In the elevator at a school of public health

An interesting thing happened today in the elevator at school. A friend of mine and I walked in to go from the second to the sixth floor. As we walked into the elevator, I noticed that it was a bit crowded. “Whoa,” I said, “I hope everyone got their flu shot.” A couple of people smiled, a couple of others giggled. One woman replied, “I don’t believe in the flu shot. Never got it. Never will.”

I was not ready for that anarchy.

A man asked her if she didn’t believe in vaccines. She clarified that she’s gotten every other vaccine, just not the flu vaccine. Why? Because, according to her, the flu vaccine has “never” been proven to work.

I almost had an aneurysm. I looked up at my friend. She was smiling at me. I think she knew what was going through my mind. We’ve had discussions on how antivaccine people really rattle my cage, so to speak. She shook her head a little bit. I bit my tongue.

I almost swallowed my tongue, almost.

The woman in the elevator was obviously, painfully wrong. I don’t know whether or not she’s been listening to a PhD who used to be at Hopkins and has said some pretty uninformed things about the influenza vaccine. I don’t know where she got into her head that the vaccine against influenza has never been shown to work. But statements like hers, from a person like her, are dangerous. They are dangerous because she has a bit of authority on the matter because she is affiliated with a very prestigious school of public health. (She was wearing a badge, but I couldn’t tell what her role there was.) It’s not unreasonable to think that a person who doesn’t know better would believe her because, hey, she’s something at a very prestigious school of public health.

A skeptical person would put her statements to the test, but not everyone is skeptical. And the evidence against her statement is not very readily available or understandable to the general public. Yet all you have to do is go to the CDC report on pediatric deaths:

“The number of influenza-associated pediatric deaths reported to CDC during the current season [2012-13] surpassed 100 this week as an additional 6 deaths were reported in FluView. This brings the total number of influenza-associated pediatric deaths reported to CDC, to date, to 105 for the 2012-2013 season.

Pediatric deaths are defined as flu-associated deaths that occur in people younger than 18 years. An early look at this season’s reports indicates that about 90 percent occurred in children who had not received a flu vaccination this season.

This review also indicated that 60 percent of deaths occurred in children who were at high risk of developing serious flu-related complications, but 40 percent of these children had no recognized chronic health problems. The proportions of pediatric deaths occurring in children who were unvaccinated and those who had high-risk conditions are consistent with what has been seen in previous seasons.”

Some people will say that the results are confounded because people who do vaccinate tend to have better health habits. So someone who is vaccinated is not being protected necessarily by the vaccine but by their habits. The problem with this is that the only habit that can prevent influenza is hand washing. Eating right, sleeping right, etc., have not been shown to increase or decrease the probability of catching influenza or not having bad outcomes from it. Even if there was some truth to the belief that the results are somehow confounded, it’s unreasonable to think that 90% of the kids who died were not vaccinated just by chance.

People who want to poke holes at the evidence will probably do, and that’s when we hit them back with other evidence. But to say that the vaccine has “never” been proven to work? That’s just uninformed or irresponsible… Or both.

If you’ve been reading what I write, you know that I don’t think that the flu vaccine is the best that it can be. It certainly is not a sacred cow to me. But it’s the best we have right now, and it works in more people than “none” and has been tested more times than “never”. The only reason why I didn’t get into it with the woman in the elevator is because I had to get going and go study for my epidemiology midterm exam tomorrow… Which is what I’m off to do right now.

Some battles can wait.

I'm a fourth-year doctoral candidate in the Doctor of Public Health program at the Johns Hopkins University Bloomberg School of Public Health. All opinions posted here are my own, of course, and they do not necessarily reflect the opinions of my school, employers, friends, family, etc. Feel free to follow me on Twitter: @EpiRen

7 thoughts on “In the elevator at a school of public health

  1. “The problem with this is that the only habit that can prevent influenza is hand washing.”

    Interesting, since children do not often have good hand washing habits.

    And example: on a family trip we all got infected with strep throat. Two of us were bad enough to get antibiotics at the emergency department of a hospital the day before we flew home. The others were treated at home. All was good.

    Except two of the kids got strep again. They took antibiotics, and were good. Only to get it again! Repeat. This lasted two months.

    So the entire family came in and got swabbed for a strep test that was not a quick strip. All three kids were infected. The one child who did “not” get sick had it too. He just kept infecting the other two. The cycle was stopped when all three took antibiotics, including our version of Typhoid Mario (Streptococcal Stephan?).

    The doctor explained we parents were not infected because we are much better at hand washing.

    If flu vaccines were ineffective and hand washing was key, then the kids who died from influenza would be split into the same percentages of those who were or were not vaccinated (and I am not finding those numbers just yet). Not 90% unvaccinated.

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  2. If people actually observed proper procedures to avoid being infected, we’d have eliminated virtually all contagious disease in a few years. Since the vast majority of the population can’t be arsed not to stick their fingers in their mouth in public, or properly cover their sneezes and coughs, vaccines seem a better bet.

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    • Karlyssa,

      What do you do with the airbornes infectious diseases? You know, the ones that don’t need any contact to spread?

      Alain

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      • Yes, and there are also those vaccine-preventable diseases which are part of the human condition, like HPV from sex. No amount of “proper procedures” have been able to tackle those. It’s been up to clear and tangible public health interventions like vaccines.

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  3. Kerlyssa, have you ever dealt with children? A set of our population that are incredible mobile infection vectors. Teaching them hygiene takes a bit of time.

    Go and read my comment. Trust me, some, like our own Streptococcal Stephan, actively try to avoid washing their hands. He would even just turn on the water, then turn it off without putting his hands in. When I noted that his hands were dry he would just put them under. I had to actually stand there and witness him washing his hands with soap.

    This was the same five-seven year old child who I saw chewing gum. This is something I frowned upon because he tended to leave gum in inappropriate places. I asked him where he got the gum, and he pointed to the place in the sidewalk where he had pulled it up. Le sigh.

    He graduates from college in June, and has thankfully become an adult with proper hygiene habits. Our water bills skyrocketed when he hit puberty.

    Also, I dealt with a rotavirus infection when my oldest was a toddler. All bets are off with the rivers of diarrhea. Despite lots of hand washing, many baths and an incredible amount of laundry in hot water: even I caught it. Thankfully there is now vaccine.

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