When I do epidemiological work, one signal that stands out within the population data is the presence of anti-vaccination pockets within society. The so-called ‘anti-vaxxers’ present an incalculable threat to communities by avoiding the standard armamentarium of vaccines in the guidelines.

Where Thinking Goes Wrong – The Behavioral Economics of Choice
Vaccines can only get so safe and effective. Their actual value in society is manifested by how many people actually show up to get immunized. Former Surgeon General of the United States C. Everett Koop opined, “Drugs don’t work in patients who don’t take them.” The more I’ve been called to review cases of under-vaccination and its effects in certain areas, the more it’s driven me to realize that orthopraxis development and trials of safe and effective vaccines are only part of the equation. The other part is to not let it be ok for casual conversation to spread around about the risks and side effects of proper vaccination. To not address these when we hear them is equivalent to tacitly endorsing the myths.

Every choice that we make has a spectrum of risks and benefits, and economically-speaking, we make choices that improve our status (money, health, etc.); After all, if I said to you as you were getting onto a plane for your flight that sitting in your seat (29E) could either have a payout of $0 as alternative A, or $20 as alternative B, most respondents would of course choose alternative B. Why? Because the effort and risk required and incumbent upon you are equivalent, but the payout improves by $20 to choose B over A. So, yes, as with every medical intervention, there are side effects, such as injection site redness or soreness, but at least in the case with the injectable flu vaccine you cannot get the flu from the flu shot. This is one of the many apocryphal social myths, which continues to circulate almost unimpeded. So, scientifically and ethically, it’s not ok to allow opinions and mis-truths to go unchallenged when the outcome is that certain numbers of those telling the tales or listening to them may opt to avoid immunization and increase the general risk in the community.

A large part of the problem is the incredible inadequacy of people to perceive and properly evaluate and weight different risks. It’s hard to appraise what hasn’t happened to you yet in the context of something with a minor alternative risk your risk of actually becoming infected versus your perception of guaranteed side effects at the moment. So even though during an infection with the flu everyone I’ve asked has said that any vaccine side effect would be preferable to the illness, at the time of a preventive office visit it is very difficult to prognosticate the probabilities of being sick and accurately imagining the range of physiological symptoms. Likewise, virtually no one, including those who work in healthcare settings, properly understands the complicated multifactor effects of how accurate the antigen selection was for the current flu season, how many people it takes to elicit herd immunity in a region, the likelihood of infectivity from someone who is ill, and how the whole matrix of probabilities interplay to make certain areas resistant or susceptible.

A Multifactorial Problem Must Be Addressed Multifactorially
A recent push in Christiana Care Health Systems’ efforts to immunize their hospital staff has had a very high degree of success: The average seasonal influenza immunization rate for healthcare workers is about 65%; and this is in stark opposition to the Centers for Disease Control and Prevention recommendations that every healthcare worker should be immunized. At Christiana Care Health Systems, their current immunization rate is 93% for this year’s flu vaccine—almost a 30% increase (42% relative increase) above the healthcare average. They have achieved this rate by very visible marketing approaches and having pre-loaded syringes ready so that groundless refusals such as the time it takes, or not having the syringe prepared are rendered irrelevant.

CDC data indicate that between about 5,000 and 45,000 people die in the United States alone each year due to influenza. Vaccines continue to be the most effective healthcare intervention ever developed by humans. We need to ensure that we do our part to not only ensure they are designed, developed, and manufactured properly, but also to dispel myths in the public that short-circuit vaccination’s ability to work through herd immunity, ensuring that there are so many people immunized in the population that preventable diseases don’t have unbroken vectors to spread through to cause outbreaks. 

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Ben Locwin
Healthcare Science Advisors

Ben Locwin, PhD, MBA, MS writes the Clinically Speaking column for Contract Pharma and is an author of a wide variety of scientific articles for books and magazines, as well as an acclaimed speaker. He also provides advisement to many organizations and boards for a range of healthcare, clinical, and patient concerns.