“I'm in with the in crowd
I go where the in crowd goes
I'm in with the in crowd
and I know what the in crowd knows.”
Dobie Gray, The ‘In’ Crowd

“What is missing, I think, is this notion of the common good.”
Susan George

Annual influenza vaccine formulations are generally less effective in two types of patients: those who are very young, and those who are very old. The why-of-it… is neither clearly understood nor has it ever been fully explained. This is not to suggest that the vaccines are ineffective in these folks… rather, only that they are less effective.

Maybe babies and geriatrics have less than optimal immune competency that lends itself to less than desired immunologic response? Maybe the vaccines bear less responsibility for the failure, than do the vaccinated themselves? Maybe the ghosts of diminished flu vaccine utility past are (unlike the ghost of poor Jacob Marley)… more of gravy than the grave. Who can say?

A busy-bee anti-vaccine faction has lately seized upon the notion of this lesser effectiveness, (but NOT ineffectiveness), of flu vaccines in kids and in seniors. It is suggested that in times of ever scarcer public healthcare dollars, money spent on promoting and providing flu shots for large pockets of citizens who respond to them poorly, might be better spent other ways. It is suggested that current efforts to promote flu vaccines for the very young and the very old is a misguided exercise… that pours tax dollars down a morbid rat hole.

This argument implies that a heretofore great job has been done by the public health effort to vaccinate most babies and most old folks… and that the effort has resulted in a costly treatment failure. Perhaps flu vaccinations are wasted on the very young, the very old, the very rural, and the very poor? Hmm. Perhaps not.

Truth be told, a shabby job is currently being done of immunizing Americans against the flu. In my rural home area of Monroe County, Michigan patients aged sixty five years and older annually immunize against the flu at rates of less than twenty percent. Young children annually immunize against the flu at rates of less than sixty percent. Teens annually immunize against the flu at rates of less than thirty percent. Americans of all ages combined annually immunize against the flu at rates of well less than fifty percent.

Percentage rates of immunization against the flu in each of the above groups plummet further… as the poverty level of the group increases. The poor and the poorly insured immunize poorly against influenza. Even poor seniors who qualify for free flu shots under current Medicare coverage immunize in paradoxically sparse numbers.

Rural counties tend to immunize against influenza at much lower rates than is normal in more urban counties.  However, even urban counties immunize against the flu at herd rates of less than fifty percent.
There are several sound reasons to immunize against the flu:

Personal protection: a flu shot can protect most recipients from catching the flu varieties represented in the influenza vaccine formulation.

Communal protection: if a large enough percentage of a population is immunized against influenza, the spread of the disease can be hindered… offering protection from the disease to the non-immunized portion of the population. This protection phenomenon is called herd immunity. A herd vaccination rate of over eighty percent is usually needed to create widespread herd immunity.

Health system protection: immunization against influenza and pneumonia can drastically reduce costly emergency room visits for the treatment of flu related complications: pneumonia, meningitis, septicemia, and debilitating diarrhea. Budget busting Medicare readmissions in under thirty days for patients covered by Medicare can likewise be curtailed. Deaths from flu complications can be greatly reduced.

The combined savings to the commonwealth from these three protections are both significant and well documented. Flu shots save big money for individuals, for businesses, and for local health systems. Deliberately reducing immunization rates against the flu for young children and for seniors would only cut these savings, and would negatively impact herd immunity. That makes little sense. It costs less to care for a healthy herd of people.

Less is not always more in the healthcare spending game. The money saved by cutting back on efforts to immunize large numbers of Americans would be mere pocket change compared to the money saved as the result of a more successful effort to push the nation’s annual rate of immunization against influenza up over the eighty percent mark.

Combining the resources of the federal government, state governments, public health system, local health systems, and licensed and certified immunizers in a program that promoted the creation of an immunized in crowd that represented over eighty percent of the American herd… would yield an impressive return on investment, and a substantial savings of healthcare dollars.

The notion that the best way to save money is to never spend money, sings a siren’s call in the ears of those currently cinching the strings of the health spending purse. The ship of state has lately favored parsimoniously piloting us onto the reef over clear sailing… when doling out needed public healthcare dollars.

However, infrastructure must eventually be served… be it for the climate, crumbling cities, the highways, the electrical grid, clean tap water, or the healthcare system. Pay a little now, or pay a lot later.

Given the choice between saving big money by preventing costly diseases and reducing human morbidity and mortality with the aggressive application of affordable and proven medical treatments like influenza and pneumonia vaccines… versus saving small change by amputating healthcare costs with the blunt instruments of budgetary surgery? I’m in with the in crowd… every time.

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“We Speak Fluent Medicare”