Should the flu vaccine be mandated?
On March 24, 2016, Brittany Andersen (Britt) complained that her throat was itchy so she picked up some over-the-counter medicine. Later that day, around 11:45 A.M., Britt’s mother heard a weird rattle sound coming from her room. She went into Britt’s room and found her lying on her back. She tried to wake Britt and then called 911. When the ambulance arrived, Britt had no pulse. The paramedics immediately began to work on her and rushed her to the hospital. Upon arrival, the medical staff told Britt’s mother that her condition was not stabilizing despite attempts to rectify her blood pressure and oxygen levels. Britt was experiencing sepsis and it was explained that her mother needed to decide whether to let the staff keep her alive. On the morning of March 26, 2016, Britt went into cardiac arrest twice within a few minutes and her mother made the difficult decision to stop life-saving efforts.
Source: Families Fighting Flu - the Andersen Family
Sadly, Britt`s is far from the only such story......
On Thanksgiving Day of 2003, Vira Cover noticed that her 23-month-old daughter, Elizabeth, wasn’t feeling well. At noon that day, Vira was sitting on the sofa with her daughter when she suddenly threw up. Vira noticed blood in the vomit and immediately grabbed her daughter and ran to the neighbors’ house for help. They called 911 and Vira started doing CPR on Elizabeth, who had become unconscious. When the paramedics arrived, they took Vira into another room of the house so that they could work on Elizabeth. They worked on her for what seemed like forever, but Elizabeth died. An autopsy confirmed that Elizabeth had contracted the flu – H1N1 specifically – and that it had led to a complication called bi-lateral pneumonia in which her lungs filled with blood.
Source: Families Fighting Flu - the Cover Family
From these truly heartwrenching stories, it's clear that death from vaccine-preventable diseases (VPDs) like influenza, can impact families, friends, and other loved ones for the rest of their lives. So, it follows that we need to motivate people to take the flu much more seriously. It is certainly true that immunocompromised patients, and older patients are more at risk. However, there is a perception among some that there is no urgency about vaccinating if one is not part of one of these groups. However as the families above had to learn in the most devastating way; this is far from the truth. Anyone can contract the flu at any age, develop severe side effects, and die in the worst cases. So it`s key to build an understanding of the impact that it can have. In time, hopefully this will build motivation in people to prevent themselves and their loved ones contracting the flu, and other infectious diseases. The first step is making sure there is a clear understanding of flu, what it is, how it is transmitted so easily, and how to prevent it. That`s what I`m going to focus on in the next few paragraphs.
First, the basics
2. What is the flu?
Most people will know that the flu is caused by infection with a virus. In more detail, seasonal influenza is an acute respiratory infection caused by influenza viruses circulating all over the globe. The 4 subtypes of influenza virus are influenza A, B, C, and D; with Influenza A and B usually causing seasonal epidemics. Thus, they are the key types that are important in public health.Flu is relatively contagious. Seasonal influenza can be transmitted relatively easily and quickly, particularly in crowded areas such as hospitals, care homes, schools, shopping centres; and so on. According to the CDC website, most experts believe that flu spreads via tiny droplets made when people cough, sneeze, or talk. Others can contract the flu when these droplets land on their nose or mouth. Less commonly, some people contract the flu by touching a contaminated surface or an object (fomites), and then their own mouth, nose or eyes. To limit flu transmission, experts recommend regular, thorough hand washing and drying of the hands. Also critical is covering mouths and noses when sneezing or coughing, and regular cleaning or disinfection of the high-risk areas mentioned above. Tissues should also be used and disposed of correctly, and avoid close interaction with people who are ill. This especially true if you or anyone you`re in contact with is elderly, immunocompromised, or otherwise at higher risk of severe disease from the flu. It's also helpful to avoid touching the mouth, nose, and eyes in order to reduce the chances of infecting yourself. These measures are essential as infected individuals are contagious before showing symptoms. Influenza viruses can be detected in infected people a day prior to symptoms developing, and up to a week after showing symptoms. Those with flu are most contagious in the initial 3-4 days after the illness begins. That said, those who are immunocompromised or infants may be contagious for over a week.
2.1 Flu symptoms
Generally, the severity of flu symptoms range from mild to severe to even death. According to the World Health Organisation, seasonal influenza is characterized by acute (sudden) development of fever, chills, cough, sore throat, a runny or stuffy nose, muscle or body aches, headache or fatigue. Some patients experience vomiting and diarrhoea, although this is more common in children than adults. In the majority of cases, flu symptoms resolve within a week, and generally don`t require medical attention. However, in certain high-risk groups of people, severe illness, hospitalisation and even death can occur.
2.2 Development of illness
In an article for theconversation.com, Professor Laura Hayne, an immunologist with the University of Connecticut describes how flu symptoms develop. She describes that “Influenza virus causes an infection in the respiratory tract, or nose, throat, and lungs. The virus is inhaled or transmitted, usually via your fingers (fomites), to the mucous membranes of the mouth, nose or eyes. It then travels down the respiratory tract and binds to epithelial cells lining the lung airways via specific molecules on the cell surface. Once inside the cells, the virus hijacks the protein manufacturing machinery of the cell to generate its own viral proteins and create more viral particles. Once mature viral particles are produced, they are released from the cell and can then go on to invade adjacent cells.” She also explains that while this infectious mechanism certainly causes some injury to the lungs, most of the damage and symptoms are in fact caused by the immune response to the flu.
Again, all age groups can be infected and develop symptoms of flu. However, certain groups have a disproportionate risk of complications and more severe disease after contracting the virus. Some examples include those who are over 65 years old, pregnant individuals, children under 5, those who are HIV-infected, on chemotherapy or steroids. Those with chronic health conditions are also at higher risk; including those with asthma, heart disease, neurologic conditions ,or diabetes. Further, healthcare workers are also at a higher risk due to ongoing exposure to infected patients, and items these patients use. As a result, healthcare workers risk infecting other vulnerable people with the virus. Of course, the degere of risk depends on the precautions they take individually, as wel as those taken by the hospital or other healthcare institution they work in. Most of the data from the CDC is about US epidemics, so that's the area I`ll focus on here. In general, influenza epidemics generally occur in the U.S during fall (autumn) and winter. Infection rates generally increase during October, peak in winter, and may extend as late as May. However, viruses (while not alive) are dynamic and change from season to season and year to year. This, along with many other factors, means that the exact time, peak and end of an influenza epidemic can vary each season. Further, the exact numbers of infections are difficult to quantify. As discussed, symptoms generally resolve within a week without medical attention. Thus, many people infected do not seek medical attention and aren`t diagnosed. So, as with any statistic, there is always a margin of error to be taken into account.
3. The flu vaccine
It's clear that there is a need for preventative measures against infections, complications and severe disease from influenza viruses. Vaccination is tne most effective way to prevent all of these. Most flu vaccines are given with a needle into the arm; however a nasal spray flu vaccine also exists. Common ingredients in some vaccines include stabilizers (to make sure the vaccine stays effective after manufacturing). They also contain adjuvants which help boost the immune response to the vaccine. Further, they may contain ingredients to kill any bacteria or toxins introduced during manufacturing. They may also contain antibiotics to prevent growth of bacteria in the vaccine during the manufacturing process. Multi-dose vials of the flu vaccine also contain preservatives such as thimerosal to prevent contamination. The key point is that the flu vaccine is safe and effective. Many flu vaccines have been used for over 60 years; so this safety and effectiveness profile is well-estabished.
4. Increasing flu vaccine uptake
I`m going to guess it will be difficult to remember all the information I just wrote. However, I`m willing to bet you remember the stories of Britt and Elizabeth from the beginning of the post. They are highly personal stories, and the strong emotional component of these stories stick with us. For that reason, stories are the most effective way for people to remember principles. Further, it's not just about information and/or stories. It's especially effective when people hear stories from someone within their community that they already know and trust. So, before we can ask how to communicate with people in a particular community about vaccines, we need to ask; who will they listen to? Who holds influence within the community? Why? Once we`ve answered that question; we can then approach them about being advocates for vaccines (and possibly other healthy behaviours, too). So, let's take the example of a highly religious, conservative Catholic community. Religious leaders within this community are likely to hold the most influence. To apply this principle in a practical way, I`ll discuss a real-world example.
A 2021 broadcast from Voice of America describes such a case. Christ Church Georgetown is one of the oldest churches in Washington. It's also where COVID-19 arrived when Reverend Timothy Cole became the city's first coronavirus patient. This earned him the nickname "patient zero." Cole has been vaccinated, and so has nearly everyone in his parish. He`s urged his parishioners to get the shot for their own health, and for the welfare of others, and he's happy for more faith leaders to do the same. Tim says that "I certainly alerted this community very early to the risks of it and perhaps this community benefited in the long run by, you know, being very quick to react. A parishioner states that "that experience made us become very aware , and made us much more cautious and aware of what we should be doing and not doing. This story interested me because a few things had to happen for the community to reach this state of caution. First is that the community probably were quite heavily religious in the first place.Otherwise, they wouldn`t respect Reverend Cole`s words of caution afer he contracted and recovered from COVID-19. He wouldn`t have had the impact he did if religion wasn`t a dominant influence on community culture. Some people practice religion quite passively, in that they might go to church, pray, or other forms of worship only occasionally. It is very unlikely that was the case in Georgetown. Something else that had to be true was that Reverend Cole had to share the values of the community. He had to be seen as someone who was part of the community, and therefore could be trusted. It's hard to integrate yourself into any group in a meaningful way if you don`t share their values; be it smaller communities like this or larger congregations. That is another element of this that was really key. In more secular communities, however, culture is less influenced by religion. So, it follows that recommendation from priests, rabbis, imams and other religious leaders won`t influence vaccination rates hugely. If that is the case, we need to look at the community lifestyle, and how this reflects their values. Once we have an understanding of community values, we can advocate for vaccination in a way that doesn`t contrast with these values. That, in turn, may make people more likely to accept vaccination. Or, if not vaccinations, just information about them. They may even be willing to schedule an appointment with their primary care physician to discuss them. Realistically, they probably won`t suddenly become hardcore vaccine advocates. However, the seed is planted. The needle is moving in the right direction.
This values-based approach was exactly what was taken in the 2014 “I immunise” campaign in Fremantle, Western Australia. The study was performed by political scientist Katie Atwell from the University of Western Australia, and psychologist Melanie Freeman from Murdoch University.Fremantle is a community known for its “natural living” lifestyle. This includes home birthing, naturopathy, growing vegetables, and as would be expected, low vaccination rates. The study was an advertisement campaign that featured members of the community, including Attwell herself. Beneath the people were slogans that implied that they integrated vaccination into the natural living lifestyle typical of Freomantle. For instance, one read “I use cloth nappies, I eat wholefoods, and I immunise”. Another: “ I use cloth nappies, I grow veggies and I immunise”. One last example: “I breastfeed, I use homoeopathy, and I immunise”. The bold “I immunise” suggested that it is not against the values of the community to vaccinate. Including aspects of the lifestyles of community members with immunisation normalises it within the community, in a way. It isn't wrong. It isn't bad. You`re not strange, odd, weird, or anything else within the eyes of the community if you vaccinate. I think that was really key - normalising a health-promoting behaviour. It also included an “I immunise” website that viewers of the ads could visit for more detailed information about community members' stories. This is beneficial as it offers people flexibillity to look at information on their own, in an environment they're comfortable in. As such, there is no pressure from other community members, medical professionals, or anyone else to either vaccinate or not. In my opinion, that element of it is important.
To conclude; it's not just information itself that`s important. It's also about who is presenting it, and how they communicate it. Thanks for reading.
15. Dr. Maya Goldenberg - Vaccine Hesitancy; Public Trust, Expertise, and the War on Science