‘Less likely to die’ is what you want when you get the flu

I was on Twitter, as I often am, and a tweet flashed by that angered me. It was from someone claiming to be a nurse who was promoting lies about influenza, that it is a benign illness and that the vaccine is unnecessary and ineffective.

The tweet was probably from a bot, but regardless it hit a nerve.

We are in a vaccine preventable disease crisis. It seems each day brings a new report of yet another measles outbreak — measles is becoming endemic again.

Vaccines, some experts say, have been a victim of their success. Most non-medical people — and even many in medicine — have never seen some vaccine preventable diseases, such as measles, mumps or polio, because of the power of vaccines. If you never see a disease or hear about its devastation, one could see how you might think it is uncommon or not serious.

Although, as an aside, I would like to point out we only develop vaccines for diseases that cause serious morbidity and mortality. It’s not as if anyone is pushing for a vaccine against the viruses that cause the common cold.

Why it’s less effective

Influenza vaccine hesitancy is a little different. Vaccination against influenza is less effective at eradicating the infection than vaccines against measles or polio. There are valid biological reasons for this, one is the strains vary year to year and that is not the case with other vaccine-preventable infections.

However, what is also true and often forgotten is you are less likely to get influenza if you have been vaccinated and if you do get influenza, you are less likely to die.

This is a good time to point out that “less likely to die” is a desirable medical outcome and, to put it bluntly, is how medicine works. For example, when offering surgery or chemotherapy for cancer there are often choices, and some surgical techniques or chemotherapies have better survival rates — meaning you are less likely to die — than others. Most people want the “less likely to die” option with their cancer care. I don’t think anyone ever has said, “Doctor, that chemotherapy is not 100 percent effective, so I will not take it.”  So, I find it stunning that “less likely to die” from influenza has many people balking.

I suspect the false belief that influenza is not a serious illness is a big part of this specific vaccine hesitancy. And so triggered by that tweet I decided to take action. I spend a lot of time learning how social media impacts medical decision making. For example, we know the more people are exposed to incorrect information, the more likely they are to believe it. We all mistake repetition for accuracy — this is called the illusory truth effect.

I wondered if I could do the same thing, but with truth. Flood timelines with accurate headlines and information about influenza?

Impact of stories

I know stories have an impact, that is why many journalists start their reporting with a human interest story. I imagine we have been communicating via stories since we were first able to communicate. And for good reason, they resonate.

And so I tweeted the following:

“I am so tired of hearing how influenza isn’t a ‘big deal’ from anti-vaccine forces. Personal stories can sway opinion. If facts did, we wouldn’t have falling vaccination rates. So if you have a #flustory to share, please add it. Maybe it will change some minds. I’ll go first.”

I started with my own stories, how my son Oliver who was born at 26 weeks and suffered from lung disease and who also has a serious congenital heart defect caught influenza when he was 2 years old and almost died. I also tweeted about having H1N1 influenza myself before the vaccine was available, and how I was so ill that I had to crawl to the bathroom for two days (never mind the fear that I would give it to Oliver).

And then people started sharing their stories and it broke my heart. So many stories of the human tragedy that is influenza.

Many health care providers chimed in early, revealing both professional and personal tragedies. Here is a sampling:

@MDiBartoloMD “In residency looked after a 7yo girl in the ICU — seen at noon in ER & sent home as mild viral infection, because her symptoms *were* mild at that point. At 7pm collapsed @ home. By 9pm on ECMO (ie. heart-lung bypass). Died the next day. Previously healthy. Devastating.”

@nursemommyleigh “I work in an ICU, and watching parents of an otherwise healthy, strong 17-year-old boy say goodbye because the nitric, proning, and VV ECMO couldn’t get him through the flu is heartbreaking.”

@medlawmd “My father died of influenza in 2017. I miss him still.”

@SDietzMD “A dear friend, an otherwise healthy man, left work early with the flu and died at home later that night. Since he lived by himself, nobody knew until someone went to check on him. I hate thinking about how he was alone at the end.”

And equally heartbreaking from the non-medical community:

@_Lilzy “My friend was 53 & sick for few days but still going 2work. Monday noon she gets very sick, another person drives her home & calls her hubby. Tuesday 10 am I get 1 of the worst calls of my life. #flustory. I still keep her emails & texts. Miss you, Anna.”

@jillpromoli “My perfectly healthy 2-year-old woke up with a low-grade fever and died hours later. Influenza B stopped his heart. I knew the flu was serious. I didn’t know it could cause organ failure. I didn’t know it killed ~3500 Canadians every year.”

Deaths are rising

In the United States the 2017-2018 influenza season was the worst on record — 80,000 deaths. This is the highest number of deaths since tracking began in 1976. The previous record was 56,000.

The influenza vaccine will not eradicate influenza, like vaccines have eradicated smallpox and could eradicate measles, but it is still highly effective medical care. It significantly reduces illness, medical visits and hospitalizations. It means if you catch influenza you are less likely to have a protracted illness or die. Pregnant women, who are more vulnerable to influenza-related complications, are 40 percent less likely to be hospitalized with influenza if they get the vaccine, and the vaccine will provide their newborn with protective antibodies.

The science around the influenza vaccine is clear — it is effective medical care and it saves lives.

I recognize science doesn’t always change minds. So if you are influenza-vaccine hesitant, go to #flustory on Twitter and read through the human tragedy that is influenza and the devastation it leaves behind.

With the influenza vaccine you are less likely to become one of these stories.

Dr. Jen Gunter is a Marin resident and an ob/gyn in San Francisco. Her column appears every fourth week.