I spend a lot of time on this blog debunking bad anti-vaccine arguments (for example here and here). Nevertheless, logically invalid anti-vaxxer nonsense continues to rear its ugly head. Therefore, in this post I am going to focus specifically on five seriously flawed, yet amazingly common, arguments against the flu vaccine.
Bad argument #1: The flu isn’t a deadly disease
This is probably the most common argument that I hear against the influenza vaccine. It’s also a complete load of crap. People often describe the flu as, “a minor illness” or “just a bad case of the sniffles.” In reality, however, the flu kills roughly 1,000-49,000 people every year in the US alone (mean = 6,309, median = 5,128; Thompson et al. 2010), and globally, it kills 250,000-500,000 people annually (WHO 2014). A disease with a six digit death toll simply cannot be described as a “minor illness.” To be clear, this is not fear mongering. It is a simple fact that the flu kills hundreds of thousands of people annually. Therefore, it is, by definition, a deadly disease.
On several occasions, I have encountered anti-vaccers who respond to these mortality rates by claiming that influenza isn’t actually the killer. They point out that most of the people who “die from the flu” actually died from secondary complications like pneumonia. Technically speaking, this is true, but those secondary complications occurred because of the flu. This response is no different from describing the death of a gunshot victim by saying, “the bullet didn’t kill him, it was the loss of blood.” Fine, perhaps the loss of blood was the proximate cause of death, but the patient lost the blood because of the bullet. The patient would not have died at that particular time if he hadn’t been shot. Even so, yes, pneumonia, heart failure, etc. are often the proximate causes of death in influenza patients, but those problems arise because of the flu and result in the deaths of people who probably would not have died at that particular time if they hadn’t gotten influenza. So if you are going to say that the flu isn’t deadly because it simply causes secondary problems rather than directly killing its victims, you are also going to have to make a lot of other rather bizarre claims. For example, you’re going to have to say that smoking isn’t deadly, because it’s the lung cancer that actually kills people. Similarly, jumping off of a sky skyscraper isn’t deadly, because it’s the impact with the pavement that actually kills you. HIV is also not deadly, because it’s the secondary infections that actually kill you. These are necessary outcomes of using this absurd line of reasoning.
Bad argument #2: Influenza isn’t serious in healthy teenagers/adults
This argument is really a continuation of bad argument #1, but it is common and important enough that I decided to treat it separately. It is an extremely frequent response to the enormous death tolls from influenza, and it’s basically just the classic, “it won’t happen to me” response that anti-vaccers so dearly love.
This argument usually goes as follows, “Influenza is only serious/deadly in the elderly, infants, and people with certain medical conditions, but I am a healthy adult; therefore, I don’t need to be worried.” First, it is true that the death rates are highest in those high-risk groups, but that does not mean that no healthy individuals ever die from it. Further, the list of people who are at a high risk of serious complications is quite extensive. The WHO says the following:
“Yearly influenza epidemics can seriously affect all populations, but the highest risk of complications occur among children younger than age 2 years, adults aged 65 years or older, pregnant women, and people of any age with certain medical conditions, such as chronic heart, lung, kidney, liver, blood or metabolic diseases (such as diabetes), or weakened immune systems.”
I’m not sure about you, but I know quite a few people who fit one of those categories, which brings me to a very important point: vaccination is about more than just your personal safety. Let’s assume for the sake of debate that as a healthy adult, you are impervious to the serious consequences of the flu. That doesn’t change the fact that you can act as a vector and spread the flu to people who are in the high-risk categories. Anti-vaccers like to claim that herd immunity is a myth, but it’s actually a well established fact. Numerous studies have experimental confirmed that it works (Monto et al. 1970; Rudenko et al. 1993; Hurwitz et al. 2000; Reichert et al. 2001; Ramsay et al. 2003), and it’s really just a simple mathematical concept that is easy to simulate. So by getting vaccinated, you are helping to keep people in the high-risk categories safe. Anti-vaccers often act as if vaccines are a matter of personal freedom, but they are actually a matter of public responsibility. Even if you are not personally in a high-risk category, you should get vaccinated for the same reason that you shouldn’t drive drunk: your actions affect other people. It is extremely easy for an otherwise healthy adult to accidentally infect a nursing home, nursery, relative who is pregnant, someone who is fighting cancer, etc. Your action (or inaction) can have dire consequences on those people.
Finally, although healthy adults generally do not experience the worst symptoms, it’s still a miserable disease. It is not just, “a bad case of the sniffles.” For most people, it is several days of fever, cramps, vomiting, and feeling like utter crap. One study estimated that each year in the US, influenza results in 3.1 million days of hospitalization and 31.4 million outpatient visits (Molinari et al. 2007). Further, a study which specifically tested the effectiveness of the vaccine on healthy, working adults found that the vaccine significantly reduced instances of respiratory infections, days of missed work, and visits to a physician (Nichol et al. 1995). To be fair, a different study (Bridges et al. 2000) did find that the effectiveness of the vaccine at preventing missed work days depended on how closely the vaccine matches the circulating viral strain, but that is not a valid reason for avoiding the vaccine (see bad argument #3).
In short, yes, the flu probably wouldn’t be life threatening for a healthy adult like me, but the vaccine is extremely safe and will only result in a sore arm and perhaps a day of feeling slightly unwell, and it will help to ensure that I don’t infect people who are at-risk, and it will help me avoid spending a week curled up in a ball, hugging the toilet, and wishing for the sweet release of death. Deadly or not, I’d much rather have a day with a sore arm than a week of abject misery.
Bad argument #3: The vaccine was only 23% effective in 2014-2015, so what’s the point?
There are several important things to note here. First, the effectiveness of the vaccine varies from one year to the next. The 2014-2015 season was a particularly bad one, but the effectiveness is often much higher. There are several reasons why the flu vaccine isn’t nearly as effective as most vaccines. A big part of it is due to the fact that the flu strain changes from one year to the next, and it’s impossible to vaccinate against all of the strains. So the strain that was active last year may not be the dominant strain this year. Thus, vaccine engineers do their best to predict which strains will be circulating in a given year, and they design the vaccine accordingly, but if their predictions are wrong, then the vaccine may not be particularly effective (you can find more on how this works here).
A second reason for low effectiveness is low herd immunity due to poor vaccination rates (see bad argument #2). Even when vaccines cause the body to produce the correct antibodies, they don’t make you impervious to the disease. They make you resistant to a minor dose (a dose that still would have caused an infection without the vaccine), but if you are constantly exposed to large doses of the pathogen, it’s going to be more than you’re circulating antibodies can handle. So, vaccines are most effective when most people are vaccinated, and by not vaccinating, you are actually making the vaccine less effective for everyone else.
Finally, even if 23% effectiveness was the norm, it would still be a good idea to get vaccinated, because your odds of getting influenza would still be reduced. Do you know what’s worse than 23% effectiveness? O% effectiveness, and that’s what you get without the vaccine. Let me put it this way, if seat belts were only 23% effective, would it still be a good idea to wear them? Yes, of course it would, because they lower your odds of having a serious injury in a car accident. Even so, even if the vaccine only prevented a few illnesses and deaths each year, it would still be a good thing because it would still save lives and prevent unnecessary suffering.
Bad argument #4: I’ve never been vaccinated and never had the flu/my uncle was vaccinated and still got the flu
Anecdotes spew forth from the mouths of anti-vaccers like water from Niagara Falls. The problem is, of course, than anecdotes are totally worthless in situations like this (see the comments). I’m sure that you know someone who received the vaccine and still got the flu, as well as someone who didn’t receive the vaccine and didn’t get the flu, but I am equally certain that you also know people who received the vaccine and didn’t get the flu and people who didn’t receive the vaccine and did get the flu. You and I can exchange anecdotes all day and never get anywhere because anecdotes are meaningless. We need proper controls and knowledge of the actual disease rates, not scattered observations. Actual studies, of course, show that influenza rates are lower among the vaccinated (reviewed in Osterholm et al. 2012). Yes, the influenza vaccine is not the most effective in the world (see bad argument #3), and we should definitely be trying to improve it, but in the meantime, some protection is still better than no protection, and anecdotes do absolutely nothing to defeat that fact.
Bad argument #5: You can get the flu from the flu vaccine
No you freaking can’t. The flu vaccine contains either a deactivated virus or no virus at all. It is not biologically possible for you to get the flu from the vaccine because the virus has been shut off. When people say that the vaccine can give you the flu, they are literally proposing a zombie scenario in which something reanimates. We live in the real world, not the Walking Dead, and in the real world, the flu vaccine simply cannot give you the flu.
Note: many people refer to the flu vaccine as having a “killed” or “dead” virus. I personally don’t like that terminology because technically viruses aren’t alive to begin with, and, therefore, can’t be “killed.” However, the fundamental meaning of those terms still applies. It’s like talking about a “dead” battery. Technically speaking, it’s not “dead” because it was never alive, but it’s still totally non-functional and inert. Even so, the virus in the vaccine isn’t technically “dead” because it was never alive, but it’s still non-functional and can’t infect you.
Is the flu vaccine a magic cure all that guarantees that you will never get sick? No, of course not. Is the flu a violent plague that threatens to wipe out humanity? No, but it is undeniable that the flu is a serious disease which kills hundreds of thousands of people each year and causes unfathomable amounts of suffering. It is also undeniable that getting the flu vaccine reduces your chance of getting the flu. So yes, you will probably live without the vaccine, and yes, the vaccine does not guarantee that you won’t get the flu, but when the cost is a few bucks and a sore arm, what do you have to lose? Serious reactions to the flu vaccine are almost unheard of, and getting the vaccine lowers your chance of getting the disease, and it builds herd immunity. Thus, it also helps to protect you and the people who are at a high risk of death or serious complications from the disease. So please, stop reading Natural News, Mercola.com, and other pseudoscience websites and go get the vaccine.
Note: I’m sure that any anti-vaccers reading this will take issue with my claim that serious side effects are extremely rare, so let me curtail your inevitable anecdotes by reminding you that the fact that event A happened before event B does not mean that event A caused event B (that’s a logically fallacy known as post hoc ergo propter hoc). So please, don’t waste my time with your logically invalid anecdotes because they are meaningless and I don’t give a crap about them. Find me a properly controlled, peer-reviewed study with a large sample size, and then we’ll talk.
Bridges et al. 2000. Effectiveness and cost-benefit of influenza vaccination of healthy working adults. Journal of the American Medical Association 284:1655–1663.
Hurwitz et al. 2000. Effectiveness of influenza vaccination of day care children in reducing influenza-related morbidity among household contacts. 284: 1677–1682.
Molinari et al. 2007. The annual impact of seasonal influenza in the US: measuring disease burden and costs. Vaccine 25:5086–5096.
Monto et al. 1970. Modification of an outbreak of influenza in Tecumseh, Michigan by vaccination of schoolchildren. Journal of Infectious Diseases 122:16–25.
Nichol et al. 1995. The effectiveness of vaccination against influenza in healthy working adults. New England Journal of Medicine 333:889–893.
Osterholm et al. 2012. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. Lancet Infectious Diseases 12:36–44.
Ramsay et al. 2003. Herd immunity from meningococcal serogroup C conjugate vaccination in England: database analysis. BMJ 7385: 365–366.
Reichert et al. 2001. The Japanese experience with vaccinating schoolchildren against influenza. New England Journal of Medicine 344: 889–896.
Rudenko, et al. 1993. Efficacy of live attenuated and inactivated influenza vaccines in schoolchildren and their unvaccinated contacts in Novgorod, Russia. Journal of Infectious Diseases 168: 881–887.
Thompson et al. 2010. Updated estimates of mortality associated with seasonal influenza through the 2006-2007 influenza season. MMWR 59: 1057–1062.
WHO. 2014. Influenza (Seasonal). Fact Sheet N°211.
A very useful roundup — many thanks.
Thank you, very useful.
Fallacy Man, I agree with most of what you write but good heavens, you make some dubious sweeping generalisations. Anecdotes are not “totally worthless” most especially in medicine. For several reasons
1. Anecdotes (casual observations etc) are often used by all scientists when formulating their hypotheses.
2. What are symptoms except a horribly unstatistical subjective biased anecdote given by a patient to his/her doctor?
3. In phase 4 of a clinical trial anecdotal information will be collected in order to determine if drugs have side effects.
4. Imagine a new infectious disease arises that causes sufferers to report strange symptoms to their doctor. Should medicine not investigate this…after all such tales will be at first mere rare anecdotes? It might be quite useful to investigate them before the disease becomes established in the population.
5. Of course the case of the man who lives to 100 smoking like a chimney, does not invalidate the general case for why people should stop smoking but that does not mean the case of the 100 year old man might not tell us something interesting about resistance to lung cancer.
Where anecdotes are bad news is considering them as data because they can be and probably are biased but even here that rule can be bent and if there is good reason to think the collected anecdotes are unbiased relative to the analysis under consideration they can even be considered as data (see 4 above). The plural of anecdote can be data. Of course, statistical data beats anecdotes in a straight fight but if the fight is not straight and it often isn’t in this wonderfully diverse thing called science, then anecdotes might be rather useful in the absence of proper data. I note even the skeptical dictionary has moderated its view of anecdotes. Let us embrace the rigour of science whilst keeping an open mind for methodology.
That is a fair criticism, and was admittedly poor wording on my part. I agree with you that anecdotes can have value in certain circumstances (especially as a starting point for future research). What I meant by my comment was that anecdotes are worthless as evidence in a debate or as a replacement for scientific data. Again, my wording choice was poor and I have attempted to make a brief note in the post to correct the error.
Thank you for the article! when I come upon an anti-vaxxer, I’ll be sharing this. I had a kidney transplant 3 years ago. It’s very hard to get across that, I may look healthy outside but I basically have no immune system due to the anti-rejection drugs. Had a cold that lasted 6 weeks! I don’t even want to imagine what the flu would be like. Thank you again.