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So why are so many of us afraid of vaccines in general, flu vaccines more particularly, and this flu vaccine even more so? And why is this fear exaggerated, if not totally unfounded? A few reasons:
1) Vaccines are intrinsically scary. For one thing, vaccines involve needles, and most people don't much care for them. They also involve having a foreign protein, combination of proteins, or weakened germ intentionally introduced into our bodies. I think it's rational to be somewhat afraid of that “invasion.” Rational, but wrong (more on that below).
2) We look just one way. Vaccine fear is largely related to the fact that we, or our kids, need to be vaccinated when feeling fine. The whole idea of immunization is to prevent illness—not treat it. When feeling fine, it is easy to think that the vaccine, rather than the disease it is intended to prevent, is the greater danger. But to get the calculation right, both have to be fully considered. Looking both ways—the pros and cons of the vaccine versus the pros and cons of getting the infection—favors the H1N1 vaccine over opting out, just as it favors the use of all vaccines recommended by the Advisory Council on Immunization Practices. This perspective is ignored by the vaccine conspiracy theories that tend to populate cyberspace, but they are just so much hearsay.
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3) We live in luxury. Fear of vaccines is a luxury that develops in societies that are not ravaged by the diseases vaccines prevent. Previous generations of parents who dreaded the arrival of summer as polio season, or who lost children to mumps or measles feared the diseases, and welcomed the vaccines. Previous generations of humanity ravaged by small pox had cause to view that vaccine as perhaps the single greatest triumph in the history of public health. Maybe 1918 is just too long ago to make us wince: In that year, pandemic flu killed more people than all the wars of the 20th century combined.
While there is no cause to think the current flu has the potential to be nearly that devastating, but there is ample reason to respect it. In fact, we don't know how devastating H1N1 might be if we don't do what we can to curtail its spread.
4) Everybody remembers 1976. That was the year a swine flu pandemic threatened, but didn't materialize—and a contaminant in one batch of flu vaccine led to cases of the Guillain-Barré syndrome. That was, in fact, the worst flu vaccine debacle in history. How bad was it? Nearly 50 million Americans received the vaccine, and roughly 500 cases of the Guillain-Barré syndrome were associated with it. That's not great, but it is still only a risk of 1 in 100,000. There were, all told, 25 deaths associated with the 1976 vaccine. That's a risk of 1 in 2 million, and makes even the riskiest flu vaccine in history about as common a threat as lightning strike.
The real problem with the 1976 vaccine effort was that the pandemic simply didn't occur. That's not an issue this time. We know for a fact that pandemic flu is among us. It is a perfectly clear and already present danger.
5) This vaccine was produced quickly. One argument against H1N1 vaccination is that the vaccine was manufactured so quickly—how can we know it’s safe? In fact, we can all be thankful and impressed that the public health gears were revved up and the H1N1 vaccine was produced with such alacrity. I see no evidence of haste or carelessness. We need a new flu vaccine every year just to deal with garden variety flu, because the influenza virus mutates annually. So the accelerated timeline for the H1N1 vaccine is a modest difference from business as usual. The development methods, testing, and oversight of this vaccine are the same as for the annual flu vaccine. All of the available evidence suggests that the H1N1 vaccine is as safe and effective as every flu vaccine has been since 1976, if not more so.
6) The H1N1 flu is mild, so why bother? It appears that most cases of H1N1 are fairly mild (my own case certainly was). Well, thank goodness for that. But even so, it has killed nearly 200 people in the U.S. so far—at least 60 of them children. By some accounts, it has killed well over 1,000. Remember that the “most dangerous” flu vaccine in history was associated with a mortality risk of 1 in 2million! Even this “mild” flu is vastly more dangerous than the worst vaccine we've ever had!
Then there is the more serious worry. In 1918, when the world was devastated by pandemic flu, it all began with a mild flu strain in the spring. As millions became infected in the fall, the virus changed and became lethal. You know the saying: Those who don't learn from the follies of history are destined to repeat them.
There was no flu vaccine in 1918, and thus no way to prevent the spread of the virus to millions. That spread, in turn, gave the virus the opportunity to mutate and wreak havoc. We certainly don't know that this would happen again if we don't use the current vaccine; but we do know that it could happen again. So while you may feel you are taking a chance by getting vaccinated, we are all playing Russian Roulette if we choose not to.
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My final thoughts: The H1N1 vaccine is safe and effective. The flu virus is neither safe nor predictable. By vacillating on vaccination, we put ourselves, our children, and our neighbors at risk. At best, opting out of immunization will result in a small number of preventable deaths, although that will be quite horrible if one of them happens to be someone you love. At worst, it is an invitation for some very bad history to repeat itself.
I understand your fear. Yes, opting out of vaccination helps you and your child avoid some very small risk associated with immunization; no medical intervention is totally risk-free. But it puts you squarely in the path of a greater danger. My advice as both a physician and a fellow parent is that you guide your child to the far lesser risk by taking them to the pediatrician to get immunized.
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