June 05, 2017
Mirella Salvatore, MD, an assistant professor of medicine and health care policy and research at Weill Cornell Medicine in New York City, said the influenza vaccine itself is at least partially to blame for some people’s refusal to receive it. First, the shot isn’t 100% effective, especially when the seasonal vaccine fails to match the circulating strain. If I get my flu shot, but can still get the flu, what’s the point? And then there’s the argument born out of misinformation that sometimes spreads faster than influenza. I don’t get vaccinated, because the flu shot will give me the flu.
Dr. Salvatore has heard all the excuses patients have for refusing vaccination, but doesn’t believe any are a valid reason for failing to receive protection against influenza. She recently talked about the importance of educating patients about receiving the annual flu shot and increasing the confidence they have in the potentially life-saving vaccine in order to prevent the spread of infection, especially among high-risk populations.
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What are the common reasons for resisting the flu vaccine?
It depends on the population, and some objections can be overcome more easily than others. There are a lot of infections referred to as the “flu” or “flu-like symptoms,” but that aren’t actually the flu. That perpetuates the mistaken belief that influenza is not a seriousness illness, and that the annual vaccine is not needed. When people get the actual flu, they say, “Oh, now I know what it is,” and are more likely to understand the importance of vaccination.
The intranasal flu vaccine is no longer recommended for use, because of a lack of effectiveness since 2013. That’s another problem for people who point to the limitations of vaccines to justify foregoing the flu shot each year. The most difficult people to reach are those with engrained beliefs that vaccination is unsafe or ineffective, even though they’re reminded about its importance whenever they see health care providers during the flu season.
Can anything be done to reach individuals, who simply don’t believe in receiving the annual flu shot?
When patients tell you they don’t believe in the flu shot, it’s difficult to change that belief, to be honest. I’ve heard patients don’t want to be vaccinated, because they think the vaccine will give them the flu. That won’t happen. You can experience a small reaction to the vaccine that might make you feel ill, but you simply can’t get the flu from a flu shot. It’s really difficult to convince patients who believe that type of misinformation. On the Internet, patients can find whatever information they want to support their beliefs or argue against beliefs they want to contradict, so it makes our jobs as patient educators more challenging.
What information do health care providers need to convey to emphasize the importance of annual flu vaccination?
More education is needed to reach patients with the right message, which should include the negative consequences of not being vaccinated. As providers, we emphasize the importance of vaccination whenever we see patients. Perhaps we need to target specific patient populations about the risks of avoiding vaccination. For example, we need to ensure diabetic patients understand the grave danger they put themselves in by refusing flu shots. Patient education sometimes needs to be explicit in order to hammer home the importance of vaccination.
What other efforts would increase flu vaccination coverage?
There’s a continued problem of inadequate access, with a lot of people who aren’t able to easily get the seasonal flu shot. Health care providers and local governments need to do a better job of targeting educational efforts and improved access to vulnerable populations. Those efforts could include offering the vaccine for free. One of the biggest successes for slowing down the spread of HIV involved free access to therapy and therapies at clinics set up in mobile care centers. That care significantly increased the number of people who were diagnosed and treated for HIV. Perhaps the same approach would prove feasible for individuals who might not have access to influenza vaccination due to cost considerations or other reasons.
What’s your opinion on mandatory vaccination?
That’s difficult to enforce. The argument boils down to protecting individual freedoms and protecting the health of our nation’s population. I’m Italian, and Italy just mandated vaccination for all children in response to the reemergence of childhood infectious diseases, such as measles. I’m not sure if that’s the approach to take here in the United States. I understand the concerns individuals have about protecting their freedoms, but, in some cases, those beliefs increase their negative reactions toward needed vaccines.
In my opinion, some vaccines should be mandated for specific population groups, but that idea opens up the possibility of discriminating against certain individuals. Some health care workers are required to get vaccinated, and I think that’s important, because infected providers can kill compromised patients. However, I also know that some health care workers don’t agree with that policy. It’s a difficult topic to hash out.