After “the blizzard that wasn't,” a number of New Yorkers criticized mayor Bill de Blasio and other city officials for their decision to shut down the New York subway system ahead of a predicted snowstorm. Others blamed the weather forecasters for all of the hype. Regardless, grocery shelves were left bare, and whether they believed the forecasts or not, people braced for the worst. Isn’t it better to be safe than sorry?
Better safe than sorry is our attitude toward preparedness, but we’re more lackadaisical when it comes to personal health. Consider the flu. Maybe you get the vaccine, and don’t get the flu. Maybe that was because you weren’t exposed, or maybe the vaccine did its job and you avoided getting sick. Isn’t that better than suffering from flu and losing days of work, or, worse, being hospitalized for complications?
This season the flu seems to be particularly dangerous. Every year both the very young and the elderly are urged to get the seasonal flu vaccine and are warned that they are at high risk for complications. This year all four members of my family—none elderly or under one year of age, and three of whom received the vaccine—battled the flu. Surprisingly, three of us had complications. Two, including me, developed pneumonia, and one developed bronchitis. Fortunately, no one was hospitalized and we all fully recovered. A five-year-old Las Vegas girl was not so lucky; she recently lost her life after complications resulting from the flu. She was also vaccinated. Why do some people get sick despite having the vaccine?
The flu virus is very unstable and is continuously mutating its genetic information through a process call antigenic drift. If the virus changes significantly, last year’s vaccine will not work well for this year’s flu.
Vaccines are one of the greatest modern medical advances—just two doses of the measles vaccine, for example, will protect 99 percent of people—but they are not perfect. The main reason for the effectiveness of the measles vaccine is that measles doesn’t really change; it looks the same from year to year. In contrast, the flu virus is very unstable and is continuously mutating its genetic information through a process call antigenic drift. If the virus changes significantly, last year’s vaccine will not work well for this year’s flu.
Deciding what components to include in each new flu vaccine is an educated guessing game. Every year, Food and Drug Administration officials meet and analyze survey data from around the world to predict the kind of flu virus that will infect Americans that year. This decision needs to be made months in advance of the flu season to provide manufacturers sufficient time to prepare enough doses of vaccine.
Even if the vaccine is a strong match for a given year’s flu virus, not everyone will generate an ideal response. That is likely why my family got sick. The elderly that receive the flu vaccine are also more likely not to develop protective immune responses because their immune systems are weaker. The Centers for Disease Control and Prevention recommends that individuals 65 and older receive a specially formulated high-dose vaccine to increase their chances of a protective response.
Despite the surveillance data, and the best efforts of the FDA, this year’s flu vaccine is not very protective. The flu virus changed after the vaccines were prepared and just prior to the start of the season, making this year’s vaccine only 23 percent effective. For comparison, in years where there is a good match the effectiveness rate can reach 60 percent. Does that mean you should skip the vaccine? No. The vaccine is safe and some protection is better than none—better safe than sorry. Besides, maybe this year’s vaccine will protect you against the strain of flu that circulates next year, or the year after that.
Still, we have all heard examples of people who came down with the flu right after receiving the vaccine. Did the vaccine give them the flu? No.
There are two types of flu vaccine. One contains a crippled virus that can only infect at low temperatures like those in the nose, but not at higher temperatures like those found in the lungs. Although it is not recommended for people with underlying asthma or other lung diseases, for the rest of us, this vaccine is safe.
The second type of vaccine is made of bits and pieces of dead flu virus and delivered in a shot. It doesn’t contain live virus and can’t give you the flu. It does, however, take two weeks for the immune system to develop a protective antibody response. If you are unlucky enough to be exposed to the flu during that two-week period, the vaccine may not yet be protective and you might get sick.
Each of us can run out to buy supplies when warned about potential blizzards, just in case the forecast turns out to be correct. Each of us should also get an annual flu vaccine. Until we have better vaccines or treatments, it is better to be safe than suffer.