Flu Shots are widely available. You can receive them at the corner pharmacy, CVS, Rite Aid, the local supermarket as well. It has never been easier to receive one. Yet Americans are not taking advantage. Why?
Wired magazine has the story.
The CDC pinpointed one possible reason for the high death rate: The number of people who got flu shots was unusually low. Only 37 percent of adults got the vaccine, the lowest rate in eight years, and only 58 percent of children, a 1 percent dip from the previous year. Flu vaccine uptake is never huge; except among the elderly, adult vaccination rates rarely top 50 percent. But the sharp decreases last season may have been enough to force the mortality rate up.v
A RAND study of people who didn’t get a flu shot, conducted in 2010 after one of the worst flu seasons on record, found that 28 percent didn’t think they needed it, 16 percent weren’t motivated to seek it out, and 14 percent said they “don’t believe” in it.
Flu changes all the the time, mutating just enough from season to season that it requires a new vaccine formula, and a fresh shot, every year.
An optimistic view is that flu vaccine is only a failure compared to other vaccines. “The expectation that if you get a vaccine, you don’t get the disease — that shows how well other vaccines are working,” says Joseph Kurland, an infection preventionist at the Children’s Hospitals and Clinics of Minnesota, who works on increasing vaccine acceptance.
But the flu vaccine’s shortfalls are a result of a complicated mix of factors: Flu vaccine formulation is a game of probabilities, reliant on educated guesses made six to 12 months in advance of the season about which direction the virus will drift. Flu vaccine manufacturing is built on the productivity of millions of chickens laying the eggs it is grown in, and the uncertainty of how well any season’s virus will grow in them.
Any time any of those go badly—the virus doesn’t grow and vaccine supplies are short, or the prediction went awry and protection is low—the vaccine takes a reputational hit. Selling the public on an imperfect product, one that reduces risk but may not eliminate it, is a difficult task.
People think about flu vaccines differently: less like a medical and legal necessity, and more like a seasonal product, the health care equivalent of a pumpkin spice latte.
One solution might be flipping the public message from the shot’s perceived failures to its documented successes. Multiple studies show that people who get the flu vaccine are less likely to become seriously ill; with the flu shot onboard, the risk of being hospitalized goes down by 37 percent. People who have been vaccinated but are hospitalized with flu are 82 percent less likely to be admitted to intensive care. If they’ve been vaccinated and still are ill enough to need an ICU, their stay is likely to be several days shorter. The effects are especially strong for pregnant women, who are 40 percent less likely to be hospitalized for flu symptoms, and for children, who are two-thirds less likely to die from flu when they’re vaccinated.
These statistics are powerful, but they make up a more complicated message than a simple guarantee of protection. And they illustrate a difficulty inherent in almost all crisis communication: it’s easier to scare people with an account of a terrifying disease than it is to entice them with a calm portrayal of nothing gone wrong. That more nuanced storytelling is something public health might be moving toward.
“We try to avoid getting into percentages and effectiveness, and really try to tap into the emotional feeling of what people want for themselves, or their family members or loved ones,”says Nicole Alexander-Scott, a physician who is director of the Rhode Island Department of Health and president of the Association of State and Territorial Health Officers. “We bring it back to personal stories about patients, so it’s real and not abstract.”
The anti-vaccination movement long ago seized on the power of narrative, publishing emotionally laden accounts of children who regressed after receiving vaccines.
To hear a public health official consider the power of storytelling is a big step. As a field it is suspicious of anecdotes, mistrustful of their data-free power to persuade. It’s not unusual, as a journalist, to hear public health scientists of a certain age dismiss a news story of a patient’s experience as an “n of 1”—meaning a numerator of 1 over a denominator of some presumed large number, or, translated from jargon, as an anecdote that isn’t statistically representative. But journalism long ago got that dramatic anecdotes have the power to make people pay attention—stories last season pointed out that flu can cause amputations and sepsis and multi-organ failure. The anti-vaccination movement long ago seized on that power, publishing emotionally laden accounts of children who regressed developmentally after receiving vaccines.
It would be satisfyingly symmetrical to see public health claim that power back. Deploying storytelling against the underestimated danger of flu might feel untrustworthy to scientists, less precise than the numbers and percentages that confer believability. But after last flu season, it seems clear that statistics aren’t a motivator for most people. It’s possible that stories are.