The Flu Shot Doesn’t Live Up To Expectations — And That Keeps Many People Away

Anna Almendrala
Updated

This flu season has been particularly grim. More people are dying of the flu than medical professionals would expect at this time of the year. One in 10 people who died during the fourth week of January died of pneumonia and influenza, and 84 children have also died so far this flu season. The number of people seeing a health care provider for flu symptoms is almost as high as 2009, when the flu hit pandemic levels.

One reason for that? There’s little faith that the vaccine will work. This year, initial estimates had suggested that the vaccine may be just 10 percent to 17 percent effective against H3N2, this season’s most common strain. That’s based on interim reporting from Canada and the final effectiveness rate in Australia for this strain.

But those figures turned out to be an underestimate. The numbers on the effectiveness of the shot among Americans, released Thursday, reveal that for all ages, the vaccine is 25 percent effective against H3N2. For children ages six months to eight years, it was even more effective against the strain, at 59 percent.

However, taking into account combined effectiveness of all of the strains, the vaccine is just 36 percent effective — lower than the usual 40 to 60 percent effectiveness of past shots.

Arguably the biggest reason that Americans don’t seem to take the flu vaccine seriously is that it simply doesn’t live up to our expectations for what a vaccine is, and how it should work, said Dr. Pat Salber, founder of the healthcare blog The Doctor Weighs In.

One or two shots that confer lifetime or years-long immunity at near 100 percent effectiveness is the model we have for serious illnesses like measles, mumps, rubella and other viruses. But the flu vaccine, with its variable effectiveness and weaknesses that require people to go in year after year, presents a compliance barrier for busy people.

“We know this from taking pills,” Salber said. “If I give you a pill and you only have to take one a day, you’re going to do a pretty good job. If you take it twice a day, your compliance falls off. If you have to take three pills a day, I can guarantee you won’t get three pills in a day on most days.”

Some flu experts hope that the severity of this year’s flu will provide a silver lining, motivating people to get the flu shot this year and in years to come. Typically, fewer than half of all Americans bother to get a flu shot in any given year, and the numbers are mostly concentrated among those who are uniquely vulnerable to the virus: children under 12 years old, and seniors over 65, said Dr. Arnold S. Monto, an epidemiology professor at the University of Michigan School of Public Health. This leaves out older children and young adults, who have the most opportunities to transmit the flu virus.

“Do we use enough vaccine to really cut down on the transmission? The answer is no, we really don’t,” said Monto.

But Eric A. Weaver, a scientist working on research for a universal flu vaccine at the University of Nebraska-Lincoln, agreed that there’s a fundamental problem with the flu vaccine as a product, and that keeps Americans away.

“When I teach about flu vaccine, I ask students, ‘Why do you need a new shot every year?’ They always answer, ‘because the strain changes from year to year,’” Weaver said. “But the other part of the answer is that by the time the next flu season comes around, you’re no longer protected because the flu vaccine is weak, even if the strain doesn’t change.”

Of course, public health experts are quick to point out that even flu vaccines with limited effectiveness are still worth getting, because they can both lessen the severity of your symptoms if you do get the flu and also prevent you from passing on the virus to people who are more vulnerable, like kids or the immunocompromised.

Weaver, who is currently testing his universal flu vaccine in mice, hopes that his research will one day provide lifetime protection in children who get the shot. Currently, yearly flu shots that are 50 percent effective are just not an attractive product for Americans, he said.

“I work on flu vaccines and I defend flu vaccines, but I’m not going to argue with somebody who says I’m not going to take it,” Weaver said. “I’m disappointed [in the flu shot]. I think we could do a little bit better.”

CORRECTION: Due to an editing error, a previous version of this story incorrectly stated that the vaccine effectiveness of the flu shot against H3N2 was 25 percent for people over 8 years old. In fact, that figure is for people of all ages.

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Hepatitis B

Your newborn should get this shot even before leaving the hospital, and receive another dose at one to two months and a third at six to 18 months. The vaccine protects against an incurable, liver-infecting virus, hepatitis B, which can be passed to a baby during childbirth if the mother is infected. This virus spreads through contact with blood or other body fluids (sharing toothbrushes and utensils can put you at risk). Soreness at the site of the shot, or a slight fever, is the most common side effect, according to Gabrielle Gold-Von Simson, M.D., associate professor of pediatrics at NYU Langone Medical Center in New York.

DTaP

The DTaP vaccine protects against diphtheria (a germ that can form a gray or black film in the throat), tetanus (an infection that can cause muscle spasms so strong they can break bones), and pertussis (a highly contagious disease that causes a severe, uncontrollable cough, known as whooping cough). Five vaccine doses are given to children at two months, four months, six months, 15 to 18 months and four to six years. (And boosters at age 11 or 12 and then every 10 years.) DTaP may be combined with other vaccinations to reduce the number of shots needed. "Now, it's DTaP with hepatitis B and the polio vaccine. So, it's five in one," Dr. Gold-Von Simson says.

MMR

This combo shot protects against three viruses: measles (which causes high fever and a body-wide rash); mumps (which causes face pain, swelling of the salivary glands, and sometimes scrotal swelling in boys); and rubella or German measles (which can cause birth defects if the infection occurs during pregnancy). The first shot is given at 12 to 15 months of age and once again between the ages of four and six. MMR is sometimes combined with the chickenpox vaccine into one shot (brand name ProQuad). "All these different preparations are designed to reduce the amount of shots the pediatrician has to give," says Dr. Gold-Von Simson.

Chickenpox

Chickenpox, a highly contagious rash that many people remember from childhood, is caused by the varicella virus. A varicella vaccine was first licensed in 1995 and now spares future generations this itchy misery. Chickenpox infections can be especially dangerous in adults who don't have immunity from the vaccine or haven't had it in childhood, and can also lead to shingles, an extremely painful blistering rash. The shot is given to children at 12 to 15 months and again between four and six years. The vaccine can cause soreness at the site of the shot, fever, and, in some cases, a mild rash.

Haemophilus Influenza Type B (Hib)

"Haemophilus influenza type b is the bacterium that causes meningitis," says Dr. Gold-Von Simson. Meningitis, an inflammation of the membranes surrounding the brain and spinal cord, is particularly dangerous for kids under the age of five. Hib vaccines are generally given at two, four, six, and 12 to 15 months of age. Depending on the vaccine used, the six-month shot may not be needed. Fever, swelling, and redness at the site of the shot are potential side effects.

Polio (IPV)

Polio vaccine is "such a success," says Dr. Gold-Von Simson. "Because of the vaccine, there are no more cases [of polio]." There are no more in the United States that is. The virus hasn't been eradicated worldwide, so kids still get the IPV, or inactivated polio vaccine, which is a shot containing killed virus. Polio is bad news, and can cause paralysis and even death. Children are given the IPV at two months, four months, between six to 18 months, and then again between the ages of four and six years.

Pneumococcal Conjugate (PCV)

This vaccine, known as PCV13 (brand name Prevnar), protects against 13 types of Streptococcus pneumoniae, which are bacteria that can cause all sorts of mayhem, including meningitis, pneumonia, ear infections, blood infections, and even death. A total of four shots are given to kids (at two, four, six, and 12 to 15 months of age) to protect them against the germs, known collectively as pneumococcal bacteria. The most common side effects of the vaccine include drowsiness, swelling at the site of the shot, mild fever, and irritability.

Influenza (flu)

Flu vaccinations are given each year starting in the fall. The Centers for Disease Control and Prevention recommends them for kids ages six months or older, although they aren't required for school attendance. (Connecticut and New Jersey require the vaccine for attending child-care centers and preschool.) Common side effects from the vaccine include soreness, redness, or swelling at the site of the shot. Fever and aches may occur too. "If you have an egg allergy, you shouldn't have the influenza vaccine," says Dr. Gold-Von Simson.

Rotavirus (RV)

The rotavirus vaccine (RV) (brand names RotaTeq, Rotarix) is given to children at two and four months of age. (RotaTeq is also given at six months.) The vaccine protects against a virus that is the most common cause of severe diarrhea and vomiting in young kids worldwide. About 55,000 children in the U.S. were hospitalized each year due to rotavirus before the vaccine was licensed in 2006. It is not required for school attendance. The vaccine is in liquid form and given by mouth to babies. It may make them a bit more irritable and can also cause mild diarrhea or vomiting.

Hepatitis A

Kids can catch hepatitis A from sharing food or drinks or by putting contaminated food or objects in their mouths. It's a viral infection that affects the liver, and can cause a number of symptoms, including fever, tiredness, jaundice, and loss of appetite. Children ages 12 through 23 months generally get two doses of the Hep A vaccine, with a minimum interval of six months between shots. Some states require the vaccine for school attendance. Soreness where the shot was given, headache, and loss of appetite are the most common side effects of the vaccine.

Meningococcal Conjugate (MCV4)

This vaccine, known as MCV4 (brand name Menactra), protects against meningococcal bacteria, which can infect the membranes surrounding the brain and spinal cord. MCV4 is recommended for kids at 11 or 12 years of age, and anyone between ages two and 55 who is at increased risk of infection (people with certain health conditions, military recruits). Teens starting college should be vaccinated with MCV4 before going to school if they didn't previously get the shot. (Freshman living in dorms are at increased risk of infection.) A little pain at the site of the shot is the most common side effect.

Human Papillomavirus (HPV)

Human papillomavirus (HPV) vaccine (brand names Gardasil, Cervarix) is given in three doses over a six-month period, and is approved for girls between ages nine and 26. While there are over a hundred types of HPV, this vaccine protects against two sexually transmitted types that are the most common causes of cervical cancer. Gardasil also protects against two types that cause genital warts and is approved for boys between nine and 26 as well. The vaccine works only if given before an infection, so doctors recommend it for kids well before they could become sexually active. Although most states don't require HPV vaccination, many are considering mandating it for preteen girls.

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