ASK DR. BAUGHAN October 15, 1999
PROTECTING THE HERD
Epidemiologists need image consultants. If we are ever really going to make the effect we want on the hospitalizations and deaths from influenza, we need some good sound-bite meisters. When the nerdy epidemiologists get together to talk about what it would take to thoroughly eliminate or drastically reduce a disease through vaccines, they talk about things like “the critical mass needed to achieve herd immunity.” Yawn. Sounds about as exciting as two hours of the Weather Channel. Sort of a mish-mash of physics and animal husbandry. No one wants to be part of a “herd.” Maybe a gang, a team, a club, or even a congregation, but not a herd. Images of sheep and cattle just don’t motivate people to go get a shot in the arm.
So far the annual flu shot campaign relies on that reliable human motivator - self-interest. For those over 65, and those under 65 with chronic diseases like emphysema, asthma, heart disease, kidney disease, diabetes, etc., the message gets out: “Get a flu vaccine and you might not get real sick or die.” And it works pretty well. However, being the country of cussedly individualistic people we are, there are still many who don’t buy it. They believe their intuition and experience more than reams of scientific evidence. They operate on principles like, “I’ve never had the flu. Why should I get it now?” Maybe they are different and have not gotten a year older since last year. Or maybe they live in On Beyond Wonalancet and never interact with creatures that walk on two legs. The other bookend to this principle is, “I got the flu shot once (or my Aunt Nellie did), and got real sick (for a week, all winter, etc.).” This is the opposite of that Great American Answer to All Public Funding - The Lottery. If you win something the first time you buy a ticket, you’re a lucky person and you will win the jackpot sooner or later. If the jackpot is big enough, the thrill of imagining winning is worth tossing away a couple of bucks. “Somebody’s got to win. It could be me just as well as anybody else.” But with the flu shot, if you connect a bad event with it, you don’t want to do it again. We are not so different from the lab rats and Pavlov’s dogs. Try this on: “I bought a lottery ticket, and I got the flu, so I will never buy another lottery ticket.” There is just as much evidence that you will catch the flu from the flu shot as you will from buying a lottery ticket.
You can’t catch the flu from the flu shot. You can’t catch the flu from the flu shot. You might get a sore arm, be achey for a couple of days, or even get a low-grade fever for a day or two. That’s peanuts compared to true Influenza. You have just as much chance of catching some virus in the week after a flu shot as you have from a shot of sterile salt water, but not the influenza virus. But some people won’t believe it. Therefore, the “herd” will have some vulnerable critters. That’s why it is important for the people who tend the herd, such as health care workers in offices, hospitals and especially nursing homes, to get the flu vaccine. Maybe they will be less likely to miss work from the flu. There is even some decent evidence that they may not get other viral infections during the winter. But the most important reason for health care workers to get the flu shot is this: If they contract the influenza virus, even before they get sick, they could transmit the virus to the people they are providing care for, the very people most likely to die or end up in the hospital from influenza. That’s the reason I get it. That’s the reason my nurse gets it.
I cannot think of other ways to motivate those who “protect the herd.” Being a shepherd is not glamorous or sexy. Maybe we need to rehabilitate the cowboy image on the cattle drive. After all, it was good for selling cigarettes. Imagine the Marlboro Man riding up to the camera with his rugged good looks and the wind in his hair when he takes off his cowboy hat and saying, “I got my flu shot. How ‘bout you?”