This article first appeared in the St. Louis Beacon, Oct. 14, 2009 - During her brief stop in St. Louis last week to promote the H1N1 vaccine, U.S. Secretary of Health and Human Services Kathleen Sebelius took the occasion to speak directly to people who don’t typically get flu shots.
"I'm troubled by the fact that year in and year out, fewer than 50 percent of all populations except for 65 and over who are targeted for the seasonal flu vaccine actually get it," Sebelius said during her news conference at Saint Louis University. "We have a pretty low take-up rate."
This season, however, with all the attention paid to the so-called swine flu, Sebelius said she has been encouraged by the increase in demand for the seasonal flu vaccine. Whether the same demand will be there for the H1N1 vaccine, which is arriving to the region in gradual shipments, largely remains to be seen.
Polls indicate that the number of people who choose not to get the H1N1 vaccine will be significant. Roughly half of Americans in an Associated Press-GfK survey said they didn't plan to get vaccinated. The poll showed that most demand came from people 65 and older who, unlike for the seasonal flu, aren’t among the groups thought to be most at risk for getting the virus.
Health officials say enough H1N1 vaccine will eventually be produced to cover everyone who wants it. The initial doses are intended for pregnant women, health-care workers, people with chronic health conditions, young adults and children. "This is a younger person’s flu," Sebelius said during her St. Louis visit.
But some surveys show that many parents are hesitant to give the shots to their children. Both an AP poll and a CBS News poll found that more than a third of parents say they aren’t likely to give the H1N1 vaccine to their children. Other surveys put that number as high as 60 percent.
Count Jen Amunategui among that group. A parent of a two boys under 7 years old, Amunategui said she isn’t planning to get her kids either the seasonal flu or H1N1 vaccine shots, even though they are recommended by the Centers for Disease Control and Prevention. (One of her sons has seasonal asthma.)
"I don’t like to overreact," Amunategui said. "We generally have good health, and chances are (my children) aren’t going to get sick. Unless something is wrong with my kids, I am not overly concerned. I’m just hoping for the best, and I have faith in the medical profession that if they are sick, a doctor can fix them."
Amunategui said her mother gets the seasonal flu shot every year and still tends to get sick even after she gets the vaccine. "It’s almost worse than if she hadn’t gotten it," she said.
Concerns Over Potential Side Effects, Adequate Testing
Like many other parents, Amunategui said she’s also worried about potential side effects of taking the H1N1 vaccine. The CDC says no red flags emerged during clinical trials of the vaccine, some of which took place at Saint Louis University. But many people remain concerned that the testing and production of the vaccine was rushed.
Both Sebelius and Robert Belshe, director of SLU’s Center for Vaccine Development, reassured people last week that that the vaccines are safe and haven’t been prematurely rushed to the market.
“One of the things that has happened with H1N1 is that, without jeopardizing any of the safety steps, the vaccine is becoming available far more quickly than anyone could have anticipated,” Sebelius said. “The virus wasn’t even identified until early April, and here we are in early October and we have the vaccine being delivered.”
Sebelius and other health officials have stressed that the H1N1 vaccine is being made in exactly the same way that the seasonal flu vaccine is made every year. The CDC says it expects the H1N1 vaccine to have “a similar safety profile” as seasonal flu vaccines, which have generally caused only mild side effects like nausea, soreness and swelling where the shot was given. The World Health Organization says it expects any side effects to be mild, but notes that even in large clinical trials it's impossible to identity rare side effects that can occur when pandemic vaccines are administered to millions of people.
Dolores J. Gunn, director of the St. Louis County Department of Health, said after the news conference last week that it's not worth taking the chance of getting infected. “The prevention of H1N1 outweighs any possible adverse effects" that might come from taking the vaccine, she said.
Pam Walker, director of the St. Louis Department of Health, said she is concerned that parents, in particular, will ignore the CDC recommendations. "Parents who have children with underlying health conditions need to be extra vigilant about taking the vaccine," Walker said.
The emergence of a widespread vaccination campaign has led to some strange alliances of groups against the effort. Some on the political right are objecting to what they say is government overreach, and some on the left are skeptical of the health assurances made by government agencies regarding vaccines. Some medical researchers have also questioned how effective flu vaccines are in general.
“There’s a strong anti-vaccine group for lots of things in the state,” Walker said. “It comes down to a personal choice and an evaluation risk.”
Some people simply think the swine-flu threat is overblown -– and that the virus doesn’t pose much of a risk to them. Chuck Bogardus is one of them. The 48-year-old self-employed consultant said he has no immediate plans to get the H1N1 vaccine.
"If enough people are getting the vaccine, there should be a pretty fair degree of containment," Bogardus said. "It’s not 1917 anymore. We have a pretty good medical system, and we know a lot more about taking care of people. In my opinion, this is going to be as much of a problem as Y2K."
There are plenty of people who feel otherwise. Joan Brannigan, a sales associate at Coldwater Creek, already has received her seasonal flu shot and said she plans to get an H1N1 shot.
"This flu thing hits hard from everything I’m hearing about it," she said. "I’m not buying into (concerns about vaccine side effects). As long as government officials have done everything needed to make sure it’ll be OK, I’m fine with it."
But Moritz Farbstein, an advocate of alternative health care and nutrition, said the government shouldn't be pushing vaccines. "I resent the interference; I don’t think it’s the government’s place to tell people to get a vaccination. It far exceeds the federal government's role, which is to educate people and provide full disclosure."
Farbstein takes a variety of nutritional supplements and said he doesn’t get the flu. He doesn’t get the seasonal flu shot and isn’t planning on getting the H1N1 vaccine. Farbstein said he questions the effectiveness of the vaccine and is concerned about possible side effects.
“Why would I put myself in the path of something with so much controversy when I don’t need it?” he said.
Doctors Hear Mixed Response From Patients
Jay Epstein, a pediatrician at Forest Park Pediatrics, said he is hearing concern from parents about whether their children should take the vaccine. His office is not a H1N1 vaccine provider, but he said he is following CDC guidelines that recommend the vaccine for young children and young people in general who have chronic health conditions.
Epstein said the H1N1 vaccine is “probably more effective” than the typical seasonal flu vaccine because it’s more targeted. Typically, the CDC and World Health Organization make an educated guess coming into fall flu season which viruses are likely to appear. “This difference is this time we know what we’re trying to protect against,” he said.
Still, Epstein said he understands parents’ concerns about the vaccines being rushed to the market. He even shares some of them -– even though he said there is no science to back them up. "When things are pushed out in a more rapid fashion, there’s a natural tendency to have some concerns about the safety of the virus," he said.
Sarah Keller, a fertility doctor who works in the division of Reproductive Endocrinology and Infertility at the Washington University School of Medicine, said she recommends her pregnant patients get an H1N1 shot. Her office will not be receiving any vaccines.
Keller said she hasn’t heard any patients express concern about potential side effects. "Pregnant women are at such a high risk and they understand the need for this," Keller said.
Nancy Holmes, a pediatrician at Central Pediatrics in St. Louis County, said parents she sees seem to be split over whether to give their children the H1N1 vaccine. Her office is planning to be a provider, but it doesn’t have the vaccines yet.
“The response I’m hearing is all over the place,” Holmes said. “Some people are very interested in it, and I’m also hearing people say they wouldn’t be caught dead giving it to their child.”
Holmes agrees with Epstein that this vaccine will likely be more effective than the seasonal flu vaccine because it is more targeted. She recommends that parents get for their children the vaccines, which she said have been tested as much as other flu vaccines. But she said she “isn’t pushy” about it.
“In the end, people have to make their own decisions,” she said.