Much ado about the flu vaccine

This is not a piece that is pro-vaccination or anti-vaccination.  I am writing this as a citizen and consumer of the health system in Canada. I have watched the messaging about the influenza vaccination both in 2009 and now in 2014.  It may be time for our health officials to pause and take the time to understand why people are (and are not) getting vaccinated.

In some provinces, the rate of immunization for influenza is a dismal 20%.  That means 80% of citizens are not getting vaccinated.  What I wonder is: why?

It is important to understand why some people get vaccinated early in the season, why others wait until a perceived crisis, and why others don’t get vaccinated at all.

A certain percentage of people regularly get their influenza vaccinations every fall.  For others, seeing headlines in the paper that announce, “Nine deaths in Alberta, 300 hospitalizations linked to the flu” is enough to send them to a clinic.  There are others who have legitimate questions that need answering before they will make their decision.

It is our health officials’ responsibility to answer our questions clearly and in plain language.  The public should not be made to feel stupid, lectured to, or scolded if they have questions about the vaccine.  I wish that health officials would find out what information we need, and help us interpret it by providing value-neutral, concise information on websites and through phone lines.  The only way to find out what information we need is to ask us, and not to make assumptions about what we need to know.

There is also a need to make the vaccinations accessible and convenient for people.  Some people won’t reschedule a cancelled appointment, or drive across town in poor weather for a clinic, or stand in line for hours for a shot.  From a consumer perspective, it is a good strategy to bring the vaccinations as close to the people as possible: at their community pharmacies or family physicians’ offices (assuming that they don’t run out of supply, as happened in Alberta) . Ontario is making it easy to set up a flu clinic at workplaces, and encouraging the sharing of success stories on the Ontario Ministry of Health and Long-Term Care website.  Clinicians who work in the inner city are famously creative in their flu shot offerings – even going to pubs and local meeting places to offer immunizations.

There are some people who will not get immunized, no matter what information is shared with them, or how convenient the immunization clinics are.  How they feel about the flu vaccine is more important than their knowledge of their risks of not getting immunized.  I think many people aren’t getting vaccinated because of a lack of trust.  This could be a lack of trust of health officials, the health system, or of pharmaceutical companies.  Immunization involves having a foreign substance injected into our bodies. So if we distrust immunization itself, question the effectiveness of the vaccine, or are suspicious of the motives around a program of immunization, our attitude isn’t going to be altered through a billboard campaign.

The vocal anti-vaccination community adds complexity to the issue.  If there is not inherent trust in health officials, then people will be influenced by dissenting opinions.  This is when things get confusing for us regular folks – who should I believe?

Health organizations need to proactively build trust with their stakeholders and citizens over a long period of time, and not just assume, during a crisis, that people will suddenly demonstrate the behaviour that they are looking for.

We make decisions about our health based on a variety of factors, and taking the time to ask why we make decisions – whether or not health professionals agree with them – is the first step to understanding the needs of the people who are supposed to be served.  It is simply not enough to tell people to get immunized “because we said so.”

The comments section is closed.

  • A. Reader says:

    Hear! Hear! I agree with every word, although my contribution may be of added help in understanding.

    I’m over 50, a hermit and at home; I never got the flu shot when I was still working because I was taught the flu was just an annual thing that people shouldn’t make a big fuss about. I was also taught not to unnecessarily “waste” taxpayer resources, and leave limited supplies of the vaccine to others who were at higher risk (eg kids, elderly, the frail and those who were less fortunate in terms of good health). In short, I was taught that a “good” woman was a self-sacrificing one, and since they do run out of the flu vaccines… My previous family doctors never tried to convince me of anything after I said “no, thanks”, and I haven’t had any flu since I left the workforce due to disability, either.

    I did, however, buy into the previous huge marketing campaigns for paps and breast exams, took the “good girl” approach and submitted, trusted my established doctors, and only recently got more informed about the pros and cons. Hence, I decided to stop “submitting” to painful and humiliating procedures every single year, as they are simply contra-indicated for me, personally, at this stage in my life. It’s my body. I will consent if I agree that they are are needed…but not not for routine screening so that the industry can get paid for inflicting pain onto me. If more women resisted the coersive tactics and marketing campaigns, perhaps the medical community would invent less painful and invasive procedures, but as it stands now, they have zero incentive to replace these with better ones.

    However, the last family doctor (I’m transitioning as the good ones retired) told me it was “your choice” about the mammogram she offered, then proceeded to roll her eyes at me when I made that choice. She did not inform me of the risks, or asky “why” I’d replied “no, thanks”. She didn’t care to know why; I think she just wanted me to agree so that her stats and bonus payments would improve. The second appointment was even worse in terms of derision, so I fired her for cause. (Yes, she showed even more egregiously problematic behaviours than the eye-rolling.)

    Yes, physicians must earn the trust of their patients, and they might want to think of offering us some indications of trust and respect if they want it from us in return. Nothing harms trust in doctors more than some of the behaviours I’ve witnessed.

    After reading this article, I may agree to a flu shot, as needles aren’t a big deal for me, and I don’t have a problem helping doctors with their numbers as a general rule. I did have mumps, two types of measles, and whooping cough as a child because the rules were different in the 60s, my family lived far away from doctors, etc. Just don’t try to “sell” me something that’s more helpful for the general public or the medical industry than for me, and don’t pull the power trip on me that’s inherent in the “because we said so” attitude.

    The “why” question is the most important one to ask, but almost no one does ask it. If they did ask, they might get a good answer and better results.

    Even the least-educated people (like my parents and many friends) I’ve had the great fortune to have known can sense when they’re being conned with a marketing campaign or a power trip.

    • David Grant says:

      While understanding you do make some very good points, I still don’t temper my criticism towards the anti-vaccine advocates because their message is sheer poison. While modern medicine does have its flaws and some people are effected by bad medicine, I still wouldn’t take western medicine over the quackery that some people have place their trust in. I am really tired of being accused of being a defender of Big Pharma because I use pharmaceutical drugs to deal with my hypertension and not CAM and because I think not getting your children vaccinated is an irresponsible thing to do. I am all in favor of people making their own choices, whatever they maybe, but this choice can affect other people and we need to take it seriously.

  • David Grant says:

    I, for one, am getting pretty fed up with all of the pseudoscience around. There is plenty of evidence that the risks to vaccines are low and the benefits are high. There are always risks in life, and these ones are pretty manageable. If one consults the blog Science Based Medicine, Respectful Insolence, or the blogs of Rachael Dunlop and you will find no support for the anti-vaccine movement. The study done by Andrew Wakefield was full of flaws and it has been debunked time and time again. It is time to stop with thinking that there is another side to this issue when there isn’t one. This is called false balance and while this is appropriate in many cases, it isn’t in regards to science. To quote the late Daniel Patrick Moynihan, “people are entitled to their opinions but not their facts”. I hope that the ideas of the anti-vaccine movement to put in the ash heap of history with a lot of other idiotic ideas.

  • Tanja Nelson says:

    refreshingly balanced perspective, Sue – thank you for sharing. I generally get vaccinated, but it slipped off the plate this year … the media-generated hype and general conflicting info from AHS and the media seriously annoyed me this year … first creating a mild panic, herding the masses into clinics, and then ‘oh, well, we’re out’ … shows immense lack of foresight and planning. If the gov’t want 70% vaccination rate (or whatever it is), they should first ensure that they have access to a realistic supply.

  • Katharina Staub says:

    A very balanced piece Sue. Thanks. We chose not to vaccinate this year. We have for the past 4 years due to the fragility of our children’s health. I now feel that with good hand hygiene, the fact that nobody in my family works or visits sick or fragile individuals at this time, I work from home and have little contact with the public, made me decide that it was not necessary this year. A personal choice really and I dislike being told what to do, I think that it is important people make their decisions based on their beliefs.

  • Linda says:

    Excellent points made here. I personally and professionally am skeptical about the flu vaccination. Although I believe vaccination is a fundamental illness prevention strategy, I have witnessed two of my colleagues suffer devastating, debilitating effects following adverse reactions to past vaccines. I think government could go a long way to build trust by transparently reporting incidences of adverse events arising from vaccination to the public, such that healthcare consumers are aware of the benefits and risks of vaccination upon which to make informed decisions.


Sue Robins


Sue is an author, speaker and health-care advocate. Her book Bird’s Eye View: Stories of a Life Lived in Health Care was published in 2019.

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