My nine month old received the H1N1 vaccine today at his pediatrician’s office. When it is more widely available I will do the same. However, the path to vaccination was surprisingly crooked for my family. And my family’s thought process on the matter is likely shared by others.
I don’t get the annual flu shot, yet I quickly accepted that H1N1 is a different animal. More generally I believe in the importance of vaccination and our son has received all his routine shots.
When it comes to thinking about our health, we seem to divide into three camps. At one extreme are the fearful, those predisposed to see health as infinitely fragile and constantly menaced by terrible threats – killer viruses in the eyes of some, killer vaccines in the view of others. It's the anxious and the obsessive who are the loudest voices in the media, clog clinics and hospitals, fulminate against demonic vaccinators and incompetent doctors, and try to weave suffocating protective cocoons around themselves and their families.
At the other extreme are the indifferent and irresponsible, who take their good health, their apparent immunity to disease and disease-talk for granted, and just tune out. We're all right, Jack. Not our problem. Cough, cough.
Most Canadians probably fall into a middle group. They're sensible people who don't like being sick, care for each other and take reasonable precautions to protect themselves and others. They have a sense of their good fortune in living in the 21st century and a sense of proportion about their priorities. When our health is at risk, we pay attention to our doctors and take our medicines and our vaccines.
I think I'm in that middle group, but there are three issues that remain. First, how severe is H1N1?
Health officials and governments justifiably put procedures in place to vaccinate the whole population. Yet according to the mass of information in the media it remains unclear how severe H1N1 could potentially be. This leaves some people wondering if a mass vaccination is necessary.
The vaccination process went relatively smoothly this morning even though the pediatrician’s office was swamped. This is in contrast to the media reports of frustrated citizens in hours-long line ups across the country.
Second, what level of risk is socially tolerable?
Would I be a bad parent for not vaccinating myself and my child? Is it irrational for someone not in a high-risk group to say no to vaccination?
Risk is in part in the eye of the beholder and by vaccinating or not one makes a statement. While I calculated the level of risk to be too high for my family to forego the vaccine, are those who choose not to vaccinate necessarily irresponsible?
A couple of Agenda episodes from last season came to mind as I was thinking about this question. One deals with risk and you can see it here:
The other examined the science and politics of H1N1:
My third and final concern is: do the benefits of the vaccine outweigh the possible costs for an infant?
On the face of it this is an illogical argument considering that young children are considered high risk. But being a first time parent of a young child often brings out the cautious, arguably irrational side.
Yet to publicly express such anguish is difficult in a society where a parent can feel like someone ready to cry out “bad parent” lurks around every corner. Again this is not quite rational, but we are all at times irrational beings.
Last season I wrote a blog post called What to do when the science is not so clear? In the case of the H1N1 virus the science is clear: vaccinations are safe and offer a certain level of protection, but at times the confusing mass of messages can make this hard to see.
However, should the science-based use of probabilities be used to outright dismiss those who either find the argument unclear or lacking? In a free society, an individual should be allowed to decline a vaccine unless it is clearly necessary. And is the H1N1 vaccine clearly necessary?
We promote critical thinking, so the voices of those rationally critical of positions of governments and health officials should not be trampled in the rush to immunize. We are doing a disservice to greater society if we do not engage these people as they work through a personal understanding of H1N1.
So with all these questions out there, I know that while my family has chosen to vaccine, many others will not.
Tonight’s program is part of a continuing public discourse on H1N1. What’s your view of the situation? Please share your thoughts here.
Thanks for the comment leaffan444.
While I take your point about the importance of being tested for allergies, is it realistic to require something to be 100% "safe" before it is widely distributed? Is this even possible?
Vaccines are not without risk, but over the years vaccines have reached a level where today they are a relatively low risk.
H1N1 has brought to light many issues including when to conduct mass immunization. Health care funds are finite so we are constantly faced with the impossible task of choosing between different levels of risk.
posted by Stavros Rougas
on 04 November 2009 at 4:49 PM
Your first question: How severe is H1N1 flu? My answer is that for most of us it is not particularly severe, in fact, not as severe as seasonal flu. However, for some of us - particularly for those with pre-existing conditions, such as asthmatics, it can produce pneumonia, which kills very quickly. Your second question: Were you being irrational to consider the advantages and disadvantages of having your family inoculated? My answer is, well, not at all! No one should be critical of you for taking a thoughtful approach to this decision. Your third question: How does one balance the benefits vs the risks here? My answer: Take your advice from medical people, not from talking heads on television, and certainly not from cranks on the Internet, who spread alarm with little or no justification for their positions. As for the comments about allergic reactions to the vaccine, I am in full agreement, that once a reaction has been discovered, a different set of rules applies. You would not accept penicillin, once you'd experienced a bad reaction to it, would you? However, if the vaccine is not for your family, all of you will need to take the extra precautions that have been listed in many places.
posted by Ex-T on 04 November 2009 at 4:50 PM
it takes at least 2 weeks after inoculation to build up immunity. the chance of being exposed to swine flu in the next two weeks, before developing immunity, is very high. so i wonder if this vaccination campaign is meant more to assuage the anxiety of the people then to actually save lives. even though few people (hundreds, but not thousands, we are told) will succumb to the virus (less than a third of a percent will be otherwise healthy with no underlying condition), it's the random nature of that affected third of a percent that scares people.
posted by brendan on 04 November 2009 at 5:23 PM
brendan: ..... it takes at least 2 weeks after inoculation to build up immunity. the chance of being exposed to swine flu in the next two weeks, before developing immunity, is very high. so i wonder if this vaccination campaign is meant more to assuage the anxiety of the people then to actually save lives.
Any vaccination ptakes some time to build up antibodies to be effective. So you get innoculated and after two weeks you are immune, with only a 2 week potential risk period. Or you don't get innoculated and remain at risk until you actually get infected and get really sick, and maybe die. So your concern is a typical Internet red herring contributing to the confusion !
posted by DieterH on 04 November 2009 at 7:29 PM
The basic concept of crisis management is to plan for the worst and hope for the best. yet each person on tonight's program kept saying nobody could see this coming. so much for planning for the worst - nobody could see the worst possibly happening. Yet all kinds of lessons could be seen, if it was Katrina or SARS those are just two examples lessons could be learned, above and beyond the concept that not enough money was thrown at it. Large amounts of money are not a solution if the people in charge cannot perceive a worst case scenario to plan and spend money on
posted by Quixote on 04 November 2009 at 9:05 PM
Today's Agenda program was the worst I have seen in 2 years: unprepared host and unprepared guests (also very much afraid to lose their job if providing constructive feedback to the Ontario government). If these guests are representatives of the people in charge of our health planning and implementation, we are in serious trouble.
posted by PlayfulSmith on 04 November 2009 at 9:30 PM
Quixote, it's one thing to plan for a worst case scenario and then another to judge what level and form of response is appropriate. As you mention "large amounts of money are not the solution" as money cannot replace good planning and decision making.
While brendan makes the point that it takes time for the vaccine to work, DieterH also makes a good point that this in itself is not a valid reason to reject vaccination.
There is so much information available from main stream media to conversations with friends that it can be difficult to weigh the facts. Yet I still believe too much information is better than too little.
What would be a better way to present information to the public if you feel what is currently being done is inadequate?
posted by Stavros Rougas
on 04 November 2009 at 9:34 PM
Quixote: Large amounts of money are not a solution if the people in charge cannot perceive a worst case scenario to plan and spend money on
See my last post on the Your Agenda discussion group. I am beginning to have a real issue with our health care / medical community. Please learn about program planning, IT and logistics !! Get off your pedestals and consult the experts at WALMART, or any large industrial organization such as an automotive manufacturer. They make stuff happen on a global scale by simply massaging a keyboard !! More money ? NOT ! The present H1N1 vaccination implementation is a bad joke, never mind any medical considerations. Without an effective modern IT infrastructure the project is hopeless.
posted by DieterH on 05 November 2009 at 1:16 AM
>>>There is so much information available from main stream media to conversations with friends that it can be difficult to weigh the facts. Yet I still believe too much information is better than too little.
It's not about quantity but rather quality Stavros. There is a difference. Right now the media is doing a very poor job of providing good information. Frankly, so is our medical community and our politicians.
posted by IAMSOUP on 05 November 2009 at 9:48 AM
IAMSOUP you correctly note that quality is the key.
Yet I would argue that quality information does exist, but it’s easily lost in the mass of information available in print, on air and online.
But what should be done, if anything, with those who "shop around" for information.
I'm referring to people who when unsatisfied with official results/conclusions/recommendations look for an alternative, which is relatively easy to do online.
Is a basic distrust of our government justified? I'm not talking about questioning policy and implementation.
posted by Stavros Rougas
on 05 November 2009 at 11:48 AM
Stavros, I most certainly don't expect every single vaccination to have a 100% safety factor or even efficacy however I do expect those that administer and plan these things to emphasize first and foremost that allergy testing should be paramount before deciding whether or not one should be vaccinated. I also expect scientists to be able to come up with something better than "eggs" in which to hold it. I mean if this is such a "pandemic" why exclude roughly 20% of the population from being able to get it? That is not "safe" as safe should mean a further minimalizing of bad outcomes.
posted by leaffan444 on 05 November 2009 at 1:31 PM
Stavros: Yet I would argue that quality information does exist, but it’s easily lost in the mass of information available in print, on air and online.
See also my latest post on The Agenda. A big problem to my mind is that the official public information out there has been dumbed down to the point of being marginal or meaningless. Thus citizens will search for additional clarification - on the Internet or tabloid press. Mature context is entirely missing. Science education is also not mandatory. My experience with the medical community is that they think their patients are ignoramuses and thus give trivial answers. I once had a detail explanation of how decimal points work after I asked about the technical sensitivity of certain of my blood test results !! The medical community also need to get off their pedestals and bring outside expertise to manage PR, logistics, IT and program management.
posted by DieterH on 05 November 2009 at 5:13 PM
Finally, some facts from the journalists. Not surprisingly, Ontario is badly managing the vaccination program:
http://www.theglobeandmail.com/life/health/h1n1-swine-flu/more-than-half-of-vaccine-doses-in-storage/article1351752/
Here is why Arlene King did not want to discuss about the Ontario vaccination results (even Quebec does better):
Province/Territory Delivered (1000s) Administered (1000s) Ontario 2,229 322 Quebec 1,331 700-800 British Columbia 818 400 Alberta 622 400 Manitoba 206 137 Saskatchewan 173 70 New Brunswick 129 128 Newfoundland 86 * Nova Scotia 160 115 Prince Edward Island 29 25 Northwest Territories 34 13 Yukon 24 * Nunavut 22 3.3 Total 5,863 2,262-2,413.3
posted by PlayfulSmith on 05 November 2009 at 8:14 PM
>>>Yet I would argue that quality information does exist, but it’s easily lost in the mass of information available in print, on air and online.
In a quick office poll most people feel differently than you do, especially when it comes to long term effects on children. Most of the moms in my office are not getting their kids vaccinated because they feel there is no data on long term effect on children. Where does someone find such data ?
posted by IAMSOUP on 06 November 2009 at 9:18 AM
We live in a world of Patents and ideas are rejected if they cannot be paten-able… Monopoly health…. http://tinyurl.com/yfxnjrv
posted by ZorroIsGod on 06 November 2009 at 4:17 PM
IAMSOUP: Most of the moms in my office are not getting their kids vaccinated because they feel there is no data on long term effect on children. Where does someone find such data ?
Well - if Ontario had a working eHealth system a simple search algorithm would give you a print-out including all the statistics in about a minute. Since our medical community is 20 years behind the times in terms of IT infrastructure all I can say is: not a chance anytime soon ! Sad but true.
posted by DieterH on 08 November 2009 at 8:14 AM
When a vaccine has not been available for many years it is difficult to make definitive conclusions on the long-term effects.
Fortunately, we have been vaccinating for generations which has allowed us to develop credible long-term data on the general benefits and risks of vaccination.
posted by Stavros Rougas
on 09 November 2009 at 11:24 AM
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safe?
The vaccinations may be safe for the majority of those that take them but they are not for those allergic to them. As I am sure you know the reaction varies among those allergic, as is the case with all allergies. A few years back my four children and I went to get the annual flu shot only to discover that my youngest developed an allergic reaction and needed hospitalization because of it. My reaction was not near as severe. Apparently the H1N1 vaccine has the same allergic properties as the annual flu vaccine. My suggestion is that everyone get tested for allergies beforehand. So please, let's not call them safe until everyone can take them without risk.
posted by leaffan444 on 04 November 2009 at 4:02 PM