaster (like young children, or the elderly), then an umbrella even on a day where it might not rain is a pretty good idea.

But other reason to get the flu vaccine is if you’re around other people where getting the flu is potentially a disaster. The thing about the flu is that you can pass on a flu virus before you feel sick. If you’re immune to the dominant virus in your area, you’re much less likely to pass it on. You’re a virus blocker. You break the chain for that virus. Which means you protect others who are either unable to protect themselves, or aren’t as good at it as you. You’re like the person who doesn’t forward email from Nigerian Princes to your friends and tells your mother to stop doing that.

What you can’t see can’t hurt you?

Dear Doctor Ninja,

I Like most people, I’ve heard the vaccination debate rolling around for the last few years, especially after one of my favorite comedians took an anti-vax stand a couple of years ago. But it’s only now with my wife is 30 weeks pregnant that it’s feeling like a very real and personal decision we’re going to have to make for our child and family. This is our first child and we’re so excited but also worried. Both my wife and I were vaccinated as children but things feel different now. I’ve been reading about vaccination extensively but I still don’t feel confident about making a decision. Can you shed some light on the situation?

W. Orried

When I was a child, I got the chickenpox. I still have a scar on my nose from it. My mom calls it “proof” that I had chickenpox. Back then, there was no chickenpox vaccine.

We were a vaccinated family: Measles, mumps, rubella, polio, tetanus, diptheria and so on. If there was a vaccine against heartbreak, my parents would have given it to me.

Whether to vaccinate your child against any particular disease is not only a personal decision for you, but a personal decision for your child. The question you have to ask yourself is, “What are the kinds of things do you see that make vaccination feel like a wrong or a right decision?” And more importantly, “What are the kinds of things you aren’t seeing that also make vaccination feel like a wrong or a right decision?”

My parents grew up in a time and country where polio was a reality. They had either friends or friends of relatives who lived with the complications of polio; unable to move certain parts of their body. Polio was present in their lives, not just theoretically, but in a concrete, experienced way, even if neither of my parents had the disease.

When asked, “Would you like to give your child a series of vaccines that would prevent them from ever getting polio?” my parents’ answer was confidently yes.

What you see today is autism. Chances are you know someone who is affected by autism or has someone close to them who is affected by it. Even if you don’t know someone affected by autism, the volume of vaccine-autism material on the internet is so overwhelming that it can create the vividness to make it real enough for you. Even if you never look at vaccine-autism material, you’ve seen autism.

A Google search today for “do vaccines cause mental problems”, comes up with over 64 million hits, the first two pages of which are about vaccines and autism.

A Google search today for “hospitalization of child for flu,” comes up with just over 1.2 million hits, and the first two pages aren’t even about kids in the hospital with flu, but when you should take your child to the hospital if they have the flu. In fact, the only way to find anything about a child in the hospital with the flu is to search “child dies in hospital with flu” which still only comes up with only 16 million hits.

Even if every case of measles, polio, or even every case of hospitalized flu was reported on the internet, it would never catch up.

For you, autism is real. For you, unlike my parents, polio is only theoretically real. Polio is only theoretically real for you because of a concerted effort to eradicate it. You would be hard pressed to find anything on social media about how polio affects anyone around you. You can tell something is really good at preventing something bad, when we forget that that bad thing exists. You can’t see what is no longer there. The bad boy/girl trope exists because you meet all the wrong people until you don’t meet the wrong one. Until then, to you, the world is full of undateable people. But “bad boys”/”bad girls” exist only because the good ones do too.

Your personal decision has very little to do with herd immunity, or the greater good, or even which of the differing opinions is true. You want the best for your child. That’s what loving parents want. You want to make the decision that protects your child and gives them every opportunity to be the person they want to be, whatever it is they want to be. Fear that you can see and feel is stronger than fear that you can’t see.

We all have blind spots when it comes to making decisions, and the key to making a good decision is to make sure that you’ve reflected not as much on what you can see, but what you can’t see, because it’s not what’s being shown to you. Because the fear you don’t see, if you could see it, would probably change how you feel about this very issue.