Why do so few Canadians get a flu shot?


VaccinationThat’s the headline for a recent Toronto Star story. It suggests that as few as one third of Canadians get a flu vaccine, and in some place the number may be as low as 20 percent.

This despite Ontario having the world’s first universal free flu shot program, introduced in 2000. The 2013-14 vaccine is on its way to doctors’ offices now. It’s also available at pharmacists’ offices. It’s free, easily accessible, it prevents and helps stop the spread of many kinds of influenza, it can save the life of anyone at risk – so why don’t people get one?

Superstition and pseudoscience. Gullible people turn to untrained, celebrity wingnuts in the anti-vaccine movement – like Jenny McCarthy – for medical advice rather than to doctors, health care professionals and pharmacists. They turn to dangerous cranks and pseudo-science wingnuts like homeopaths, “faith healers,” astrologers and psychics instead of doctors.*

Many of these people deliberately and purposefully distort or misrepresent the facts about vaccines, disease, scientific research and health. Others are simply ignorant of the facts and accept what others say, without bothering to verify it through independent sources or published research.**

I know, you’re probably thinking like I was when I read this story, “are people this crazy?” And the answer, it seems, is yes.

McCarthy’s anti-vaccine preaching was called “belligerent ignorance” by the Toronto Star earlier this year, noting,

From McCarthy’s point of view, it’s a major victory in her battle to get her message out: vaccines are bad and autism can be cured, if you just ignore the scientists and sawbones who insist on pesky factual data.
It’s David vs. Goliath, Warrior Mom vs. Stuffed Shirt Medical Establishment, New Age Rebel vs. The Man.
Ah, but there’s another side: those who value facts over opinions and view McCarthy as a fear mongering dimwit whose sanctimonious crusade, however well-intentioned, threatens to turn the clock back on medical science.
Given that measles and whooping cough have already staged a comeback as parents panic and vaccination rates drop, it’s also potentially dangerous.
To be clear, there is no medical evidence to support her assertion — based on a discredited study — that vaccines cause autism, no evidence that the alternative treatments she promotes will have any positive effect on this ballooning developmental disorder and no evidence that her own son was, as she insists, “cured” of autism (the diagnosis has been disputed by experts).

The LA Times concluded the same about McCarthy:

She also peddles the discredited, poisonous claims that the way we vaccinate our children against the diseases that were once regular killers of children places our young ones at greater risk of developing autism — the kind of conspiracy theorizing that will draw only more eyeballs.

And the New Yorker wrote of McCarthy:

McCarthy has spent much of the past ten years campaigning against vaccines—which, it must be said, are the most effective instruments of public health in human history, aside from clean water. That does not mean that vaccines carry no risk: nothing is entirely without risk, and there is a small but measurable possibility that any vaccine can cause a serious adverse reaction. Still, the benefits for society so powerfully outweigh the risks that suggesting otherwise is irresponsible at best. It spreads fear and incites the type of ignorance that makes people sick. That is exactly what McCarthy has been doing. By preaching her message of scientific illiteracy from one end of this country to the other, she has helped make it possible for people to turn away from rational thought. And that is deadly.

And The Nation wrote,

Oprah Winfrey’s decision to let McCarthy act as an expert, to dismiss science with alchemy, without asking any tough questions, was unconscionable. The same could be said of the producers of Larry King Live and Good Morning America, both of which hosted McCarthy soon after. Even though they at least asked questions about her views, Larry King had her debate a doctor, as though her disproven ideas should be given the same equivalence as those of a medical expert.

In fact, McCarthy’s beliefs—that vaccines and mercury cause autism, that a good diet cures autism and that “diagnosticians and pediatricians have made a career out of telling parents autism is a hopeless condition”—have been roundly dismissed and discredited by doctors and scientists, who insist that her claims are based on no scientific data or research. McCarthy wasn’t deterred. “The University of Google,” she said to Oprah, “is where I got my degree from.”

Let’s be clear: there is no connection between vaccines and autism.

McCarthyitesThanks to McCarthy and her band of ignorati, the body count of people who died from preventable diseases has risen. Perhaps she and he cohorts should be held morally and legally responsible for those preventable deaths.

In June of this year, Science Daily reported on the number of American lives saved from flu shots since 2005:

Approximately 13 million illnesses and over 110,00 hospitalizations may have been averted by the flu vaccine over the last 6 years in the U.S, according to calculations published June 19 in the open access journal PLOS ONE by Deliana Kostova and colleagues from the U.S Centers for Disease Control and Prevention.

The researchers calculated the healthcare burden of flu cases that would have occurred in the absence of vaccination based on factors such as illness and hospitalization rates during the flu season, vaccination coverage and vaccine effectiveness. Based on these data, Kostova and colleagues estimate that flu vaccines averted several million instances of illness and over 110,000 flu-related hospitalizations in the flu seasons of 2006 to 2011. The largest number of averted cases occurred during the most recent period studied, 2010-2011, when 5 million flu cases, 2.1 million medical visits and 40,400 hospitalizations were prevented by vaccination.

And another story on Science Daily reported that, “Flu Shot Effective Regardless of Circulating Flu Strain”

New research out of St. Michael’s Hospital has found that despite popular belief, the flu shot is effective in preventing the flu, even if the virus going around does not match the vaccine.
“It’s quite common for people to say they are not going to get the flu shot this year because they’ve heard it does not match the strain of flu going around,” said Dr. Andrea Tricco, the lead author of the paper and a scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital. “However, we’ve found that individuals will be protected regardless of whether the flu strain is a match or not.”
The review of the literature analyzed more than 40 years of data, from 1971 to 2011, and included 47 influenza seasons and almost 95,000 healthy people.
Dr. Tricco and colleagues were particularly interested in flu seasons when the flu vaccines were not matched well to circulating strains. They wanted to understand whether the flu vaccines would still be effective when the strains were not a match.
Vaccines work by giving the body an inactive, or non-infective, form of the flu virus so that the body can produce antibodies. When an individual comes into contact with the virus in the future, the body can use the natural antibodies it has created to fight it off.

An earlier story on Science Daily also dispelled five common myths about the flu vaccine:

Myth No. 1: Flu vaccines can give me the flu
False. Injectable flu vaccines are composed of pieces of inactivated flu proteins — and it’s impossible for them to “cause” flu. The nasal spray vaccine has live flu organisms weakened so they cannot multiply or cause disease.
Myth No. 2: Flu shots never work anyway, so why bother?
Also false. When there is a good match between the viruses causing disease and those in the vaccine, protection is excellent in otherwise healthy people. Protection is lower if you are unhealthy or in the frail elderly group. But vaccines are like seat belts: They are not perfect but they are the best protection we have against serious injury and death.
Myth No. 3: Flu vaccines are dangerous, especially for pregnant women
Also false. Concerns about pregnant women getting vaccinated began when women were advised not to get any kind of vaccination during pregnancy, Dr. Poland says. Today’s flu vaccines are safe for expectant mothers and highly recommended. A recent large study demonstrated significant increases in maternal death among unvaccinated women infected with influenza. However, because they have not been studied in pregnant women, pregnant women should stay away from nasal flu vaccines, which do contain live, weakened flu virus, Dr. Poland says.
Myth No. 4: It’s too late to get vaccinated
Again, false. While it’s always better to get vaccinated before flu season begins — it can take about two weeks for the vaccination to take full effect — it’s never too late to get a flu vaccine, Dr. Poland says. Even if you didn’t get vaccinated and caught the flu, get a flu vaccine to protect yourself against the other strains that are circulating, Dr. Poland says.
Myth No. 5: It’s just the flu. What’s the big deal?
Once again, false. While it might be “just” the flu, Dr. Poland says we should still be concerned, regardless of our age or physical condition. In an average year, up to 40,000 Americans die from influenza and its complications, and over 250,000 are hospitalized. Millions are sick, miss school, work, and important events and spend money on over-the-counter “cold remedies.” Complications and death are particularly frequent in infants and young children, those with chronic medical conditions, the elderly, pregnant women and people who are obese. Health care providers also should get immunized to prevent spreading flu to vulnerable patients, Dr. Poland says.

Dr. Poland makes the point that flu is a serious illness, not like a cold:

“No one should confuse influenza with a “minor illness.” Serious complications and death result every year due to flu. Vaccines, while imperfect, offer the best protection available for you and your family, as well as others you come in contact with,” says Dr. Poland, the Mary Lowell Leary Professor of Medicine and director of the Vaccine Research Group at Mayo Clinic.

A recent story in Scientific American linked the rising number of whooping cough cases in California to the anti-science anti-vaccine movement:

A California whooping cough epidemic in 2010 was one of the worst U.S. outbreaks of the disease in the past several decades. Ten infant deaths occurred among the more than 9,000 cases—the most in that state since 1947. Now, a study reveals that parental refusals to vaccinate their children may have played a part in that epidemic and possibly in a concurrent nationwide resurgence of the disease. The research found significant overlaps of areas with high numbers of whooping cough cases and areas where more parents had sought legal exemptions to opt out vaccinating their children…

Public health efforts to prevent epidemics of infectious diseases typically rely on herd immunity: The more people in a community are vaccinated or otherwise protected from a disease, the less likely it is to be transmitted throughout the population. This approach is particularly crucial with pertussis, which is almost as contagious as measles and requires about 95 percent vaccination coverage to maintain herd immunity. Increasing numbers of parents opting out of vaccinating their children can erode this immunity. “When you look at statewide or countywide data, the increases in nonmedical exemptions don’t look that significant,” Atwell says, “but when you look at community-wide coverage, it is much lower than the threshold needed to maintain herd immunity in some areas.”

Unvaccinated individuals in the 2010 epidemic were eight times more likely to contract pertussis than vaccinated ones. But unvaccinated individuals pose risks to the community as well. “It’s a choice you make for yourself and a choice you make for those around you,” Offit says. “Infants need those around them to be protected in order not to get sick. We have a moral and ethical responsibility to our neighbors as well as to ourselves and our children.”

The article concludes:

Parents who turn down vaccinations for their children are often misinformed about the safety and effectiveness of vaccines. “I don’t think people understand that our control of vaccine-preventable diseases such as pertussis and measles is fragile,” Atwell says. “We need to continue to educate people about the implications of not vaccinating their children.”

Science Daily had a story titled, “Conspiracy Theories May Put Children’s Health at Risk” which said:

A belief in conspiracy theories may influence parents’ intentions to have their children vaccinated against diseases such as measles. That is the conclusion of research being presented today, 28 August 2013, by Daniel Jolley and Karen Douglas at the Annual Conference of the British Psychological Society’s Social Psychology Section in Exeter…
Dr Douglas added: “Our findings point to the potentially detrimental consequences of anti-vaccine conspiracy theories. It is easy to treat belief in conspiracy theories lightly, but our studies show that wariness about conspiracy theories may be warranted.”

In an opinion piece in the LA Times, Nina Shapiro asked, “With fewer vaccinations, is your child’s school safe?” She argued for making public schools zones where unvaccinated children were not allowed:

But the great bulk of children face a far greater risk of harm from disease. If the goal is really to protect children, I’d like to see all schools declared “unvaccinated-free zones.”

The law in California mandates that students in public and private schools be immunized, but it also allows easy-to-get exemptions for personal beliefs.

Although some 90% of the state’s kindergartners are up to date on their immunizations, it is not uncommon for individual public elementary schools to report that more than one-third of their kindergartners are not.

On the Science Based Medicine blog, David Gorski writes:

If there’s one thing I’ve learned over the years opposing the antivaccine movement, it’s that these days its “Holy Grail” (well, a “holy grail”) is to have a “vaccinated versus unvaccinated” study performed, or, as it’s frequently abbreviated, a “vaxed verus unvaxed” study. The reason they want such a study so badly is not because they think there’s a scientific question that genuinely cries out for an answer. Rather, they believe it will confirm their fixed, unalterable belief that vaccines are the root of nearly all chronic health conditions children suffer today, particularly autism and autism spectrum disorders. In particular, they believe that a “vaxed versus unvaxed” study would demonstrate once and for all that vaccines are the cause of the “autism epidemic.” Hilariously, a few years back, the antivaccine group Generation Rescue tried to do such a study. It was more an utterly incompetently administered and analyzed telephone survey than anything else, and, ironically, its results actually were just as consistent with the conclusions that vaccines protect against autism as that they predispose to autism. And don’t even get me started on an even more hilariously incompetent vaxed versus unvaxed study by a German antivaccine homeopath (I know; “antivaccine homeopath” is redundant) that antivaccinationists were touting a while back. That took attempts to ape science to depressingly ridiculous extremes.

Meanwhile, other than incompetently performed studies by antivaccinationists (this one, for instance) many large, well-performed epidemiological studies have failed to find even the suggestion of a link between vaccines and autism or between mercury in the thimerosal preservative that used to be in childhood vaccines and autism, such that the Institute of Medicine reaffirmed this finding just this year. Yet, antivaccinationists remain undeterred. True, they seem to have accepted that their original Holy Grail, namely a prospective randomized, placebo-controlled trial in which one group is vaccinated and another is not, is considered highly unethical because it would intentionally leave one group of children unprotected against vaccine-preventable diseases. (I say “considered” because antivaccinationists are so convinced of the harm done by vaccines that they do not accept that a randomized controlled trial of vaccinated versus unvaccinated children would be unethical in the extreme.) Unfortunately, however, that doesn’t stop them from demanding other forms of vaxed versus unvaxed studies, even though such a study would be difficult, bias-prone, and unlikely to provide a definitive result, as I explained in detail before.

Well, they’re at it again. Antivaccinationists are trying to legislate where they have utterly failed to convince using science. It’s a standard tactic of cranks, but unfortunately there are nearly always credulous legislators who will be duped into going along or who are cranks themselves and therefore go along. Remember Dan Burton? He was antivaccine to the core and used his position as a Representative from Indiana to cause a lot of mischief with hearings on vaccines. Fortunately he’s retired now, but there are still Representatives who are either antivaccine themselves or easily duped into carrying antivaccinationist’s water.

I could go on, citing report, story and research, but here’s the gist: Vaccines are safe and effective. They save lives. They don’t cause autism.

A blogger on the Huffington Post wrote about the moral dilemma when freedom of speech intersects with dangerous and potentially lethal ideas:

Time’s survey points to another challenge. More and more patients are turning to various forms of media, and other patients, for medical information instead of exclusively relying upon doctors. Dr. Dan O’Connor in an article for The Journal of Law, Medicine & Ethics addresses the issue of apomediation within the field of human subjects research: “Now, almost any¬one with a broadband internet connection or a smart phone can share ideas, data, and opinions with just about anyone else on the planet..” He’s right, and this applies to the medical field in general.

This brings up an interesting point. Are networks morally responsible for the views expressed on their programs? To a certain extent they must be — they are the ones (along with the FCC) who are approving the content. Networks have an obligation to their viewers to express diverse and often conflicting viewpoints, and their right to do so is protected by the Bill of Rights. The question is where do we draw the line? Perhaps it needs to be drawn between fact and opinion. McCarthy is entitled to espouse whatever opinion she likes, but she isn’t allowed to peddle fiction as fact to the American people.

Should we hold Jenny McCarthy and her anti-vaccine wingnuts responsible when a child dies of a preventable illness? Or are the parents ultimately to blame and the anti-science crowd gets away under the guise of ‘freedom of speech’? If parents turn to cranks like homeopaths or “faith” healers instead of real medicine, and the child dies, should we hold the pseudo-medicine practitioners to blame?

Can we refuse entry to schools for children without vaccines? Don’t we have a moral responsibility as a society, as a community, to protect children from dangerous, even lethal practices?

The Center For Skeptical Inquiry wrote (in 2007)

The forces of irrationality are arrayed on this issue. There are conspiracy theorists, well-meaning but misguided citizen groups who are becoming increasingly desperate and hostile, irresponsible journalists, and ethically compromised or incompetent scientists. The science itself is complex, making it difficult for the average person to sift through all the misdirection and misinformation. Standing against all this is simple respect for scientific integrity and the dedication to follow the evidence wherever it leads.

The Globe and Mail made it clear in a story last month: “Preventing influenza with a flu shot is a shared responsibility for all Canadians.”

“The flu vaccine is the most effective way to protect yourself and the people around you from the influenza virus,” says Victor Wong, a Toronto-based pharmacist and pharmacy owner at national drugstore retailer Shoppers Drug Mart. “The flu vaccine has been shown to reduce the chances of getting the flu by about 70 to 90 per cent in healthy adults.”

The Public Health Agency of Canada (PHAC) recommends all Canadians over the age of six months to get immunized against influenza, a respiratory illness that strikes between 10 per cent to 20 per cent of the population each year. About 20,000 Canadians are hospitalized and between 2,000 to 8,000 die every year because of the flu.

The Chatham Daily News asked, “Is advice to guard against the flu falling on deaf ears?”

In Chatham-Kent, 35.5% of the local population rolled up their sleeves for a flu shot, according to the latest information on Statistics Canada website, which shows an Ontario influenza immunization average of 31.2%.

It’s not just here, in reasonably well-educated North American culture. Children are dying in Pakistan from measles because fundamentalist Muslims and the Taliban are suspicious of vaccines. The Telegraph wrote about it in an article titled “Why vaccination matters, and why hippies and conspiracy theorists who say otherwise are dangerous.”***

… Al Jazeera reports that hundreds of children have died in Pakistan as a result of a measles outbreak. According to the World Health Organisation, the disease killed 306 children last year, up from just 64 in 2011. The WHO hasn’t given a reason, but a “provincial health official in Sindh said that the disease hit areas where poor families did not vaccinate their children.”
“Many Pakistanis, especially in rural areas, view vaccination campaigns with suspicion as a western plot to sterilise Muslims,” the story continues.

The bottom line: vaccines are safe, prevent disease and death, and help our general health. They protect children and save lives. Vaccine deniers are superstitious cranks who have no scientific or medical authority. Homeopaths, naturopaths and psychics can’t and won’t protect you from these diseases. Vaccines will and do.

Do the right thing for yourself, your family, your neighbours, your co-workers and your community this season: get the flu vaccine.

~~~~~

* From Arstechnica:

In the end, this overview provides a clear demonstration of tactics used by many practitioners of pseudoscience: make a large number of vaguely scientific arguments in the hope of making the desired conclusion seem inevitable. It is essential to recognize that a disconnected assemblage of weak arguments does not create a single, strong scientific argument.

From the Montreal Gazette:

Obviously it’s easy to make fun of homeopathy. The concept is absurd. But millions of people around the world do rely on homeopathic medications. Can they all be wrong? The simple answer is: Yes.

Popular ideas are not necessarily right. After all, bloodletting went on for thousands of years, and at one time the notion that Earth was the centre of the universe was quite popular. And today, many believe that the Earth was created less than 6,000 years ago. Science, though, is not a popularity contest. It relies on facts, not on opinion. And the fact is that homeopathic medications contain no active ingredients. And more important, while hundreds of studies on homeopathy have been published, there are no repeated trials that have provided proof of efficacy.

 ** They are not only against flu, measles, whooping cough and similar vaccines. they’re against the HPV vaccine, although their pseudo-science has been debunked several times.

*** Conspiracy theories themselves are infectious, and there seems no inoculation against them. A story in Mother Jones this month, titled, “If You Distrust Vaccines, You’re More Likely to Think NASA Faked the Moon Landings,” reported studies that showed how people with a belief in one conspiracy theory were likely to adopt others, no matter how wacky or dangerous (emphasis added):

The new study, by University of Bristol psychologist Stephan Lewandowsky and his colleagues in the journal PLOS ONE, finds links between conspiratorial thinking and all three of these science-skeptic stances. Notably, the relationship was by far the strongest on the vaccine issue. For geeks: the correlation was .52, an impressive relationship for social science. Another way of translating the finding? “People who tend toward conspiratorial thinking are three times more likely to reject vaccinations,” says Lewandowsky. (By contrast, for climate change denial and GMO resistance, the correlation with conspiratorial beliefs was real but much smaller, .09 and .13, respectively.)

The finding may cast a great deal of light on the strange persistence of anti-vaccine views, which have centered on the claim that childhood vaccines are behind an alleged “epidemic” of autism. This assertion has been rejected by scientists. The Centers for Disease Control and Prevention and the Institute of Medicine have both weighed in strongly on the matter; and one chief proponent of the vaccine concerns, Andrew Wakefield, has even seen his original 1998 paper raising concerns about the MMR (measles, mumps, rubella) vaccine retracted by the journal that published it, The Lancet.

Yet vaccine fears have persisted in the face of all scientific refutation (not to mention medical and public health experts saying that the failure to vaccinate is downright dangerous). And if these beliefs are often conspiratorial, that might help explain why. Almost by definition, conspiracy theories are irrefutable; rejections by scientific authorities just become part of the conspiracy. Indeed, several prior analyses of anti-vaccine views, undertaken by analyzing their expression on the web or on YouTube in particular, have found them to be highly conspiratorial in nature.

The full paper is here. It concludes:

Conspiracist ideation, by contrast, is associated with the rejection of all scientific propositions tested. We highlight the manifold cognitive reasons why conspiracist ideation would stand in opposition to the scientific method. The involvement of conspiracist ideation in the rejection of science has implications for science communicators.