Friday, October 04, 2013

Why you should get your flu shots

The flu season is just about upon us. Soon flu shots will be available to virtually everyone free of charge. And yet, if past years are anything to go by, some 20,000 Canadians will be suffering so severely from the flu virus that they will end up in hospital. The rest of us will foot the bill for their by and large avoidable health care costs. Public Health Canada reports on its website that between 2,000 and 8,000 Canadians die every year of the flu or its complications.

Strangely only those of us in possession of a valid health card will be able to access the flu vaccine free of charge through our health care system. That obviously makes no sense at all. Because of this policy those amongst us without a health card will be more likely to contract the flu, and, quite a few of them will pass it on to others. Any sensible public health strategy would offer these shots to anyone to increase the level of protection for everybody.

There are, of course, as with every pretty obvious issue, a large number of people out there who won’t get the flu shots even though they are entitled to receive them free of charge. They encompass conscientious objectors as well as people simply too lazy to bother. People who do not get immunized themselves pose a higher risk to others, both those who are also not immunized as well as those who are immunized. The latter are also subjected to a higher than necessary risk, because while the flu vaccine offers a higher degree of protection, it is not 100% efficacious (few things in modern medicine are).

What is the morality of our behavior in the age of influenza? Are we ethically obliged to get vaccinated? Should it be compulsory for people who have contacts with large numbers of customers, clients or even patients to get vaccinated? Should employers be permitted to fire or remove temporarily from work those employees who refuse to get vaccinated? And what about those of us who catch influenza, should we stay at home, or should we drag ourselves to work or school regardless? Seeing that we would be carriers of a highly infectious illness that has the habit of killing thousands of us every year, should we be yanked off trains, buses and planes to protect members of the public that otherwise would be stuck with us?

Let’s start with the easy one: Yes, we should get vaccinated. It does not take a degree in public health or in bioethics to figure out why this is so. In important matters that affect only ourselves or predominantly ourselves it needs a very good reason for the state to override our decisions. When it comes to influenza vaccination the issue is not only about ourselves but also about potential harm to others. Now, you could say that there wouldn’t be any risk to those who got vaccinated, and whoever does not get vaccinated and decides to venture out during flu season kind of consents to the risk of catching it. That isn’t quite correct. The risk of catching the flu is only reduced by about 60% for those who got vaccinated, and even this figure varies depending on one’s age group and other factors. So, those of us who choose not to get vaccinated not only pose risks to others who also have not been vaccinated but also to those of us who did what they could to protect ourselves and others by getting vaccinated. Basically the negative impact of a single person who decides not to get vaccinated quickly cascades through society. The more people there are who don’t get vaccinated the more people we will see ending up in hospitals and, unfortunately, in the morgues. That does seem an unreasonably high price to pay for individual laziness or unfounded ideas about vaccines and autism.

Autism and vaccines? Oh, in case you have not heard, like with all good things, there are always some people (like ex Playboy model and actress Jenny McCarthy) who make wild public claims about matters they know little about. In the case of vaccines, a quite efficient grassroots campaign has got off the ground irresponsibly misinforming us that we should not get vaccinated lest we wish to increase the risk of developing autism.  Health authorities around the planet, including Health Canada and the Centers for Disease Control in the USA have declared categorically that vaccines do not cause autism. There is zero evidence for the claim that autism is linked to vaccines. Will that stop the fans of conspiracy theories from claiming the opposite? Likely not. Is that a good reason to refuse getting vaccinated? Not really.

Well, back to our questions. What if you failed to get vaccinated or you got vaccinated and you realise the vaccine doesn’t quite do the trick for you. Should you drag yourself to work or school and show that you’re not a wimp? Well, the long and short of it is that you should stay at home to protect others as good as you can. The best you can do is to limit the number of people you interact with while you are highly infectious. The primary aim of your actions should be societal harm minimization. It follows that if you can avoid going on the journey you booked, do not board buses, train and planes as it is very likely that while you and the other passengers are stuck in these confined spaces for a couple of hours, you will infect a whole bunch of others who in turn will infect a whole bunch of others, etc.

Should we require health care professionals who see patients as part of their daily work routine to get vaccinated? Of course we should. Health care professionals typically see people in an already weakened health state. The last thing these patients need is to be treated by professionals who think nothing of passing a dangerous virus on to them. First do no harm remains one of the foundational principles of medical practice. It would behoove health care professionals refusing to get vaccinated against influenza to keep this one in mind. Even though influenza vaccines do not grant 100% protection, at least they dramatically decrease the likelihood of a vaccinated health care professional catching and passing the virus on to their patients. Working in the healing professions both comes with special rights as well as special obligations.

Udo Schuklenk is a bioethics professor at Queen’s University, he tweets @schuklenk

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