An ounce of influenza vaccine is worth at least a few tons of Tamiflu

It’s still flu season, although the flu gods have shown a bit more mercy than in years past.  So many variables determine whether each winter brings a relatively mild flu season, a “flunami,” or something in between.  I’m a country boy doing primary care in the city, and I have only a modest understanding of which influenza strain is circulating, the concepts of antigenic drift and shift, and how the big brains decide which antigens to include in the yearly vaccine.

It sure seems that scientists have done a great job this year predicting which strains to vaccinate against, and for this I am eternally grateful.   I hope I’m not giving the “Sicilian kiss of death” to all my fellow clinicians on the front lines by making this observation.  I guess I’m a bit superstitious like that.  In addition to the occasional unfounded superstition, country colloquialisms continue to influence me daily.  My favorite medical one is: “An ounce of prevention is worth a pound of cure.”

Prevention is not sexy.  There isn’t a single TV series telling the stories of lives saved by seat belts, vaccines, or blood pressure medications.  A trio of heroes tackles and subdues a terrorist on a train, and they are (rightfully) widely celebrated.  But no one celebrates the TSA for all the bombings and hijackings they have prevented by merely being there.  Prevention is dull — I fully understand that.  Watching someone scroll through a slideshow full of prevention statistics and graphs isn’t exactly riveting.  Show us the dramatic saves, last minute rescues, and patients impossibly ripped away from Death’s icy grip — that’s must-see TV.

Prevention is so boring (and perhaps so poorly marketed) that we have allowed the expectation of cures to overshadow the utility of prevention.  Many Americans today become standoffish at the mere suggestion of receiving an influenza vaccine.  The misinformation regarding the vaccine is staggering.  These same Americans however, will demand oseltamivir (Tamiflu) within a few hours of developing cough, headache, fever, fatigue, or sore muscles.  This is an expensive medication rife with side-effects, and at best offers modest benefit.  Yet, thanks in large part to its marketing, millions of Americans are convinced it is a magic bullet for the flu.

There is a landslide of data which supports the seasonal influenza vaccine.  When discussing the risks and benefits of the immunization, I have found that this statistic resonates with patients and parents when other data seems to fall on deaf ears.  90 percent of influenza deaths in the pediatric population in 2013 were in unvaccinated children.  Nine out of ten kids who died of influenza and its complications were unvaccinated.  Although the CDC doesn’t comment particularly on this, you can bet the farm that all of those children who later died got Tamiflu when they arrived to the hospital desperately ill.  I understand that comparing the vaccine and comparing the therapy for the disease isn’t fair to do head-to-head, as the vaccine is a primary preventative measure and the medication is not.  The point of this piece isn’t to write off Tamiflu.  According to the CDC, it still has its utility in appropriate high-risk patients, and I typically follow their recommendations.

The point of this piece is to highlight our turning away from simple, country wisdom.  The paradox of prevention is that quantifying lives saved through preventive efforts is difficult to impossible.  These saves, unexciting as they may be, are legion.   That is sexy in its own right.  An ounce of prevention is still worth a pound of cure, regardless of how much the cure costs and how aggressively it is marketed.  When the “cure” isn’t actually a cure (as in the case of Tamiflu), then it stands to reason that an ounce of influenza vaccine is worth at least a few tons of Tamiflu.

Keith Pochick is an emergency physician.

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