The following originally appeared on The Upshot (copyright 2018, The New York Times Company).
One of the biggest problems in trying to convince people that they need to immunize against things like the flu is that they don’t really feel the pressure. After all, for most people, the flu shot is an inconvenience, and they’re unlikely to get the flu in a given year. So why bother? Quite a few readers expressed this view after my article “Why It’s Still Worth Getting a Flu Shot” on Thursday, including this one.
I promise this is an honest question: Are people routinely being destroyed by the flu or something? (I mean, first I’d ask, ‘Is everyone but me simply vaccinated, and thus gifting me with herd immunity?’ And so I did. My first Google search brought me to yearly C.D.C. flu-vaccine coverage statistics, and for the last four years, the percentage of flu-vaccinated adults has been in the low 40s. So… nope.)
I’m not a particularly healthy person — I get colds, sinus infections, etc. — but I just can’t recall ever having had the flu, or at least *knowing* I had it. This seems to indicate that the flu is either 1) rare enough that it’s possible for me to have been lucky forever (in which case it’s fairly rare, apparently), or 2) not severe enough of an illness for me to have noticed experiencing it.
Both lead me to conclude that skipping the vaccine is fine.
I’m just a regular idiot, presumably representing other regular idiots, amenable to changing their habits, but who haven’t done so — not due to obstinance or contrarianism, but due to signals so mixed as to inspire ambivalence — and if this article can be said to have provided the ‘why’ its headline promises, unfortunately it hasn’t provided the ‘why’ idiots like me need to hear:
Why is the flu a big deal literally at all? — Chrystie, Los Angeles
Although I devote some of my articles to telling you not to worry so much about some diseases or other risks, influenza is one thing you actually should worry about. It’s terrible; it’s also far too common.
Influenza, commonly called the flu, spreads easily. You can catch it from someone who coughs, sneezes or even talks to you from up to six feet away. You can infect others a day before you show any symptoms, and up to a week after becoming sick. Children can pass along the virus for even longer than that.
Influenza is not a reportable disease, so its prevalence must be estimated. The Centers for Disease Control and Prevention believes that, since 2010, between 9.2 million and 35.6 million people have come down with the flu in the United States each year. That means that in a bad year, more than one in every 10 people in the United States might get it.
Many of those people end up in the hospital. In a good year, we might see as few as 114,000 people hospitalized with flu-associated illnesses. In a bad year, that number rises to more than 700,000.
In 2014, more than 57,000 people died of influenza/pneumonia. It was the eighth-most common cause of death, behind diabetes (just under 80,000 deaths). It’s also the only cause of death in the top 10 that could be significantly reduced by a vaccine. Lowering risks of heart disease, cancer or Alzheimer’s are much, much harder to do.
In 1995, the worst year of the AIDS epidemic in the United States, fewer than 51,000 people died of it. In 2014, just over 6,700 deaths were attributable directly to H.I.V. Yet it is H.I.V., not the flu, that people dread far more.
Because the flu is so common, we tend to minimize its importance. Consider the contrast with how the United States responded to Ebola a few years ago. We had a handful of infections, almost none of them contracted here. One person died. Yet some states considered travel bans, and others started quarantining people.
Worldwide, just over 10,000 people died in the 2014-15 West African outbreak of Ebola: a relatively new, frighteningly contagious illness that people feared could become a global pandemic. It’s not surprising that it got a lot of attention. Yet the tens of thousands who died of influenza in the United States the same year barely made the news.
It’s possible that so many adults ignore the danger because it seldom affects them directly. Most of the hospitalizations and deaths occur among children and older people. The rates of hospitalization of those less than 5 years of age are twice that of adults under 50. The rates among those 65 or older can be 10 times that of other adults. Almost two-thirds of deaths are among older people.
So much of this is preventable. The C.D.C. estimated that in the 2015-2016 flu season, the flu shot prevented more than five million cases of the flu, about 2.5 million medical visits and more than 70,000 hospitalizations. It was also estimated that it prevented 3,000 deaths.
If just 5 percent more people had been immunized, we could have probably avoided 500,000 illnesses, 230,000 medical visits and 6,000 hospitalizations.
We should also note that the 2015-2016 flu season was also mild. More worrisome is something like what happened with the Spanish flu in 1918-1919. One third of the world population was infected, and about 675,000 Americans died.
They died from the flu.
If you fall into one of the lower-risk groups (i.e., adults age 18-50), you might still think that the flu isn’t such a big deal, and that you don’t need to worry much. I could argue that there’s evidence that even if the shot doesn’t prevent you from getting the flu, it could make your illness less severe. But even this misses a huge point. You don’t get immunized just to protect yourself. You also get immunized to protect those who can’t protect themselves.
Chickenpox — and the varicella virus that causes it — had long been considered a “nuisance” by many. When a vaccine was introduced in 1995, some questioned whether it was necessary for children, since most who got the disease were fine. Pediatricians disagreed; they had cared for the many young children who were hospitalized by the illness, and the surprising number who died — mostly infants.
A study published in Pediatrics in 2011 made the case for why thinking about only yourself is the wrong way to look at varicella vaccination. The first thing it showed was that from 2001 through 2007, as rates of vaccination rose, the rates of death from varicella were low, with just a few children dying from chickenpox nationally each year. But more significant, from 2004 through 2007, not one child younger than 1 year old died in the United States from chickenpox.
What was amazing about this finding was that we don’t vaccinate children that young for chickenpox — therefore, those babies’ deaths were not prevented because they were vaccinated. Their deaths were prevented because we vaccinated their older siblings. That achieved the herd immunity necessary to slow or prevent the rates of infection significantly.
Adults need to get vaccinated to protect children and babies. They need to get vaccinated to protect older people and the immuno-compromised. This is true for almost all diseases, including the flu. Less than 50 percent of children are immunized against the flu. About two-thirds of people 65 and older are.
But only a third of adults 18 to 49 are.
They can do better. If not for themselves, then for those they love.