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It's Time To Face My Flu Shot Fears

I haven't had the flu or a flu shot for almost a decade, but that's a weak argument against vaccination.

by Michael Byrne
Oct 30 2016, 12:00pm

Image: AZP Worldwide/Shutterstock

This will sound like I'm jinxing myself, but I've made the following boast enough times that the damage has already been done. So, here goes: I haven't been sick since 2008. Two or three low-level colds and the occasional allergy-related sinus snrkk, but nothing really consequential—certainly no flu. No aches, no chills, no neon secretions. My body, from respiratory epithelial cells to lymph nodes, is a peaceful regime.

I haven't had a flu shot in that entire time. In fact, the last time I had a flu shot was in 2008, where it was administered in the conference room of the alt-weekly newspaper I was working at. And that winter, I didn't just get sick, I was mostly sick. The first flu hit around Thanksgiving. After a week or so in bed, I was back at work, only to immediately be hit with strep throat, an excruciating bacterial infection that makes swallowing hell. This was another few days in bed, followed by another week of lingering shittness. Then, in late-January, the whole entire episode happened again.

It was a total copy. A week of flu, a couple of days of kinda-sorta recovery, and then the sudden just-swallowed-some-glass sensation of strep. This time I didn't fuck around. The doctor looked at my throat and recoiled in actual fear. "I can't even look at the stuff without catching it," he mumbled, scrawling a script for a big ol' antibiotic.

But then that was it. Flu seasons came and went, while I remained unvaccinated and flu-free. As far as anecdotal evidence goes, this has been hard to shake. Flu shot: sick. No flu shot: sick, way sick. I'm a real dick about science and evidence too—my recent health history is but an anecdote. I know that. Barely a blip of an anecdote, in the grand scheme of things. To me, however, it's a hell of an anecdote.

It's time to get over it. And to do that, I'll need to convince myself. I need to make a case.

Let's start back in 2008 with the flu shot in question. Flu shots are pretty weird: Every year a bunch of epidemiologists get together and make an educated prediction as to the forthcoming flu season. The flu is always changing—it's not just a moving target, it's a target that disappears and reappears in often unpredictable ways.

More than 100 national influenza centers in over 100 countries conduct year-round flu surveillance, reporting their data to five centralized centers, including the CDC in Atlanta, GA. These five make up the Influenza Vaccine Effectiveness (VE) Network. A couple of times a year—once for the Northern Hemisphere and once for the Southern—the WHO consults with these five agencies, aggregating data from surveillance, laboratory, and clinical studies. They take this data and match it with vaccine viruses that are actually available and come up with a vaccine cocktail likely to be the most effective in the forthcoming flu season. For the Northern Hemisphere, the decision is made in February. In the United States, this is taken as a recommendation and a final decision is made by the FDA as to the vaccine makeup.

The flu vaccine doesn't catch every flu virus. The virus is always changing and coming up with new and improved versions of itself (a phenomenon known as "drift"). At the end of a given flu season, the CDC releases data as to the effectiveness of the flu vaccine for that season. This can vary quite a bit. In 2011-2012, the vaccine was 47 percent effective at presenting the flu across all populations. In 2014-2015, this went down to 19 percent. (According to the CDC, there was a remarkable mismatch that year between predicted and actual viruses. Some 80 of circulating flu viruses weren't covered by the vaccine.) Last season, the effectiveness went back up to the 47 percent. From 2004-2005 through last year, the year by year average is about 41 percent.

Curiously, my bad flu shot year is the one that happens to be missing from the CDC's published data. Ian Branam, a CDC spokesperson, explained that this had to do with staffing changes at the time and offered the figures in question. The 2008-2009 flu vaccine was about 41 percent effective. Perfectly average.

Getting a flu shot is a contribution as much as it's a protection.

But it's also not at all fair to look at a yearly average across all populations and relate it to my own sick self. That's not how statistics work, and it's also not how vaccinations work. My own vaccination is a contribution to a larger project known as herd immunity, which is not really concerned with individuals in the same sense that anecdotes are. Simply, once enough members of a population become immune to some illness, the illness as a whole becomes less and less able to ascend to the level of outbreak. It becomes less mobile, and this benefits the entire population, vaccinated and unvaccinated. The real role of my vaccination is then mostly unknown: How many times did I not get the flu and how many times did I not transmit it? How many transmission chains did I wind up breaking in 2008-2009?

Herd immunity is pretty old news to anyone that's followed the great vaccine debate of recent years. Getting a flu shot is a contribution as much as it's a protection.

The real end of my own internal argument about the flu shot is about the nature of anecdotes and evidence. Anecdotes—stories—are powerful as reductions. Anecdotal evidence is then a reduction to cause and effect. It comes at the expense of information that may not quite fit, and, boy, do I have some information that doesn't fit.

Two flu seasons after that last flu shot, I took an extremely powerful preventative measure. I ditched civilization. One year I was in a cabin near Telluride, then I was in the high-desert near the Four Corners, and, since, I've been living in an actual RV in rural Washington state. Compared to my previous city life of constant socialization, my flu-free years have featured scant opportunity to acquire a flu virus.

This life is over, however. I'm back in the city full-time next Thursday, which is pretty weird. I'll be around people and new viruses—once again, a member of the herd. This means that I'm dangerous. A vector. I am a potential link in a chain that might kill someone more vulnerable than me to a viral infection. I'll be at CVS on Monday.

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