Public Health

How Well Does The H1N1 Vaccine Work?

Many readers and listeners have raised questions about how effective the H1N1 vaccine is. This one comes from Jennifer Meegan, who is wondering whether she should bother getting vaccinated. She explains:

The fact is ... the efficacy of flu vaccines is under scrutiny by many legitimate doctors and scientists. I don't necessarily subscribe to the idea that the vaccine(s) itself is toxic, etc, etc. But there is a growing case to be made as to whether or not flu vaccines do any good at all.

Meegan specifically mentions a provocative article in this month's Atlantic magazine.

The cover asks "Does the vaccine really work?" The article itself offers the answer "not really," and suggests more tests need to be done.

But there are a lot of problems with that article. We'll deal with two here: One is that it generalizes from the seasonal flu vaccine to the new one. The other is that it ignores a slew of data.

The article points to flaws in some research that suggests that flu shots decrease the overall death rate by 50 percent. It turns out that it may be that healthier people get the flu shots in the first place, so their death rate is lower anyway. So all fine and good — in the elderly, seasonal flu vaccines don't work as well as some people may believe.

But there's plenty of other evidence showing the seasonal flu vaccine is of at least some value in decreasing flu and flu deaths in the elderly.

We talked to Lisa Jackson of Group Health Research Institute in Seattle, who did much of the work to debunk the death rate studies. You might think that because of her work on the seasonal vaccine, she wouldn't believe the new H1N1 could play any role in helping the elderly through the flu season. You'd be wrong. She told me once the younger people who are more at risk of getting the flu in the first place are vaccinated, older people should get in line.

Neal Halsey, who has criticized some vaccines in the past, agrees. He directs the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health. "A 50 percent reduction in a potentially severe and life threatening condition is something I would invest in," says Halsey. And so far, he points out, the vaccine is proving to be very safe.

What about people under 65? The Atlantic article skips right over them. The new flu is attacking mostly younger people, and in younger people this vaccine (like seasonal flu vaccines), is very effective — 70 to 90 percent effective, according to Anthony Fauci. And that, he says, is very good.

"It's never 100 %, it will never be 100 %, but it's enough to have a major impact on disease and on the spread of this virus," he says.

So generalizing from questions about the seasonal vaccine's effectiveness in older people to the value of the new H1N1 vaccine in younger people is a bit too much of a stretch.

Public health is all about making decisions in the grey zone. Wait until you have a nearly 100 percent effective vaccine, and you're going to lose a lot of people to the disease. Move too early, and you're going to have the swine flu incident of 1976, where millions of people got vaccinated against a virus that never moved off an Army base in New Jersey, and several hundred vaccine recipients developed a paralytic condition called Guillain Barre syndrome.

The short answer to the vaccine's effectiveness? Getting the vaccine will reduce your risk a lot if you're under 65, and a significant amount if you're older. Whether it's worth the hassle of tracking it down, since shortages continue in many areas, that's a decision only you and your doctor can make.

If you've got a swine flu question, email us at shots@npr.org. Please let us know where you're from when you write.

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