Get Your Flu Shot, Or We All Pay The Price!

Unvaccinated Adults are a Costly Economic Burden Ever Year in the U.S.

LabelsNewswise, October 31, 2016 -- Many of us have seen the signs at work, gotten the emails from our health care insurer, or heard the ads on the radio telling us that it is flu season, and thus time to get an annual flu shot.

Many Americans will comply with this yearly health edict, but many will challenge medical wisdom and opt to face their impending exposure to an onslaught of sneezes, coughs and sniffles without the shield of vaccination. In fact, the CDC estimates that only 42% of adults ages 18 and older received the flu vaccine for the 2015-2016 flu season.

This results in many adults getting sick, causing lost days from work, health care expenses, and even death for those highly susceptible, such as the elderly.

Vaccines are available for prevention of many illnesses, and most Americans get a thorough course of vaccinations as children.

There are also vaccines that the CDC recommends for adults, such as those for influenza (flu), HPV, hepatitis A and B, and meningococcal disease. As we age, our susceptibility to certain illnesses increases, so the CDC urges older adults to get immunized against pneumonia, shingles, and influenza, which are particularly dangerous to the elderly.

Younger adults in late teens to early twenties are strongly urged to get vaccinated against human papilloma virus (HPV), which is sexually transmitted and so common that most American adults will contract a strain of it at some point in their lives.

College-aged adults are also urged to get the meningococcal vaccine, which protects against a potentially deadly infection that causes swelling of the protective coverings surrounding the brain. Many universities require this vaccine for incoming students prior to allowing them to register or move in to on-campus housing.

Despite the proven efficacy and minimal risks associated with vaccines, many American adults continue to forgo getting vaccinations, usually due to doubt of effectiveness, concerns of the safety of the vaccines, or just a lack of consistent follow-up on their personal health care needs.

The result is costly health and economic losses, both to themselves and to the general public.

A recent studyrevealed that illnesses attributable to vaccine-preventable diseases in the U.S. caused a $9 billion economic burden in 2015. Ninety-five percent of these costs ($8.3 billion) were health care expenses, with the remaining 5% ($700 million) representing productivity losses, such as lost income during treatment.

The majority of these costs, approximately $5.8 billion, was attributed to influenza illnesses alone, even though flu shots are readily available at low or no cost to both the insured and uninsured in the U.S.

Many employers offer shots free of charge to employees during flu season, and many health care providers and pharmacies make the vaccine available at convenient times by holding special flu shot clinics in evenings and weekends and at community-based locations during flu season.

In addition to the personal health toll vaccine-preventable illnesses can make on the individual, unvaccinated adults put others at greater risk of illness through exposure to the diseases.

Children, the immune-compromised, or others who have health conditions that preclude them from receiving certain vaccinations are put at unnecessary risk of exposure to illness by the unvaccinated who become sick.

 In a place such as Washington, DC, where there is close contact with many people in crowded public venues or through the use of public transportation, these risks of exposure and disease spread are amplified and further illustrates the need for all those who can to get properly vaccinated.

Vaccines are available to adults for the following 14 illnesses: HPV, Herpes zoster (shingles), varicella (chicken pox), pneumococcal disease (pneumonia), meningococcal disease (meningitis), influenza (flu), Measles, Mumps, and Rubella, Tetanus, Diphtheria, Pertussis (whooping cough), and hepatitis A and B.

To find a location where flu shots are available, use this link. Many locations also offer vaccinations for the other 13 diseases for low cost, and health insurance will cover most or all of these shots as well.

You can also test your Flu I.Q. by taking this CDC quiz.

The O’Neill Institute for National and Global Health Law at Georgetown University is the premier center for health law, scholarship, and policy. Its mission is to contribute to a more powerful and deeper understanding of the multiple ways in which law can be used to improve the public’s health, using objective evidence as a measure.

The O’Neill Institute seeks to advance scholarship, science, research, and teaching that will encourage key decision-makers in the public, private, and civil society to employ the law as a positive tool for enabling more people in the United States and throughout the world to lead healthier lives. 

Treating patients’ misperceptions is key

October 3, 2016--Federal health officials are already urging all Americans to get their flu shots as soon as possible. Yet the number of people who receive flu shots remains low, with less than one-third of adults between the ages of 18 and 49 getting vaccinated.

“Flu is serious. Flu is unpredictable,” Dr. Thomas Frieden, the director of the Centers for Disease Control and Prevention, told reporters ​last week during a joint briefing with the National Foundation for Infectious Diseases. “Flu often does not get enough respect.”

Unfortunately, there’s no clear prescription for how health care providers and public policy officials can effectively encourage patients to hit the flu clinic. Filling the communication gap are patients’ personal beliefs and biases about the vaccine’s effectiveness and impact on their own health.

“Many people refuse to get vaccinations due to misconceptions, such as flu shots are ineffective, cause people to get sick, or are unnecessary for healthy people. These beliefs minimize the benefits of vaccination and tip the scale in favor of not getting a flu shot,” says Wake Forest University’s Frederick Chen, an expert in the economics of public health.

The public health costs are staggering. Each year, between 5 and 20 percent of Americans are infected with influenza. The infectious virus lands more than 200,000 people in the hospital and causes thousands of deaths. The economic impact has been estimated at more than $80 billion a year.

“There seems to be this sentiment in the public health community that to combat these misconceptions we should give people more information, more statistics, and more data about flu vaccines, but recent studies have shown that this approach can have a backfire effect,” said Chen, an associate professor of economics.

“Vaccine skeptics inundated with pages of written information about why the vaccine is effective or safe might become more skeptical, not less.”

Chen’s most recent paper, published by Health Promotion International and co-authored with Ryan Stevens in the department of economics at New York University, combines behavioral economics and psychology to offer suggestions to boost flu shot numbers. Recognizing that people’s situations and understanding of flu shots can differ widely, Chen and Stevens recommend methods that humanize the issue and employ a more personal, concrete approach. Suggestions include:

• Mobilize community volunteers — Connect real people with positive outcomes from flu shots as they talk one-on-one about the benefits of vaccination with neighbors. The idea is based on door-to-door canvassing campaigns which have proven highly effective in increasing voter turnout, especially when canvassers are friends or people from one’s own community.

• Invest in public service ads and videos — People sharing stories about how they stayed healthy after a flu shot should be more memorable and have better impact on decision-making than reading a pamphlet.

• Partner with celebrities — Well-known figures have the potential to raise awareness on health issues. Katie Couric’s live colonoscopy on NBC’s TODAY Show 16 years ago led to a 20 percent increase in the number of colonoscopies performed in the following months.

• Make it personal — Asking people to recall the last time they were sick or someone close to them was sick with the flu is potentially much more effective than public health messages that simply tell people to “take time to get a flu vaccine.”

Chen says recent research in behavioral economics and psychology shows that misconceptions can arise when people construct ‘stories’ in their mind to help make sense of the world. These stories, which may not be accurate descriptions of the world, can nevertheless influence people’s decision-making.

“We can see when the vaccine fails to protect us because we get sick and feel terrible but we can’t see anything different from our normal healthy state when it works,” said Chen.

“Because negative experiences with flu vaccinations are more noteworthy and newsworthy than the positive experiences, if we are exposed to more negative stories than positive ones through our family members, friends, the media, and online, that may cause us to believe that flu shots aren’t all that effective when in fact a good match between vaccines and the flu virus reduces our risk of catching the flu by 60 percent.”

Behavioral economists and psychologists have made enormous strides recently in studying how errors and biases arise when people process information and how these affect decision-making.

Based on this research, adopting a more personal and humanistic approach that makes it easier for people to relate to the flu and its consequences could increase vaccination rates and reduce the societal cost of influenza.

THE MEDICAL MINUTE: WHAT YOU NEED TO KNOW THIS FLU SEASON

Newswise, October 3, 2016 — As flu season approaches, medical experts have some new recommendations – along with some old standards – on how to reduce your chances of getting sick.

FluMist is ‘out’

The Centers for Disease Control and Prevention (CDC) no longer recommends use of the mist version of the vaccine – which was most commonly used among children and the needle-phobic – noting it has been found to be ineffective.

“During the last three seasons, FluMist hasn't provided any additional protection against flu compared to no vaccine,” said Dr. Jessica Ericson, a pediatric infectious disease specialist at Penn State Children’s Hospital. “The recommendation is that the injection vaccine be used instead.”

The mist was found to be only 3 percent effective, compared to 65 percent for the injection.

Egg allergy? No problem.

Even people who are allergic to eggs can now get vaccinated, according to the CDC. However, Dr. Cynthia Whitener, interim chief of the Division of Infectious Diseases and Epidemiology at Penn State Health Milton S. Hershey Medical Center, said people with a severe allergy to eggs may want to avoid drive-through and walk-in options offered by some drug store chains.

“If they only experience hives, they can get the vaccine wherever they choose,” she said. “If they had a more severe reaction to eggs, such as breathing trouble, or if they needed a shot of epinephrine, then they should get vaccinated in a medical setting.”

When to get the vaccine

The flu season typically begins in December, though it can start as early as October and often lasts through March. While opinions vary on how early is too early to get the vaccine, both Whitener and Ericson suggest getting the flu shot as soon as it is available. While there is a gradual drop off in the antibodies created by the vaccine, the protection from the vaccine should last through the season for the average person.

“The current CDC recommendation is to get it as soon as it becomes available so that you're not missing your opportunity,” Ericson said.

It’s not too late if the vaccine is missed and cases are already being reported in the area.

“If it's just now hitting your area, it could hang around the region for months thereafter,” Whitener said.

It takes up to two weeks after vaccination for the body to make the antibodies that fight off influenza. Those who have had the flu should still get the vaccine to protect from additional strains that are circulating.

Who should be vaccinated?

Ericson and Whitener recommend that everyone 6 months and older should get the flu shot every year. The vaccine reduces flu illnesses, doctor visits, missed work, missed school and prevents flu-related hospitalizations.

“It's the first and best way to protect themselves and family and friends from the flu,” Whitener said.

People with compromised immune systems or chronic medical conditions, children under 5, adults over 65, pregnant women and people who live in long-term care facilities should especially be vaccinated. These same groups are at higher risk for complications, hospitalization and death from the flu. Caretakers of people in these categories, including those with infants younger than 6 months, should get a flu shot for the protection of their at-risk loved ones, friends and coworkers, as well as themselves.

Protect yourself this flu season

In addition to the vaccine, Whitener suggests avoiding sick people, washing hands frequently to reduce the spread of germs and staying home from work or school when sick. She adds that there is prescription antiviral medication that anyone suffering from influenza can receive, though it is especially important that those who are prone to complications from the flu consult with their doctor about it.

A Shot in the Arm for Flu Vaccine Distribution

Newswise, February 19, 2016— Each fall, doctors stress the importance of getting a flu shot: influenza is the most frequent cause of death from a vaccine-preventable disease in the United States. But on-time delivery of the vaccine can be tenuous, and there can be shortages during times of peak demand, as seen in 2014.

Research co-authored by Fuqiang Zhang, professor of operations and manufacturing management at Washington University in St. Louis’ Olin Business School, proposes a new contract scheme for the vaccine supply chain that could reduce patient wait time.

“In the past, we have seen major flu vaccine shortages during the vaccination season, even though the total supply for the flu vaccines was abundant,” Zhang said. “The major reason for this is because of late delivery.”

The process begins months in advance of influenza season. Starting in January, manufacturers make educated guesses about what flu strains the federal government will target and start production of a vaccine to match. They try to make a large quantity that will be ready to sell to retailers by vaccination season, which usually runs from late September to mid-November.

The U.S. Food and Drug Administration makes its vaccine recommendation in February or March. If manufacturers have guessed incorrectly on any of the strains, they must restart that part of production.

Retailers, aware of the manufacturers’ risk, anticipate potential delay in shipments and may commit to smaller orders to avoid requesting a large supply that could arrive in late fall, when public demand will be down, and then being left with unused doses. The manufacturers, knowing that retailers will be cautious, are reluctant to produce a large amount before the FDA’s final announcement.

The manufacturer-retail gap is called a negative feedback loop. The result can be a shortage during the period of peak demand, as happened in 2014.

“Two parties are making their own decisions, but they are dependent on each other,” Zhang said. “When you have a decentralized supply chain with independent parties and they are self-interested, they may not want to make decisions that are optimal for the entire supply chain. They will make decisions that maximize their own payoff or profit.

“That’s a key issue behind this flu vaccine shortage problem,” he said

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Zhang teamed with Tinglong Dai of Johns Hopkins University and Soo-Haeng Cho from Carnegie Mellon University and examined the current supply chain process from start to finish.

In the research, recently accepted by the journal Manufacturing & Service Operations Management, Zhang and his partners propose a new solution called a Buyback and Late Rebate (BLR) contract.

Both buybacks (returns for time sensitive products) and rebates on late shipments have been used separately in an attempt to alleviate the flu vaccine negative feedback loop, with limited success. Zhang said the combined incentive approach will make a big difference in fixing the supply chain gaps.

“If you use buyback and late rebate separately, they don’t solve the whole problem,” Zhang said. “We found that combining these two incentive contract terms, we optimize the supply chain’s performance and maximize its efficiency.”

Zhang and his co-authors believe that the combination of 100-percent buyback and rebates on late shipments would motivate retailers to commit to larger orders, which in turn would lead manufacturers to commit to greater and more prompt production. The negative feedback loop would be broken, and a steady, reliable flow of vaccine would be available, to the benefit of manufacturers, retailers, and patients.

“We looked at incentive issues for the different parties, and then tried to provide a holistic solution to the problem,” Zhang said.