I am thinking about the flu shot.
I have never gotten it. Shocking, I know. But as far as I can understand, the evidence for the flu shot’s effectiveness is a whole lot shakier than the claims made for it.
The US CDC, for example, roundly states on its website that “the flu shot works.” But then (if you actually read the page), it turns out that “works” means: “reduces the risk of flu illness by between 40% and 60% among the overall population during seasons when most circulating flu viruses are well-matched to those used to make flu vaccines.”
You see, influenza viruses change every year. There’s always a bunch of them in circulation. Pharma companies make educated guesses, each year, about what the coming season’s flu mix will look like. When they guess wrong, notes the CDC, “vaccination may provide little or no protection.”
And how frequently is that the case—all those nurses, just firing blanks? We simply are not told.
And that’s before we ask what the phrase “reduces the risk,” in that guessed-right, 40-60% scenario, actually means. And that’s before we get to the nature of the studies that are used to support that claim. And that’s before we get to the many non-flu viruses, circulating each season, and causing flu-like symptoms; against which the seasonal flu shot (as CDC frankly notes) has zero effect.
So, basically, I pass no judgment on people who get the flu shot. But, on my own judgment, I pass.
Now, I understand that bugs some people. “OMG,” they’ll say. “Obviously no vaccine is a hundred percent effective”—but I have to stop them there. Admitting that the flu shot doesn’t confer perfect immunity is like admitting that a crystal amulet doesn’t prevent all cancers.
The question is not whether we should get a vaccine that clearly confers at least some significant benefit. The question is whether we should get a vaccine that may well confer little benefit, or none.
“Ok—fine” (says my imaginary flu-shot friend). “Let’s grant, for the sake of argument, that the flu shot may be only marginally effective. That’s still an argument for getting the shot! If you catch the flu, you’ll probably experience temporary loss of productivity. You may need attention from the health-care system. And you’ll participate in a cycle of viral mutation and transmission that puts some people, such as the elderly, at serious risk.
“Maybe the flu shot only moves that dial a little. How little is too little (you selfish contrarian jerk)?! The flu shot is an approved medical intervention that has the potential to reduce human suffering, at least a bit. That’s a clear win. So go get the shot! What’s the down side?”
It’s a pain, first of all. That may sound outrageously trivial, compared to the alleged potential benefit of the flu shot. But of course, the question before us is precisely whether there really is any such potential benefit.
Suppose you are told to travel to an unfamiliar location, present identification, fill out a bunch of forms, and wait for a while—so that somebody can stick a pin in you. At least in those mysterious and uncounted “guessed wrong” years, that pretty much describes getting the flu shot. I think in such a case we struggle to see the upside, not the down.
Then, there is real and measurable risk in getting any shot. There can be side-effects. Puncturing the skin and inserting something into the bloodstream, in general, seems like an activity you want to avoid. So does crowding into a waiting room with a bunch of strangers who may be carrying various contagions. To be sure, these are almost certainly small risks. But how small is small enough? This is the risk-benefit argument in reverse. For a vaccine, like those against Covid-19, that moves an important dial quite a lot, benefit clearly outweights risk. It is far from clear, I would say, that the same goes for the flu shot.
Finally: it seems to me that we should really only render ourselves patients of the medical system when necessary. This isn’t only a moral point, but also a hygienic one.
When we are healthy, we do not need doctors. When we do not need doctors, we are healthier than when we do. A high positive value, both moral and hygienic, attaches to non-contact with the medical system.
Sometimes, to be sure, we have no choice but to give this up. Illness makes us submit, for prevention, or cure. But this, with regard to our management of our own lives and health, is always negative, and never trivial. The down side.
In the case of something like Covid? Yes, we have to take that hit. Once, twice, maybe even three times.
But in the case of something like seasonal flu—year after year after year after year? I really don’t think so.
It seems to me that the decision to get or not get the flu shot stands well within the range of choices that individal adults need to make, for themselves, about the management of their own health.
And I certainly hope it remains there.
(Coda: The “stopping the spread” argument is perhaps the most persuasive one for getting the flu shot. Protecting the elderly, the immunocompromised, “those who can’t get the shot,” etc. This seems to me a weird one, on two grounds.
First: if, as may well be the case [see above] the shot is actually ineffective against flu, then it is hard to see how it can be effective against transmission of flu.
Second: One thing that has been drummed into us with regard to Covid-19 is that vaccinated people–and here we are talking about vaccines of high, demonstrated efficacy–can still spread the virus. It has even been loudly insisted that the vaxxed, precisely because they can contract the virus without getting sick, may blissfully be carrying higher viral loads than the unvaxxed, and are therefore *more* dangerous transmitters of the virus. [Cue scenes of fully-vaxxed people wearing masks and having to undergo PCR tests.] Can it really be the case that a flu vaccine of dubious effectiveness is nonetheless more effective than the Covid vaccines at halting the transmission cycle? Curiouser and curiouser. Perhaps the pharmaceutical companies whose bread and butter the yearly flu shot is can explain it to us.)