Brian Rudman: Vaccination saves everyone from misery

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A word in defence of hippies. Over the weekend, chastened, born-again vaccinator Ian Williams fronted a publicity drive for immunisation, after his child almost died from tetanus. Williams, a science graduate and food technologist, and his health worker wife, Linda, had previously refused to allow their children to get their recommended jabs.

"When it came to my kid's health," he said, "I let the hippy win. I should have let science win." Around 300 years after vaccinations for smallpox had been first introduced to Europe from the Ottoman Empire, he certainly should have let science win. But why suggest hippies were flat-earthers as well?

I was never a hippy myself. Beads and incense weren't my thing. And after years of listening to Auckland University lecturers drone on, I had no wish to rush to India to sit at the feet of yet more gurus. But travelling overland to Europe at the time, we travelled the same roads, caught the same local buses, stayed at the same four rupees-a-day hotels, and swapped information. Like where to update one's vaccinations.

Which is how I ended up in a Russian medical centre on the outskirts of Kabul one freezing morning with assorted hippies, facing a nurse with the demeanour and build of one of her country's then famous shot-putters. She wielded a syringe that could have euthanased a wild elephant at 10 paces. But in my mind, and that of my hippy mates, the fear of catching cholera kept us there.

The Williams' conversion to vaccination came as a result of a face-to-face encounter with tetanus. When my schoolmates and I lined up to receive the miraculous new polio vaccine, there was no dissent that I can recall. We knew the alternative. He clattered around the asphalt playground with one leg encased in heavy metal calipers.

But we humans are an odd lot. Even when we know a quick, almost painless jab will more than likely save us from up to 10 days of winter-time misery, most still choose to do nothing. The public health authorities are now building up for the release of the latest influenza vaccination campaign. Yet unless there's a remarkable change in behaviour, more than 75 per cent won't bother to protect themselves or their families from a nasty disease that will this year kill, either directly or indirectly, about 100 more victims than the 306 who died on the roads last year. Even for those 65 and over, who qualify for a free jab, the uptake is only about 63 per cent.

The size of the casualty list is eye-boggling. The experts estimate between 10 and 20 per cent succumb to the disease each year. Last year, 50,561 visited their doctor with flu-like symptoms. In 2009, the worse year since 2000, the figure was 116,335. A proportion of these end up in hospital.

An investigation into the hospitalisation costs of the 2009 pandemic, published in the November NZ Medical Journal, estimated the cost at about $30.5 million. That was for the hospitalisation of 1508 people. The authors say this is an underestimation of the true hospital costs, leaving out items such as "blood products" and also the costs associated with disruption of normal hospital operations.

Also not recorded are the societal costs linked to absenteeism from school and work.

Released around the same time was preliminary findings from a five-year Southern Hemisphere Influenza Vaccine Effectiveness Research and Surveillance (Shivers) study which suggests that hospitalisation rates related to influenza are greater than previously thought.

Last winter, 1370 flu victims ended up in hospital, 38 in intensive care. Infants under one had the highest rate, followed by the 80 years-plus, then 65 to 79s, then children aged one to four. Researcher Dr Sue Huang noted that "influenza causes more illness each year than any other vaccine-preventable illness".

Despite the misery it causes, fewer than 25 per cent of us will bother to do the obvious. My employer provides me a free on-site jab, no doubt because they appreciate it's cheaper and less disruptive to fund the vaccine than have to splash out a week or more's sick leave to 10 per cent or more of the workforce. In the end, though, more than 75 per cent of New Zealanders gamble on not being among this season's victims. Safely vaccinated myself, it would be tempting to sit back a laugh when they succumbed. But it isn't that simple.

The experts cover themselves by saying the vaccine is only 80 per cent effective. That's to cover themselves if this year's cocktail doesn't include a new strain of the disease. That means the more unvaccinated potential carriers sitting next to me on the bus, or in my workplace, the greater the risk that I might succumb to some errant strain.

In other words, the idiots who are putting themselves and their families at risk by not vaccinating, are also upping the chance I might succumb anyway. That makes me grumpy.