'Ordinary' Influenza: A Public Health Failure

This post by ScienceBlogling revere about the horrendous human cost of influenza is getting some serious exposure. This gives me an excuse to mention something I haven't in a long time:

Stop worrying about avian influenza. Get serious about 'ordinary' influenza.

Why? Last year, 'ordinary' influenza killed roughly 36,000 U.S. residents. That's about equal to breast cancer which kills 40,000 annually. Before the polio vaccine, the polio virus killed 3,000 people annually, and, even if you adjust for population increases, that number would be roughly 9,000 in today's terms. HIV/AIDS kills about 18,000 U.S. residents annually. That means, in the U.S., for every person who died from AIDS, two people died from influenza. With AIDS and breast cancer, people run, walk, jump, skip, and pogo stick for The Cure. Lots of fucking ribbons. But influenza is a silent killer.

And most of those deaths could be prevented.

I've described elsewhere how a sane vaccination strategy could lower influenza deaths by eighty percent--that's over 28,000 lives. And we don't need to piously invoke Hope for a Cure. We just have to vaccinate more people--and the right ones. It's that simple.

Could you even imagine the kind of pandimensional shitstorm that would ensue if we could reduce AIDS or breast cancer by eighty percent, and we didn't, simply because we couldn't get our shit together?

For a long time, I was willing to support the concern about avian influenza because I figured that the steps needed to prepare for avian influenza could be 'repurposed' for ordinary influenza. All of the things we'll need to stop a pandemic are the same things we can use every year to treat the annual influenza outbreak: the ability to rapidly produce hundreds of millions of doses of vaccine, a serious distribution system (actually, having a system would be helpful), and educating people about proper public hygiene.

None of that has happened. We don't produce enough vaccine to adequately vaccinate the U.S. population against the annual epidemic (we would need roughly 200 million doses), and that's a reflection of our 'surge' capability, so good luck if an avian pandemic happens.

But what's truly scandalous is our vaccination strategy--or lack thereof. Let's leave aside the fact that people actually have to pay money to receive a vaccine against a disease that kills 36,000 people annually.

Actually, rattle that last sentence around in your noggin. For that not to be utterly insane, you have to have Ayn Rand's Atlas Shrugged shoved so far up your ass that it's sticking out of your mouth.

And the people who are vaccinated are the wrong people. Yes, elderly people should receive the influenza vaccine because it reduces their likelihood of death by about thirty percent. The focus on the elderly, however, ignores a basic, albeit Yogi Berra-esque, rule of viral transmission: the best way to avoid getting influenza is to not come in contact with people who have it. In other words, we have to vaccinate those who spread the disease: medical workers, nursing home patients and staff, and children aged 5-18. Studies indicate that vaccinating seventy percent of children aged 5-18 could reduce influenza deaths by up to eighty percent. In other words, the grandchildren are killing their grandparents.

All that requires is enough vaccine and a system to get it to the people who need to take it (for children, it called schools). Since we can't even do this right, even though we know that we will have an ordinary influenza 'epidemic' every year, I don't think we stand a chance against a real pandemic.

The reason we haven't implemented these simple steps, I think, is because we've been far too focused on avian influenza. Quite simply, people don't really care about avian influenza. They're too focused on trying to get by, not lose their jobs, and, to use El Jefe Maximo's phrase, "putting food on their family." Worrying about something that might happen isn't even on their radar screens in any serious sense*.

We need to stop focusing on a possible pandemic, and start focusing on the annual epidemic. Because right now, we're not prepared for either.

*Of course, if you ask people, they'll state they're worried, but not enough to do anything about it, which is what matters.

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Where is the 30,000 deaths/yr for influenza broken out? I have seen death data but they always slam influenza and pneumonia together (and get about 60,000 deaths so the number sounds correct). I was just looking for some specific data on ages, etc.

Oh, well, as for that, I have Rand in my DNA (close enough) and it occurs to me to point out that SOMEONE has to pay for the vaccines.

That said, the people at risk are the poorest, and it is in the (cover your ears) "enlightened self-interest" of the better-off to pay for the vaccines of the poor. It is worth the money. I, and any other thinking person, would gladly contribute to the cause.

By speedwell (not verified) on 24 Aug 2007 #permalink

The professional nursing community has been silent on this issue for far too long. School nurses - both in K-12 and colleges/university settings, community health nurses, public health nurses and nurses in ambulatory care settings are best placed for reaching the largest segments of the at-risk populations. Professional nurses have the practice outlook to teach, coach and mentor people to be able to successfully manage disease transmission reduction, management of symptoms and determining successful health decision-making.

But instead,k school nurse position have been eliminated or case loads increased dramatically, with many school nurses covering multiple schools and thousands of students, faculty and staff. There is no partnership of nurses between practice settings, and all vaccination programs are run independently and in isolation for the most part.

It would be incredibly helpful if the American Nurses Association took the lead on this and worked with its constituent sate members to provide a campaign to build a mission, vision and objectives for national influenza transmission reduction and illness management, to create a communication and planning nexus for nurses from various practice settings and employers, and a research nexus to be able to study population variables, nursing programs efficacy, intervention efficacy, and flu transmission reduction, incidence, and morbidity and mortality rates.

It's a different world up here in Canada. As a teacher I get the vaccination every year for free (so my students don't kill me). I just pop into the local health center in the fall and they set me up right away.

Speedwell, it's people with your attitude that I just don't get. Sure someone has to pay for it - that's what taxes are for. A national vacination strategy saves the health system money and helps the economy by reducing the amount of sick time people take off work. According to HealthCanada statistics we range from about 500 to 1500 deaths per year (including pneumonia). Since the US has roughly 10 times the population of Canada that is the equivalent of 5000 to 15,000.

A socialized medicare system allows a nation to practice preventitive medicine which saves money and makes everyone healthier in the long run.

A contrarean view with no stats, but I have heard Influenze called "the old persons friend" in other words, everyone got to dead sometimes, and this might be a better way to go than some of the alternatives.

Speedwell, it's people with your attitude that I just don't get. Sure someone has to pay for it - that's what taxes are for.

Ha! I'm always amused by statements like this.

Brian, the smaller the society, the easier it is to ensure that the government is sensible and enlightened. I'm sure you've got a nice system going in Canada. Trying to implement it in the US, directly, would tear it apart completely.

By Caledonian (not verified) on 25 Aug 2007 #permalink

The American Lung Association has a great site 'Faces of Influenza', with information in lay terms, with a really moving public service announcement (if you're interested).

As for information for healthcare workers, virtually every professional organization/agency strongly encourages the immunization for influenza of all healthcare workers: Joint Commission, APIC, OSHA, CDC, FEMA...and yet the average rate of HCW immunizations at most healthcare organizations is around 40%. Virginia Mason in Seattle reached 98% (got a nice award from CDC), but only by making it a 'condition of employment', which riled the nurses' union...but you can find that information for yourself.

We're attempting a major immunization push at my hospital this year (maybe you'll read about us getting that CDC award next year). My personal strategy will be to call anyone who balks at an injection of dead virus in saline solution a 'big, fat, whiny baby'. Of course, Legal hates when I say that.

Ha! I'm always amused by statements like this.

Why is it amusing? Sounds like common sense to me.

By Michael Schmidt (not verified) on 04 Sep 2007 #permalink

Speedwell, it's people with your attitude that I just don't get. Sure someone has to pay for it - that's what taxes are for. A national vacination strategy saves the health system money and helps the economy by reducing the amount of sick time people take off work