Vaccine Efficacy: A Fact, Not Just Something to Believe In

As I like to keep my hand slightly in emergency medicine yesterday I worked one of my (infrequent) shifts in the emergency department of my hometown hospital. Throughout the course of the shift at this medium-sized community hospital, I took care of several cases of pneumonia and likely influenza.

One patient encounter particularly struck me. I took care of a girl of about 6 years of age who had upper respiratory complaints such as cough, sore throat, and fever. I make a point of asking every parent of a child with a potential infectious disease the vaccination status of the child because it is an important piece of information to know for diagnostic purposes and, if found to be lacking, an important opportunity for education. This particular child was fully vaccinated except against influenza. The mother stated "we don't believe in flu shots." Her reason was that the shots, she alleged, make her entire family sick immediately upon receipt. I tried to debunk this "belief" but really didn't get anywhere. I left the room and went back to the nurse's station and vented to the nurse who said she didn't "believe" in flu shots either!

I find the nurse's position really untenable as she is well educated on the efficacy of vaccines and the role they play in controlling infectious diseases and preventing the worst complications of infections such as influenza. This is something taught in nursing schools and written about in nursing journals; it is a well established part of nursing practice. I suppose this nurse is someone that will unfortunately prove recalcitrant to any mandatory influenza vaccine campaign which the major academic medical center for whom I primarily work introduced this year.

What I think is interesting is both the mother and the nurse used the concept of "belief" when it came to the efficacy influenza vaccine. The definition of belief is "a state or habit of mind in which trust or confidence is placed in some person or thing" and I do have confidence and trust in the influenza vaccine but I would never put it that way. The efficacy of a vaccine, about 60% (which could be much better) in the case of the flu vaccine, is an established fact dependent only on the immunological phenomenon elicted by the vaccine. The immunological effects of the vaccine occurs whether someone "believes" in it or not. In other words, it is a fact independent of anyone's recognition of it. 

A fact can be evaded, but it will still be a fact. Reality has primacy and vaccines work.