If Your Patients Reject the Flu Shot: How to Urge Them On

Arthur L. Caplan, PhD


October 09, 2019

This transcript has been edited for clarity.

Hi. I'm Art Caplan and I'm at the Division of Medical Ethics at NYU Langone Medical Center. Flu season is upon us, which raises the annual question of whether to get a flu shot.

For many Americans, the answer has been no. Uptake of flu shots is very poor, hovering around 50% in many parts of the country. We need much higher rates to achieve herd immunity.

There are many people who need to get a flu shot because they're exposed to others who are likely to have the flu, such as an airline worker, someone who's working on a train, or people in hospitals and nursing homes. There's a large amount of exposure. Even if we can't achieve herd immunity, it's still really important for most people to receive the flu shot.

What do they need to hear and what are the ethical challenges that seem to get in the way of people getting a flu shot? There is the perennial safety issue. People still worry that somehow the flu shot is going to make them sick, or if they take it during pregnancy, it could make their baby sick. To date, every study points out that it's better to protect the baby against the flu and other problems by getting a flu shot.

The side effects of a flu shot—which I just had, by the way—include a sore arm, but there really aren't many big problems associated with flu shots. Some older patients need to be reminded to get the high-dose flu shot. I think that could be more expensive, which is a different kind of problem. Regarding safety, I think you can honestly say that there aren't any data or evidence [against the flu shot].

Other concerns include people saying that the flu shot causes the flu; every time they get it, they seem to get the flu. It's important to remember that that is not true. Some of these people already have the flu when they get the flu shot.

If huge numbers of Americans get the flu shot, and, say, 100,000 had gotten the flu the day before, they'll think the shot gave them the flu. You cannot get the flu from the flu shot. There's no live virus, so it is impossible.

Others will say that they wash their hands and remain in good health, [so they do not need to get the flu shot]. That can be helpful too, but you really have to do serious handwashing. Recent studies have shown that even if you use an anti-disinfectant, such as Purell, it does not kill the flu virus effectively. It has to be soap and it requires handwashing for a couple of minutes. You could remind people of what hygiene really requires, but most people aren't going to do it. It's better to get the flu shot.

The last argument is that the flu shot doesn't work very well. That is true; some years, the flu shot isn't particularly effective. There have been years where only 20% of people who had the flu shot were protected. I think the right answer, ethically, is that 20% is a good target.

There's one other fact. If you get the flu shot and you still get the flu, even if the strain is different from what the vaccine contained, it seems to boost your immune system so that getting the flu isn't as bad. The symptoms aren't as bad, it doesn't last as long, and it's less miserable.

There are many factual reasons that can be brought to bear to try to persuade people to go out and get that flu shot. Morally, we have an obligation to try to protect one another against communicating the flu. It's important to realize that if you do get the flu shot, you're likely to be able to go back to work or send your child back to school more quickly.

These are social goods and positive public benefits. Tell your patients to get that flu shot.

I'm Art Caplan from the NYU Langone Medical Center. Thanks for watching.

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