Gonna Get on this Hobby Horse and Ride

I finally made time to get a flu shot at a local CVS and so now you all get treated to a public health PSA (but it’s got an ethics/duty angle, so it’s totally technically within the scope of this blog).

I could just make a pitch from self-interest: get a shot so you won’t get sick.  After all, even without insurance, the cost of the shot (~$30 at CVS) is affordable for a lot of people, and, once you’re actually sick, you’re likely to wish you could take the trade.  Plus, for people my age, the least likely to get sick, you don’t even have to pony up that much since you can be covered under your parents’ insurance til 26, now that Obamacare is in effect.  But if you think you’re fine to weather the risk, or if you’d like a slightly higher-minded reason, I’ve got a much better pitch.

When you go in for a flu shot you’ll get handed a clipboard with a checklist like this one from the CDC website:

People who should NOT get a flu shot

  • People who have a severe allergy to chicken eggs.
  • People who have had a severe reaction to an influenza vaccination.
  • Children younger than 6 months of age (influenza vaccine is not approved for this age group), and
  • People who have a moderate-to-severe illness with a fever (they should wait until they recover to get vaccinated.)
  • People with a history of Guillain–Barré Syndrome (a severe paralytic illness, also called GBS) that occurred after receiving influenza vaccine and who are not at risk for severe illness from influenza should generally not receive vaccine. Tell your doctor if you ever had Guillain-Barré Syndrome. Your doctor will help you decide whether the vaccine is recommended for you.

Since these people can’t be inoculated, their first line of defense is YOU.  They’re relying on herd immunity – the critical moment when so many people are vaccinated that it’s hard for the disease to keep leapfrogging susceptible hosts  until it gets to the truly vulnerable.

So when you skip a vaccination you can afford, you’re putting all those people at risk.  This is also the reason I’m really in favor of innoculating boys against HPV, now that the vaccine’s been approved for them.  Even if most boys won’t be affected by the virus (though more will than you assume; viral-linked anal and oral cancers are on the rise), why would they choose to by carriers for a disease that could sterilize or kill their partners?

So go get your shots, and you can feel a warm glow of happiness (or just the relief of duty fulfilled, if you’re a straw-man Kantian) the next time you see a less than six-month-old baby on the street.  The virus has one fewer avenue of attack thanks to your inoculation.

(poster from the ever-wonderful Vintagraph health and safety section).

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  • Joe

    Didn’t get a flu shot this year yet. Thanks for the guilt trip. LOL

    • leahlibresco

      Well, I hope it worked and you schedule one.

  • keddaw

    Yeah, how dare we allow kids to get non-fatal diseases that may ultimately improve their immune system and someday save them from severe diseases.

    The argument “won’t someone think of the children” is such an overused fallacy that you should really be embarrassed to use it. I should get an unnecessary medical treatment that may have some negative side effects to guard against a disease that will have a minimal effect on me but may stop me spreading it to others? That reasoning is utter bullshit.

    As for the HPV, if you want boys to get it then simply encourage girls ask if boys have had it before they agree to have sex. This will greatly increase the number of boys who want to get it done voluntarily, much like the recent (20 year?) increase in condom usage.

    • Heartfout

      “Non-fatal diseases”

      Flu shot.

      Can’t say I see the link myself.

    • leahlibresco

      If you want to improve your kids’ immune systems, let them horse around outside. Most vaccines work by exposing you to either a weakened virus, a dead virus or cut up parts of a virus. Vaccines are effective because they trigger and train your immune system in a pretty similar way to an actual infection (minus most of the danger). So you’re not kneecapping yourself by getting vaccinated.

      deiseach is correct down below to point out the current strains of flu are more dangerous than usual. Normal flu can be fatal for the elderly, children, and people with compromised immune system. Swine flu (which is still around) is more harmful to people with active, effective immune systems (i.e. 20somethings like me). The disease causes the immune system to overreact and you end up poisoned by a cytokine storm.

      Finally, if you think girls will believe boys are truthful about their vaccination status when it appears to be the last hurdle to clear before sex, perhaps you are from a idyllic, less cynical age. Guess it’s an O tempora o mores kinda thing.

      • keddaw

        It was the idea of herd immunity I was talking about rather than how vaccines work themselves, I should have made that clearer. If we allow a growing section of the population to be prevented from getting any diseases we leave ourselves more and more open to a massive epidemic. Whether that risk is a reasonable one to take to avoid whatever short-term illnesses we would have, and their associated problems inc. death, is a much more complicated discussion than the one usually presented by both the pro-vaccination section and the anti-vac sect.

        • Luke

          I don’t think Leah misunderstood your point, she addressed it. The question of how vaccines work is directly relevant.

          I’m not aware of any mechanism by which vaccines increase the population’s susceptibility to epidemics. Having said that, I’m a physicist not a biologist and am aware that my understanding of vaccination and the immune system is a fairly simplified one. If you can explain the danger you’re alluding to I would be interested to hear about it. (I do, by the way, mean that entirely sincerely. I worry that it could come across as sarcasm in the general atmosphere of internet commenting.)

          • keddaw

            Luke, I’ll take you at your word.
            The issues I am about to highlight also apply to several other forms of viral protection such as quarantine, so this is not anti-vac as such, more just pointing out potential problems of it against allowing diseases to run their course.

            The vaccination usually involves a small fragment of a virus so that the body can react to the foreign invader (part thereof), which takes a little bit of time to get the immune system to generate the appropriate response – hence we don’t simply give people live viruses. This is very effective in many people but leads to a couple of potential problems:
            If we simply become reactive to a certain part of the virus then if there is a mutation that alters it we are back at square one, and perhaps worse than if we had allowed our bodies to naturally react to the virus (i.e. individuals might react to more than a single part or different people might react to different parts).
            The other issue is that if we vaccinate against diseases we can drive them to near extinction (small pox, polio etc.) and at that point we cease vaccinations. Should there (much) later be an outbreak no-one is protected against it and the risk of an epidemic is huge.

            The biggest danger is not a health one, it is a moral one. To guilt trip people into having unnecessary medical treatments for the ostensible benefit of others through herd immunity is not a very nice thing to do, let alone blame people who don’t when someone else gets sick. To take it a step further and force people into it is downright wrong.

          • Gilbert

            The part about using only a small part of the cell is a general feature of our immune system though, not a problem specifically with vaccinations. Memory B cells are produced in the lymph nodes by an evolutionary algorithm, adapting them to whole cells would take centuries at least. So there is some efficient compromise where antibodies adapt to some specific sequence. This can change under mutation and that is why a new flew shot is needed every year. But it’s the same if you came to your immunity by suffering the illness, you don’t get any better immunity in that way.

            With flue shots you have a point though. Since a new one is needed every year herd immunity is basically unachievable. Even if it gets spread over many years the herd immunity threshold is hard to reach. So on the flu in particular the herd immunity argument isn’t as strong as it is for many other infections.

            But with, say, smallpox I think the forced immunizations were pretty obviously justified. If we’re in both in a desert together, I have enough water for two and you have none I simply have no moral standing to claim property rights. And similarly if getting vaccinated is demonstrably necessary to prevent more of this, I don’t get to complain about the minimal invasion of my bodily integrity. Autonomy is just not that sacred.

  • deiseach

    keddaw, two things: first, the strain of flu currently going around is not the ordinary miserable-but-survivable strain; my sister and her family picked up the first go-round back in Christmas 2010 and had to visit the doctor and were exceedingly ill with respiratory trouble. So it makes sense to get vaccinated for, as Leah says, herd immunity. This is one flu strain you don’t want to get, believe me (I got a dose, ironically just as I was thinking of going for the flu shot). It goes right to your chest and any vulnerable person is going to be in danger of respiratory collapse.

    Second, not all flu strains are non-fatal. May I bring to your attention the 1918 Spanish Flu of ill-repute, popularly supposed to have killed more than the Great War managed?

    Thirdly, I’ve always felt that boys as well as girls should be getting the HPV vaccine, even though I’m not too happy about the politicisation of the damn thing. After all, boys get viruses too and pass them on to their partners, and what’s sauce for the goose is sauce for the gander, and for the sake of their own health, surely they should be vaccinated also?

    • keddaw

      I quite agree and would happily be vaccinated against everything going. It was the reasoning in Leah’s argument that I have an issue with and the (unspoken) idea that we should force people to get immunised, potentially against their will, for the sake of herd immunity. The principle that I can be directly blamed for indirectly causing someone else’s health problems as I was part of the population that stopped herd immunity from protecting them is an insidious argument. i.e. I didn’t pass the disease to person A but by allowing the disease to exist in the population in the first place I am somehow to blame. That is not an argument I can allow to stand unchallenged.

  • JSA

    Regarding “non-fatal”, CDC estimates that more than 30,000 people die of flu each year in the U.S. About the same as the number of traffic deaths.

    However, a study reported last month found that the flu vaccine is effective only 59% of the time. I wouldn’t be surprised if other measures, like maintaining good health and low stress levels, and washing hands, is more effective in avoiding the flu. I’ve only had a flu shot twice in the past twenty years, and got the flu both times. During that twenty year period, I never got the flu when I didn’t have a flu shot.

    The herd immunity threshold for influenza is about 75%, so even if you had 100% participation, you’re not going to hit the threshold (since the vaccine is not 75% effective). As long as the threshold is not credibly within reach, people can rationalize their lack of participation by telling themselves that “one person won’t make a difference”. Assuming liberally that 20% of people are getting vaccinated each year, that means that each non-vaccinated person, on average, contributes to 1/10000 of a death each year. Many people are comfortable with those odds. And once the 75% threshold can be credibly reached, it will be more difficult to cross, because people will be able to rationalize that they personally deserve to be in the 10-25%.

    The math reminds me a lot of this xkcd comic about tragedy of the commons.

    Finally, I’m personally worried about the longer-term dangers of maintaining herd immunity. Humanity has co-evolved with viruses, and we’re not even close to understanding fully how our genetic structure interacts with these diseases. For something that is relatively innocuous like the flu, I think we risk a situation where a localized herd such as the U.S. becomes fragile and risks mass deaths from a virus that hops from a population like China where it might be far less dangerous.

  • How does one get HPV, again?

    • leahlibresco

      Contact with sores particularly, but also sharing bodily fluids (spit excepted) with asymptomatic carriers.