Posted on 22 May 2013 by

HCPs: Get your flu vaccines

Summary: The flu vaccine significantly reduces the morbidity and mortality associated with influenza and its complications. Myths about vaccinations (such as a supposed link between thimerosal/vaccination and autism) have been proven wrong by scientists many times over. Unfortunately, these myths have not been dispelled in the eyes of the public. Public trust in the flu vaccine, and vaccines in general, is declining. Healthcare professionals must be mindful of this, and realize that off-handed comments about the flu vaccine can be a strong negative influence on patients and undermine important public health initiatives. Patients should receive thoughtful evidence-based advice that considers their opinions and state of health. This advice should underscore the importance of vaccination in general, the personal benefits of vaccination, as well as the public health benefits of vaccination.

NB: This post is specifically addressing the small proportion of healthcare professionals who refuse to be vaccinated. The majority of healthcare professionals receive the flu shot, and most often recommend that patients also receive a flu shot.

The flu vaccine works well, not 100% well, but well enough to make a significant difference in morbidity and mortality (especially if the majority of the population receives the shot). Unfortunately all people have to do to discredit an important preventative care measure is tie it to "Big Pharma." "Big Pharma" only cares about profit. Did you know that drugs are manufactured by "Big Pharma?" Vaccines are tied to the pharmaceutical industry because vaccines are made by the pharmaceutical industry, thus vaccines will always be regarded with some level of suspicion by the public.

Don't even get me started on the homeopathic vaccines that Health Canada recently approved; just save your money and buy a bottle of water.

Dietary supplements have far less evidence (in relatively healthy people with a somewhat balanced diet) of efficacy than vaccines, even imperfect shots like the flu vaccine. Don't even get me started on the homeopathic vaccines that Health Canada recently approved; just save your money and buy a bottle of water. It'll be just as effective against disease as the homeopathic vaccine.

"Big Pharma only cares about profit!" The masses cry, "Big Pharma rigs studies to sell their products! Big Pharma suppresses the real information! We can't trust anything they say!"

If we could measure the malice of corporations by looking at profit margins then the multi-billion dollar dietary supplement and natural products market would certainly be as guilty of deception. Of course, we can't measure malice by looking at profit. The dietary supplement and natural product companies escape the public's suspicion because they play on the "natural products are good, chemicals and vaccines are bad" paradigm which is being espoused by television personalities and all sorts of self-proclaimed healers. Money, meet drain.

Do you believe the flu shot works? 50% yes, 50% no.

CBC readers were split almost 50/50 when asked the question "Do you believe the flu shot works?"

What Happens When HCPs Negatively Contribute to the Noise?

What makes me most upset is that a small proportion of healthcare professionals failed to educate themselves, let alone their patients. They feel ill after receiving the vaccine, therefore the vaccine made them ill. This is incorrect, as you can still feel ill after receiving the flu vaccine for a number of reasons. The flu vaccine works, but you might get sick with a flu-like illness or suffer minor side effects after the shot. You might have gotten the flu during the period between receiving the vaccine and having your immune system mount an effective response against the flu. Predictions on which influenza viruses would be prevalent may be off, and you might get infected by a strain that isn't covered by the vaccine. This all sounds wishy-washy, but the bottom line is flu vaccines significantly reduce morbidity and mortality.

The collective public knowledge of microbiology and immunology isn't sufficient for patients to make evidence-based decisions from scientific literature without guidance from qualified healthcare professionals. We're supposed to be helping our patients interpret the literature to make an informed and independent decision.

We're supposed to be helping our patients interpret the literature to make an informed and independent decision.

We're supposed to be leaders in health. Some of the healthcare professionals that are supposed to be educators and advocates for public health are flouting the vaccine. The public is watching, and what they see is some professionals pushing for increased immunization rates while others balk at the idea of personally receiving a vaccine. There is solid evidence that proves that the flu vaccine is both safe and effective.

(As an Aside: If you want to know more about the vaccine's effectiveness, I found this great article from 2009 on Science-Based Medicine by infectious disease specialist Dr. Mark Crislip on flu vaccine efficacy. TL;DR: Flu jabs are worth the trouble to reduce morbidity and mortality in the general population.)

The Push For (And Against) Mandatory Vaccination in British Columbia

You only have to go back a few months to see just how serious this problem is. In August of 2012, the provincial public health officer responded to poor vaccination rates amongst healthcare professionals by requiring workers in publicly funded facilities to either (1) get a flu shot or (2) get a mask.

By November, the British Columbian government decided to drop the mandatory flu-shot policy. The B.C. Nurses' Union campaigned against the policy, and their president went so far as to say that there is "conflicting evidence" about the shot's effectiveness.

“We welcome this decision by the Ministry of Health,” said BC Nurses’ Union president Debra McPherson. “We have always encouraged our members to get a flu shot because it is the best preventative measure available. However, we consider the decision on whether or not to get a shot a personal one.”

McPherson also said that there is conflicting evidence about the effectiveness of the shot.

And thus another healthcare leader contributed to the suspicion and misinformation surrounding vaccines. You don't have to look far to see how the public interpreted the actions of those healthcare professionals.

A bunch of comments on a CBC article which made me incredibly sad.

These comments were taken from an article entitled "B.C. backs off on flu-shot policy for nurses." There's so many false and blatantly incorect statements that I could write ten more articles using just this image. There are patients who are worried because nurses refuse to get the shot. There are people pushing the "unnatural" bit. There's an individual who read the package insert without any context and thinks the vaccine is toxic waste. There's someone saying that the CDC linked vaccines to autism – when the CDC states the exact opposite. No credible scientific study has found a link between vaccines and autism, or a link between thimerosal and autism. Receiving vaccines will not "cause auto-immune deficiencies."

Ontario, Present Day

Fast forward to the present time, and we're seeing roughly the same problem in Ontario. Ontario's chief medical officer of health is calling for workers to get their flu shots. There was recently a severe flu season amongst residents of long-term care homes in Ontario, which is troubling because most of those residents have already received the flu shot.

The funny thing about the flu shot is that it doesn't work very well in the populations that really need protection from influenza: elderly individuals and individuals with compromised immune systems don't benefit as much as a healthy young person would. Those vulnerable individuals are more protected as the rate of vaccination in the general population gets closer to 100%, as transmission of the virus down a chain of people becomes harder. This is known as herd immunity, a theory that basically says that as the number of people immune to the virus increases (due to vaccination), the risk of a susceptible individual (e.g. an elderly person) meeting an infectious individual goes down, limiting the spread of the virus.

Ontario's chief medical officer is simply urging healthcare professionals to get the shot, not mandating it. It'll be interesting to see if anything comes of this, or if it's already yesterday's news.


Major points from the Public Health Agency of Canada influenza immunization page:

  • Influenza results in about 20,000 hospitalizations a year and 2,000 to 8,000 of those patients will die of influenza or complications related to influenza
  • Get your influenza vaccine early, between October and December
  • Canada's National Advisory Committee on Immunization encourages all Canadians over six months of age to get a flu shot; PHAC encourages all healthcare providers to protect themselves and their patients by getting the flu shot
  • The flu shot, combined with regular hand washing, is the best way to protect yourself from the virus

Healthcare professionals, get your flu shots. It'll protect you and your patients. It is an important evidence-based public health policy. At the very least, if you are wary of the flu vaccine yourself, be careful not to make off-handed comments. Patients with concerns should be able to speak with their healthcare providers and receive evidence-based advice that is specific to themselves, considering their opinions and beliefs, and also the personal and public health benefits of vaccination.

Photo Credit: A special thanks to Greg Hinson for taking the featured photo entitled "H1N1 Vaccine," posting it on Flickr, and licensing it under a Creative Commons license.