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Why some people will say no to the H1N1 vaccine

Although reports from the state health department indicate that the most recent wave of H1N1-related illnesses may be cresting, no one knows when enough vaccine will be produced for everyone.

Although reports from the state health department indicate that the most recent wave of H1N1-related illnesses may be cresting, no one knows for certain when the H1N1 vaccine will be produced in sufficient quantities to be available to most people. But when it finally does arrive, a recent McClatchy-Ipsos poll suggests, many Americans won’t take advantage of the vaccine.

The poll found that 47 percent of Americans reported they weren’t “at all likely” or weren’t “very likely” to get vaccinated.
 
Doug Schultz, a spokesperson for the Minnesota Department of Health, says that number’s a little higher than some of the poll numbers he’s seen, which suggest that 30 to 40 percent of people will say “no thank you” to the H1 N1 vaccine. But he noted that these kinds of polls are often hard to interpret for a variety of reasons, and that it’s difficult to predict public demand for a vaccine.

“It really depends on a lot of things: how they perceive the supply, if they perceive that there’s going to be a lot of disease or not, and how they perceive their risk,” Schultz explained.

It’s easy to understand that one’s willingness to be vaccinated would be proportionate to the perceived threat, but it’s been difficult for many to gauge how threatening this pandemic virus really is. Certainly the possibility of getting infected with H1N1 is very high, with the number of cases nationally and globally already being far in excess of any typical flu season.
 
But is the H1N1 virus more virulent, more deadly than the standard seasonal virus? According to the U.S. Centers for Disease Control and Prevention, seasonal influenza kills about 36,000 Americans every year. Despite widespread flu activity, as of now, there have been 3,900 H1N1-related deaths in the United States.
 
Comparing those two numbers (and conceding that the flu season is hardly over), why is it that H1N1 feels so much more virulent? Yes, the sheer volume of H1N1 infections has been taxing and in some cases overwhelming to our health care system. But it may not be the number of people who are dying, but rather who those people are that’s the most disturbing.
 
With seasonal influenza, over 90 percent of deaths and about 60 percent of hospitalizations occur in people older than 65. But that’s not been the case at all with H1N1. Because many older folks have immunity against the novel virus from exposure to similar flu viruses in their youth, the elderly have been relatively spared, and the most serious H1N1 infections have primarily involved pregnant women, healthy young people from birth through age 24, adults 25 to 64 with underlying medical conditions, and children under 5 years of age, particularly if they have a high risk medical condition.
 
No life is more valuable than another, but an octogenarian passing away in the nursing home won’t make the evening news, and the death of a pregnant woman certainly will. The death of a healthy 17-year-old just feels more tragic, and it understandably generates the kind of worry that would make for vaccination lines of unprecedented length. The results of the McClatchy-Ipsos poll—nearly half the country saying they don’t plan on getting vaccinated—seem to argue against that, but conversely, the H1N1 threat led to an early season run on this year’s seasonal influenza vaccination. “That’s because people perceived there might be a scarcity,” Schultz explained, “so it’s like ‘Get it now before it’s all gone.'”
 
Whatever one’s personal perception of the H1N1 threat is, there seems to be several factors at work for those who won’t be getting in line for the H1N1 vaccine.
 
‘Because H1 N1 is a new virus, no one really knows how the vaccine will act’

Yes, it’s true that H1 N1 is a new strain of the influenza virus, but every year the standard flu vaccine is updated to contain the most active strains from the previous year’s flu season, plus any newly identified strains. So yes, H1N1 is a novel strain of virus, but beyond that, everything is just standard procedure: the vaccine is produced in the same (antiquated and slow) manner, with the same protocols and safety measures.
 
There’s also some public sense that for the sake of immediacy, the H1N1 vaccine has been slapped together and hurried through. That certainly isn’t the case, but if the vaccine were indeed being fast-tracked, then why in the world is it taking so long?
 
Understand that early trials and ongoing analysis of the vaccine show it to be safe and effective.
 
‘What about the problem with the swine flu vaccine in the mid-1970s? Couldn’t that happen again?’

In 1976, a swine flu variant capable of infecting humans was identified, and a vaccine developed against the virus carried a 1 in 100,000 risk of getting a rare but potentially serious neurological disorder called Guillain-Barré syndrome (GBS). That risk was slightly higher than what is seen in the general population, where the most common trigger for GBS is an infection from food contaminated with a bacteria called Campylobacter jejuni. Infectious mononucleosis (“mono”) can rarely be a trigger as well.
 
Though the link between 1976 swine flu vaccine and Guillain-Barre Syndrome is real, as often happens with history, the risk of one leading to the other has become mythic and exaggerated. According to the CDC, numerous studies with yearly flu vaccines given since 1976 have shown no association with GBS, with the exception of two studies which suggested that approximately 1 additional person out of 1 million vaccinated against seasonal influenza people may be at risk for GBS.

Driving being the risk it is, you’re probably putting yourself more in more danger by popping out to the local store for a gallon of milk than by getting the flu vaccine. In any case, the CDC and the FDA are well aware of this perceived threat, and intensive monitoring of those who have received the H1N1 vaccine has shown no such risk.

But what about mercury? Doesn’t the flu vaccine contain mercury?

The subject in question is thimerosal, a mercury-containing preservative that’s added to multi-dose vials to prevent contamination with bacteria and fungi. A limited number of thimerosal-free single-dose vials have been available to pregnant women, but not to the rest of us.

One shot of a standard, injectable flu vaccine contains about 25 mcg of mercury. Desperately trying to put that number into perspective, I set out to quantify it in terms of our state’s most recognizable currency: the walleye. Even here in the land of sky blue waters, all fish contain mercury — some more, some less, depending on the age and size of the fish and where it is perched on the fishy food chain.

The Minnesota Department of Health recommends we eat walleye just once a week to limit our mercury exposure. And when I read on an immunization website that most commercial fish contain an average of 23 micrograms of mercury per 8 ounces of fish, I thought I had my sensationalist headline: “Walleye can’t save your life, but H1N1 vaccine can!”

Not so fast, says Pat McCann, a researcher of the health effects of environmental mercury for the Minnesota Department of Health.

“The mercury that’s in fish is methyl mercury, and the mercury that’s in thimerasol is ethyl mercury,” McCann explained. “So we really try to stay away from making the comparison between getting the flu shot and eating a meal of fish, because it’s not really a direct comparison as far as the dose you get. Mercury isn’t just mercury. It has different forms and the form makes a difference as far as toxicity.”

OK, so my walleye-to-vaccine mercury comparison “spit the hook,” as they say. That’s just as well, because the CDC would argue that the comparison is not only imbalanced but also moot. The CDC website states: “The most recent and rigorous scientific research does not support the hypothesis that thimerosal-containing vaccines are harmful.” Nevertheless, with thimerosal taking on arsenic qualities in the public eye, the FDA and the CDC took the unusual step of ignoring the science and pulling the preservative (except in trace amounts in some cases) out of all vaccines for children under the age of 6. The CDC describes this move as a “precautionary step,” which is a pragmatic way of saying that a vaccine can’t prevent anything when it’s lying on the shelf. Hurdles, real or imagined, must be removed.

‘I already had H1N1: Why would I need to get vaccinated?’

Perhaps the best reason to not get vaccinated against the H1N1 virus is as simple as, “No thank you, I had the real thing.” Indeed, an actual infection with a particular contagion is a more potent stimulator of our immune system than a vaccine is. So if you’ve already been infected with H1N1, why bother with the shot in the arm? 
 
According to Schultz, the MDH is following CDC guidance on this issue. “Unless you’ve had a culture-confirmed case of H1N1 — which basically would mean anybody hospitalized with H1N1 — you don’t really know for sure whether you’ve had H1N1,” Schultz noted. “And so it would make sense to get the vaccine, because the vaccine is safe, and then you would know that you’re protected.”
 
“Obviously, we recognize that some people will naturally assume that they have had H1N1. If their symptoms were very characteristically influenza, and if they had it during the peak, there’s a good chance they had H1N1,” Schultz reasoned.

But without confirmatory testing, one can’t be absolutely sure. “Our advice is to be safe,” Schultz said, “and the best bet is to get the vaccine.”
 
When it arrives. Whenever that is.