4 ms·

This article is good and reminded me of a key issue: herd immunity. I wish I could explain to more of my friends how irresponsible it is to not get the flu shot

This article is good and reminded me of a key issue: herd immunity. I wish I could explain to more of my friends how irresponsible it is to not get the flu shot - they view it as simply an individual decision like "I'm choosing to not get the shot knowing full well I might get sick" - but they don't think of the possibility that if they do get sick, they may play a part in infecting other, more vulnerable people, such as a grandparent. Even though the vaccine isn't that effective this year, as long as it's at least somewhat effective in mitigating transmission, it's worth it.

nonbel 9y ago
>"Even though the vaccine isn't that effective this year, as long as its at least somewhat effective in mitigating transmission, it's worth it" How can you tell if something is "worth it" without considering any costs (side effects, price, time, etc)?
- opportune 9y ago
  I suppose if it's only 0.001% effective it would not be worth it, but that's really a pedantic nitpick because we know it's not that ineffective. The vaccine this year is about 32% effective against H3N2 in the US and 39% effective overall [0]. That's not amazing but it's definitely "worth it" for a few dollars and 5 minutes at a CVS. [0]https://www.cdc.gov/flu/about/season/flu-season-2017-2018.htm https://www.cdc.gov/flu/about/season/flu-season-2017-2018.ht...
  - nonbel 9y ago
    Basically your argument is that the costs of getting the vaccine are so negligible they can be ignored? What about side effects? https://www.cdc.gov/flu/protect/vaccine/general.htm https://www.cdc.gov/flu/protect/vaccine/general.htm
    - opportune 9y ago
      Yes, they exist and aren't that common/severe. I mean at the end of the day it's a personal decision and if you're already unhealthy I understand why you wouldn't want to get the side effects. The problem is one of ignorance: people don't even know what herd immunity is and why it's important. In my opinion the side effects pale in comparison to the effects of getting the flu and are not a big "sacrifice" to make whatsoever - but you need to understand the importance of herd immunity to make a truly informed decision I'm not going to continue replying to this conversation because I can sense that it's going to become unproductive
      - nonbel 9y ago
        Ok, but besides my main point (regarding doing a cost benefit analysis), from your comments I doubt you understand herd immunity, and probably should not be attempting to teach others about it... If the virus is too infectious you need very high rates of immunization for it to work. https://en.wikipedia.org/wiki/Basic_reproduction_number https://en.wikipedia.org/wiki/Basic_reproduction_number Most of the time those R0 values assume "well mixed populations" (any one person is just as likely to contact any other person) amongst other things, so don't take them too seriously. However, the basic idea that you don't automatically get herd immunity is simple enough. Eg, just what I found quickly on the topic: >"Whether vaccination of healthcare personnel can lead to a herd effect reducing laboratory-confirmed influenza among patients is still inconclusive. Pooled data from a Cochrane review of 3 cluster randomized controlled trials showed no reduction of laboratory-confirmed influenza (OR 0.86, 95% CI 0.44–1.68; p = 0.66), lower respiratory tract infections, admission to hospital (OR 0.89, 95% CI 0.75–1.06), and deaths from pneumonia (OR 0.82, 95% CI 0.45–1.49) in patients when healthcare personnel were vaccinated [35]. However, given that mathematical models suggest a herd effect [36], more rigorous studies need to be conducted." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171704/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171704/
    - bigtex 9y ago
      Yep, all you have to do is review the government statistics on vaccine injuries to see the list of all the people who got GBS from the flu shot https://www.hrsa.gov/advisorycommittees/childhoodvaccines/Meetings/20171208/doj-presentation.pdf https://www.hrsa.gov/advisorycommittees/childhoodvaccines/Me...
      - nonbel 9y ago
        I wasn't really thinking about GBS, but that is one of the more severe possible (but rare) side effects. Most people (everyone?) feels under the weather for a few days after a flu shot.
  - lutorm 9y ago
    All I had to do was take time out of my day to go to the pharmacy, copay with my insurance was $0. Which just makes sense from a financial point of view for the insurance companies, too.
    - nonbel 9y ago
      This gives an inaccurate assessment of the cost. Obviously you are paying for the shot by paying more for insurance (either directly or via taxes or via taxes spent on that rather than some other government service you could take advantage of). My point is that you can't say something "is worth it" without considering both costs AND benefits (I have recently seen friends get so ill they almost got fired because doctors ignored the side effects of prescriptions). Also, costs aren't zero just because they were prepaid or deferred.
      - smileysteve 9y ago
        > Obviously you are paying for the shot by paying more for insurance Wrong calculation. The insurance company is trying to SAVE expenditures of doctors and hospitalizations; therefore, customers getting the flu shot cost the insurer less. Even further for herd immunity (the pt), 1 insured getting the flu shot might reduce 4-8 others from getting the flu.
        smileysteve 9y ago
        And in the case of workplace or family, are likely covered by the same insurer. There's probably some patient n with diminishing returns for the modern tech workplace, where, if they live alone, commute alone, visit no family, and have no onsites.
        nonbel 9y ago
        >"The insurance company is trying to SAVE expenditures of doctors and hospitalization" Interesting point (not sure how far down a rabbit hole this can go...), so you are claiming that the introduction of flu shots has reduced insurance costs? Is it even possible to assess this or are there just too many confounds?
- apendleton 9y ago
  You should consider costs. This tradeoff is a large part of what the field of epidemiology studies. Turns out vaccines don't need to be that effective to be worthwhile, because of the way disease spreads. There's this concept of a "reproduction number" (r-naught) that predicts how many people a given infected person will pass the disease to, based on a combination of the virulence of a disease, how long infected people remain contagious, how much contact people have with each other, etc. The flu often has a value of around 2, meaning the average infected person will infect two others before they're over it. You can use this number to estimate how fast a disease will spread, how likely it is to be successfully contained, or in the case of seasonal diseases, how many people will get it before seasonal societal changes (school getting out, people spending more time outside, etc.) will effectively curtail transmission for the year. Looking at a vaccine on an individual basis, if it's only, say, 50% effective, that sounds pretty awful -- maybe almost not worth the bother. But on a society-wide basis, if every person were vaccinated, that would effectively knock the R0 value from 2 to 1, which is huge. Transmission is exponential: if you infect two people and they infect two people and they infect two people, etc., the total number of infected looks dramatically different than if everybody only infects one person. So in isolation it's only 50%, but societally, with high vaccination rates, there's a huge multiplicative effect that has the potential to dramatically reduce each person's risk of infection if vaccination rates are high enough. And that's still true even if it's even less effective than 50%, and has all sorts of economic and social consequences.
  - nonbel 9y ago
    >"The flu often has a value of around 2, meaning the average infected person will infect two others before they're over it." The R0 value refers to the potential for infection (ie in a 100% susceptible population it would be what you wrote). >"But on a society-wide basis, if every person were vaccinated, that would effectively knock the R0 value from 2 to 1, which is huge. Transmission is exponential: if you infect two people and they infect two people and they infect two people, etc., the total number of infected looks dramatically different than if everybody only infects one person." I just wrote a little SIR model and did not see this behavior. Depending on the parameters either 100% of the susceptible population was eventually infected, the infection died out quickly, or, if turnover was high enough (eg birth/death/viral mutation leading to a constant stream of susceptibles), there was a cycle and about the same number of people got infected either way. Do you have a source for this behavior so I can see the details of the model?
Jach 9y ago
Doesn't that just raise the question of why an at-risk elderly person wouldn't get the flu shot to protect themselves from all the people who don't? I've heard this irresponsibility argument a lot, I understand it, but I think it's overblown. Herd immunity works best when the vaccine is actually effective. For flu vaccines, every year they're not very effective.
- lutorm 9y ago
  Even if they do, since the vaccine is not 100% effective it still helps if other people are vaccinated since it decreases the chance of them getting it in the first place.
- opportune 9y ago
  The vaccine is still >30% effective. And you may be confused regarding how vaccines for things like the flu work: they have varying efficacy against different strains but getting vaccinated for a certain strain does not at all mean you won't get sick with that strain - it reduces the likelihood. Imagine all the people in the world as a graph with weighted edges representing the probability of one person transmitting the flu to another. The more people become vaccinated, the less the weights of the edges, and the less people get sick overall.
  - Jach 9y ago
    Sure, I'm not disputing that flu vaccines suck compared to vaccines for other things. I'm just disputing that "irresponsibility" is a poor argument against those who decide not to get one, given that the flu vaccines suck, and given the greatest magnitude intervention for an at-risk person ought to be getting the vaccine themselves no? (If you wanted to make a stronger argument for irresponsibility, I think you'd need to provide some actual numbers. Raising or lowering the likelihood doesn't mean much without knowing the magnitude and what the base rates are. After that one could attempt to translate it into a measure of irresponsibility, but that's probably where most of the less productive arguments would happen, including what-about comparisons to other choices that may or may not have much greater impact magnitude like not coming to work while feeling sick, so there's still not much point to the exercise.)
Raphmedia 9y ago
Not nitpicking or trying to be an idiot but shouldn't it be the vulnerable individuals that get the shot? It seems that the only people I know who get vaccinated for something as benign as the flu are: nurses, teachers, children, elderly. Everyone else simply take one or two day off during flu season in the event that they do catch it (most don't). Am I missing something? I have never been vaccinated for it and asking around me, nobody at my current place of employment did either.
- wes-k 9y ago
  https://www.cdc.gov/flu/protect/whoshouldvax.htm https://www.cdc.gov/flu/protect/whoshouldvax.htm > Children younger than 6 months are too young to get a flu shot. > People with severe, life-threatening allergies to flu vaccine or any ingredient in the vaccine. This might include gelatin, antibiotics, or other ingredients. See Special Considerations Regarding Egg Allergy for more information about egg allergies and flu vaccine.
- opportune 9y ago
  Vaccines aren't perfect - you can get vaccinated for certain diseases/strains (such as the flu) and still get them. It's the aggregate of vaccines that stops transmission and prevents disease outbreaks. That's what a lot of people (including other people that replied to my comment) don't understand about vaccinations - they reduce the chance of acquiring a disease. It's still entirely possible to get vaccinated, spend a lot of time around infected people, and get sick. The entire point of herd immunity is to make disease less likely to spread between individuals so that outbreaks don't occur in the first place. Even though the vaccine this year is less effective than normal at preventing the spread of flu, it's still pretty effective, and in a way that means that collectively it's more important to get vaccinated this year.
- apendleton 9y ago
  Some nontrivial percentage of the time, though, the vaccine doesn't take, and this becomes more likely in immunocompromised people (e.g., the elderly). Those people might end up protected from ending up getting infected even though the vaccine won't end up helping them if the people they interact with are also vaccinated and had better luck. As for nobody at your place of employment getting vaccinated: these days that seems pretty surprising to me, but maybe it's a regional thing or something? My office brings in a nurse to do everybody at once.
ProfessorLayton 9y ago
As someone who didn't have any kind of health insurance growing up, and had both parents working for hourly wages, I would like to add that it is a little more complex than "irresponsibility". My working-class parents would have certainly felt the impact on their budget spending ~$50/person for a shot that might not even work that year, not to mention the money lost by not working to go get the shot. I think people should get their flu shots, but am a bit more hesitant to judge those who don't.
- ceejayoz 9y ago
  Under the ACA, the flu shot is free (no copay/deductible), and everyone's supposed to have insurance. Cost should be a substantially lower issue than in the past.
  - waterphone 9y ago
    There are over 27 million uninsured people in the U.S.
    - ceejayoz 9y ago
      Yes, which is down by half (plus the folks whose insurance didn't cover it pre-ACA), hence "substantially lower issue". That leaves 300 million people for whom cost is not a good reason to avoid it.

nonbel 9y ago

>"Even though the vaccine isn't that effective this year, as long as its at least somewhat effective in mitigating transmission, it's worth it" How can you tell if something is "worth it" without considering any costs (side effects, price, time, etc)?

opportune 9y ago
I suppose if it's only 0.001% effective it would not be worth it, but that's really a pedantic nitpick because we know it's not that ineffective. The vaccine this year is about 32% effective against H3N2 in the US and 39% effective overall [0]. That's not amazing but it's definitely "worth it" for a few dollars and 5 minutes at a CVS. [0]https://www.cdc.gov/flu/about/season/flu-season-2017-2018.htm https://www.cdc.gov/flu/about/season/flu-season-2017-2018.ht...
- nonbel 9y ago
  Basically your argument is that the costs of getting the vaccine are so negligible they can be ignored? What about side effects? https://www.cdc.gov/flu/protect/vaccine/general.htm https://www.cdc.gov/flu/protect/vaccine/general.htm
  - opportune 9y ago
    Yes, they exist and aren't that common/severe. I mean at the end of the day it's a personal decision and if you're already unhealthy I understand why you wouldn't want to get the side effects. The problem is one of ignorance: people don't even know what herd immunity is and why it's important. In my opinion the side effects pale in comparison to the effects of getting the flu and are not a big "sacrifice" to make whatsoever - but you need to understand the importance of herd immunity to make a truly informed decision I'm not going to continue replying to this conversation because I can sense that it's going to become unproductive
    - nonbel 9y ago
      Ok, but besides my main point (regarding doing a cost benefit analysis), from your comments I doubt you understand herd immunity, and probably should not be attempting to teach others about it... If the virus is too infectious you need very high rates of immunization for it to work. https://en.wikipedia.org/wiki/Basic_reproduction_number https://en.wikipedia.org/wiki/Basic_reproduction_number Most of the time those R0 values assume "well mixed populations" (any one person is just as likely to contact any other person) amongst other things, so don't take them too seriously. However, the basic idea that you don't automatically get herd immunity is simple enough. Eg, just what I found quickly on the topic: >"Whether vaccination of healthcare personnel can lead to a herd effect reducing laboratory-confirmed influenza among patients is still inconclusive. Pooled data from a Cochrane review of 3 cluster randomized controlled trials showed no reduction of laboratory-confirmed influenza (OR 0.86, 95% CI 0.44–1.68; p = 0.66), lower respiratory tract infections, admission to hospital (OR 0.89, 95% CI 0.75–1.06), and deaths from pneumonia (OR 0.82, 95% CI 0.45–1.49) in patients when healthcare personnel were vaccinated [35]. However, given that mathematical models suggest a herd effect [36], more rigorous studies need to be conducted." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171704/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171704/
  - bigtex 9y ago
    Yep, all you have to do is review the government statistics on vaccine injuries to see the list of all the people who got GBS from the flu shot https://www.hrsa.gov/advisorycommittees/childhoodvaccines/Meetings/20171208/doj-presentation.pdf https://www.hrsa.gov/advisorycommittees/childhoodvaccines/Me...
    - nonbel 9y ago
      I wasn't really thinking about GBS, but that is one of the more severe possible (but rare) side effects. Most people (everyone?) feels under the weather for a few days after a flu shot.
- lutorm 9y ago
  All I had to do was take time out of my day to go to the pharmacy, copay with my insurance was $0. Which just makes sense from a financial point of view for the insurance companies, too.
  - nonbel 9y ago
    This gives an inaccurate assessment of the cost. Obviously you are paying for the shot by paying more for insurance (either directly or via taxes or via taxes spent on that rather than some other government service you could take advantage of). My point is that you can't say something "is worth it" without considering both costs AND benefits (I have recently seen friends get so ill they almost got fired because doctors ignored the side effects of prescriptions). Also, costs aren't zero just because they were prepaid or deferred.
    - smileysteve 9y ago
      > Obviously you are paying for the shot by paying more for insurance Wrong calculation. The insurance company is trying to SAVE expenditures of doctors and hospitalizations; therefore, customers getting the flu shot cost the insurer less. Even further for herd immunity (the pt), 1 insured getting the flu shot might reduce 4-8 others from getting the flu.
      - smileysteve 9y ago
        And in the case of workplace or family, are likely covered by the same insurer. There's probably some patient n with diminishing returns for the modern tech workplace, where, if they live alone, commute alone, visit no family, and have no onsites.
      - nonbel 9y ago
        >"The insurance company is trying to SAVE expenditures of doctors and hospitalization" Interesting point (not sure how far down a rabbit hole this can go...), so you are claiming that the introduction of flu shots has reduced insurance costs? Is it even possible to assess this or are there just too many confounds?
apendleton 9y ago
You should consider costs. This tradeoff is a large part of what the field of epidemiology studies. Turns out vaccines don't need to be that effective to be worthwhile, because of the way disease spreads. There's this concept of a "reproduction number" (r-naught) that predicts how many people a given infected person will pass the disease to, based on a combination of the virulence of a disease, how long infected people remain contagious, how much contact people have with each other, etc. The flu often has a value of around 2, meaning the average infected person will infect two others before they're over it. You can use this number to estimate how fast a disease will spread, how likely it is to be successfully contained, or in the case of seasonal diseases, how many people will get it before seasonal societal changes (school getting out, people spending more time outside, etc.) will effectively curtail transmission for the year. Looking at a vaccine on an individual basis, if it's only, say, 50% effective, that sounds pretty awful -- maybe almost not worth the bother. But on a society-wide basis, if every person were vaccinated, that would effectively knock the R0 value from 2 to 1, which is huge. Transmission is exponential: if you infect two people and they infect two people and they infect two people, etc., the total number of infected looks dramatically different than if everybody only infects one person. So in isolation it's only 50%, but societally, with high vaccination rates, there's a huge multiplicative effect that has the potential to dramatically reduce each person's risk of infection if vaccination rates are high enough. And that's still true even if it's even less effective than 50%, and has all sorts of economic and social consequences.
- nonbel 9y ago
  >"The flu often has a value of around 2, meaning the average infected person will infect two others before they're over it." The R0 value refers to the potential for infection (ie in a 100% susceptible population it would be what you wrote). >"But on a society-wide basis, if every person were vaccinated, that would effectively knock the R0 value from 2 to 1, which is huge. Transmission is exponential: if you infect two people and they infect two people and they infect two people, etc., the total number of infected looks dramatically different than if everybody only infects one person." I just wrote a little SIR model and did not see this behavior. Depending on the parameters either 100% of the susceptible population was eventually infected, the infection died out quickly, or, if turnover was high enough (eg birth/death/viral mutation leading to a constant stream of susceptibles), there was a cycle and about the same number of people got infected either way. Do you have a source for this behavior so I can see the details of the model?

Jach 9y ago

Doesn't that just raise the question of why an at-risk elderly person wouldn't get the flu shot to protect themselves from all the people who don't? I've heard this irresponsibility argument a lot, I understand it, but I think it's overblown. Herd immunity works best when the vaccine is actually effective. For flu vaccines, every year they're not very effective.

lutorm 9y ago
Even if they do, since the vaccine is not 100% effective it still helps if other people are vaccinated since it decreases the chance of them getting it in the first place.
opportune 9y ago
The vaccine is still >30% effective. And you may be confused regarding how vaccines for things like the flu work: they have varying efficacy against different strains but getting vaccinated for a certain strain does not at all mean you won't get sick with that strain - it reduces the likelihood. Imagine all the people in the world as a graph with weighted edges representing the probability of one person transmitting the flu to another. The more people become vaccinated, the less the weights of the edges, and the less people get sick overall.
- Jach 9y ago
  Sure, I'm not disputing that flu vaccines suck compared to vaccines for other things. I'm just disputing that "irresponsibility" is a poor argument against those who decide not to get one, given that the flu vaccines suck, and given the greatest magnitude intervention for an at-risk person ought to be getting the vaccine themselves no? (If you wanted to make a stronger argument for irresponsibility, I think you'd need to provide some actual numbers. Raising or lowering the likelihood doesn't mean much without knowing the magnitude and what the base rates are. After that one could attempt to translate it into a measure of irresponsibility, but that's probably where most of the less productive arguments would happen, including what-about comparisons to other choices that may or may not have much greater impact magnitude like not coming to work while feeling sick, so there's still not much point to the exercise.)

Raphmedia 9y ago

Not nitpicking or trying to be an idiot but shouldn't it be the vulnerable individuals that get the shot? It seems that the only people I know who get vaccinated for something as benign as the flu are: nurses, teachers, children, elderly. Everyone else simply take one or two day off during flu season in the event that they do catch it (most don't). Am I missing something? I have never been vaccinated for it and asking around me, nobody at my current place of employment did either.

wes-k 9y ago
https://www.cdc.gov/flu/protect/whoshouldvax.htm https://www.cdc.gov/flu/protect/whoshouldvax.htm > Children younger than 6 months are too young to get a flu shot. > People with severe, life-threatening allergies to flu vaccine or any ingredient in the vaccine. This might include gelatin, antibiotics, or other ingredients. See Special Considerations Regarding Egg Allergy for more information about egg allergies and flu vaccine.
opportune 9y ago
Vaccines aren't perfect - you can get vaccinated for certain diseases/strains (such as the flu) and still get them. It's the aggregate of vaccines that stops transmission and prevents disease outbreaks. That's what a lot of people (including other people that replied to my comment) don't understand about vaccinations - they reduce the chance of acquiring a disease. It's still entirely possible to get vaccinated, spend a lot of time around infected people, and get sick. The entire point of herd immunity is to make disease less likely to spread between individuals so that outbreaks don't occur in the first place. Even though the vaccine this year is less effective than normal at preventing the spread of flu, it's still pretty effective, and in a way that means that collectively it's more important to get vaccinated this year.
apendleton 9y ago
Some nontrivial percentage of the time, though, the vaccine doesn't take, and this becomes more likely in immunocompromised people (e.g., the elderly). Those people might end up protected from ending up getting infected even though the vaccine won't end up helping them if the people they interact with are also vaccinated and had better luck. As for nobody at your place of employment getting vaccinated: these days that seems pretty surprising to me, but maybe it's a regional thing or something? My office brings in a nurse to do everybody at once.

ProfessorLayton 9y ago

As someone who didn't have any kind of health insurance growing up, and had both parents working for hourly wages, I would like to add that it is a little more complex than "irresponsibility". My working-class parents would have certainly felt the impact on their budget spending ~$50/person for a shot that might not even work that year, not to mention the money lost by not working to go get the shot. I think people should get their flu shots, but am a bit more hesitant to judge those who don't.

ceejayoz 9y ago
Under the ACA, the flu shot is free (no copay/deductible), and everyone's supposed to have insurance. Cost should be a substantially lower issue than in the past.
- waterphone 9y ago
  There are over 27 million uninsured people in the U.S.
  - ceejayoz 9y ago
    Yes, which is down by half (plus the folks whose insurance didn't cover it pre-ACA), hence "substantially lower issue". That leaves 300 million people for whom cost is not a good reason to avoid it.