Einstein/Montefiore Department of Medicine

Faculty Respond: Vaccination Resistance

Mistrust, Laziness Still Hinder Flu Vaccination

Image: Stephen G. Baum, MD

Last year saw the emergence of a new strain of influenza virus (novel Influenza A[H1N1]) with increased virulence and high contagion. The Wall Street Journal recently reported that this year, the government is tooling up to produce vaccine against this and other seasonal influenza viruses in greater amounts and available at an earlier date than was possible last year. 

Getting enough people and the right people to take annual flu shots has always been a hard sell.  Some of the reasons for this involve fear of needles, distrust of vaccines and general sloth about one's own health.

  • This year's vaccine is made exactly like the seasonal influenza vaccine and so there shouldn't be any side effects except for some sort of soreness at the injection site which in fact not everybody will experience.
  • The standard influenza vaccines, both seasonal and H1N1, are killed subunit vaccines. There is no live virus in them and it's biologically impossible for a human to contract influenza from that preparation. This is the vaccine that is recommended for most people and it cannot cause influenza or even an influenza-like syndrome.
  • There's also a live weakened or attenuated vaccine--the nasal vaccine--and that virus could conceivably give someone influenza-like symptoms. That is why this vaccine is recommended for healthy people between the ages of 2 and 49, and not for anyone who is immunocompromised.
  • People who get sick the day after they visit the doctor are either sick with something other than influenza, which they just coincidentally got, or they were incubating a case of influenza and got to the doctor's office a day or two late.

"Getting enough people to take flu shots has always been a hard sell."

This year, the target population for the vaccine has been expanded and pretty much includes everyone because young healthy adults were particularly at risk for serious infection as are pregnant women and children aged six months and older.

The good news is that H1N1 as well as another common strain of influenza A and a strain of influenza B are all included in one shot so that only one vaccination will be required for anyone who has already been vaccinated in the past. Combining all the probable influenza viruses in one shot should mean that more people will be vaccinated; however, reluctance to be vaccinated remains and a vital public information effort will still be required to maximize the number of people vaccinated. The biggest challenges for the government will be convincing the public that vaccination is necessary (the outbreak last year was not as widespread as was feared), safe and effective, and producing enough vaccines so that there is no shortfall.

Influenza is a highly preventable disease that can be devastating in terms of morbidity and mortality if it occurs. The most effective way to prevent it is to get as many people vaccinated against it as possible. Everyone who can be vaccinated (there are very few contraindications) should be. 

Stephen G. Baum, MD
Senior Associate Dean for Students 
Professor, Department of Medicine (Infectious Diseases
Professor, Department of Microbiology & Immunology


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