Patients Can Join the Fight Against Flu Without Firing a Shot

Later, on another floor, a secretary expressed similar suspicions: "My cousin died the day after he got the flu shot. I just don't trust it." I told her that the death was certainly unrelated to the vaccine. She remained skeptical -- and unvaccinated.

My brief conversations reflected what researchers have long known. A 2006 analysis of 32 studies of why health-care workers chose not to be vaccinated showed four main reasons.

First is a fear of side effects, in particular the misconception that the dead virus the vaccine contains can cause disease.

A recent experience helped me understand how even professionals can feel that way: At my bank one day, a financial adviser stopped blowing his nose long enough to reach out for my hand. So as not to appear rude, I shook it and then forgot to wash my hands afterward. That evening, I began to have sniffles. Instinctively, I attributed my stuffy head to the bank employee, even though I know better than any layman that it takes two to four days after an exposure to a virus for illness to develop.

It's only human to look for causes when we become ill. In a given year, the average American gets two to four episodes of the common cold; if one of those occurs within a week or two of a flu shot, that average American is likely to blame the vaccine.

The second reason is that health-care workers falsely believe they are too healthy to get the flu or have natural defenses against it. Again, studies show otherwise. One study in 1999 showed that in any given year, 7 to 26 percent of unimmunized health-care workers had evidence of influenza virus in their blood. But of those infected people, fewer than half recalled being ill. Those asymptomatic workers, however, were contagious and could infect patients who were presumably less robust. (A person who has acquired the influenza virus is contagious for nearly a week, starting a day before any symptoms appear.)

The third reason why some health-care workers do not get vaccinated is that they believe the vaccine is not effective enough. There is some truth to that. Because there are new strains of influenza virus every year, it's sort of a moving target. Scientists must constantly develop new vaccines, and in any given year the vaccine is only 50 to 70 percent effective. But why should a worker not do everything possible to reduce the risk of transmission?

The fourth reason health-care workers give for not getting vaccinated is that it is inconvenient. It seems to me that any busy worker could make that argument. In any case, many hospitals are addressing the issue, vaccinating staff members in the hallways and at health fairs. I got vaccinated just before our annual medical staff meeting.

That kind of attempt can make a profound difference. In 1988 there was an outbreak of influenza at the University of Virginia Health System in Charlottesville, where only 4 percent of health-care workers had been vaccinated. That prompted the hospital to promote employee vaccinations and ensure that workers stayed home if they got sick. A decade later, the vaccination rate was 67 percent, the confirmed influenza cases among health-care workers declined from 42 percent to 9 percent, and transmission of influenza to hospitalized patients was dramatically reduced. A similar impact has been shown in nursing homes, with decline in overall mortality rates.

At the infectious-diseases gathering I attended in Washington, Don Wright, the principal deputy assistant secretary for health in the Department of Health and Human Services, said various other agencies are working to improve the situation. For example, HHS is tracking and vaccinating its own health-care employees.

But I think we can do more. HHS Secretary Mike Leavitt's initiative on transparency and value-based purchasing could be applied to flu vaccination; that is, providers who receive Medicare funding can be required to publicly report their employee vaccination rates. Also, future payments could be aligned with improvement in the rate. That would get the providers' attention.

Meanwhile, I believe patients can and should act in their own defense.