Renate Rothwell had not planned to have a flu jab. “I am 71, so I’m invited to have it at my GP surgery, but I ignored the invitation,” she says. “My feeling was that I didn’t need it. But then I went to see the doctor about something else, and he said I should have the jab.”
She did – and regretted it. “I was unwell for four days. It more or less wiped out the week. I’ve never had flu so I can’t compare it with having the illness itself, but I can’t remember ever being that ill. I felt nauseous, I felt weak, I couldn’t eat anything.”
She says that if she had known then what she knows now, she would have been firmer about not needing the jab: “I’m very healthy, I eat well, I go to the gym. I think they need to be more honest about the side-effects. If I’d known I could get that ill, I wouldn’t have had that jab.”
Yet while many people feel they are invincible, up to 17,000 people in the EU die annually from flu, which might be why healthcare workers have a high level of takeup. Last winter, 68.7% of frontline NHS staff received the vaccination, with some health trusts having vaccinated more than 90% of their staff.
This is partly because if they get flu they can pass it on to more vulnerable patients, but also, says Professor Anita Simonds, a consultant in respiratory medicine at the Royal Brompton hospital, because they have seen the worst that flu can do. “Every year, I see people who end up in the intensive care unit because of it. And people die: it’s one of the biggest causes of death.”
But some people still have questions. Will the vaccine work? Last year’s was not as effective as in previous years, so how do we know 2018’s will be any good? There is also the question Rothwell is asking: are you actually inviting an illness that, while it may not be as bad as flu itself, certainly isn’t much fun?
With the vaccination now widely available in chemists and even supermarkets for as little as £7, and with more people than ever offered it free on the NHS (to qualify you must be over 65 or between two and 10, or be pregnant, have a health condition such as asthma or diabetes, or be a carer), the direction of travel would seem to be towards increased takeup. However, research out this week from the European Commission has found more scepticism about the flu vaccine, especially from younger adults. While more than 85% of Britons still believe the vaccine is safe, less than 60% of French, Latvian and Austrian people do.
Public Health England is so busy that no one is available to talk about the flu jab, but it does supply some reassuring responses to my emailed questions. Yes, the flu vaccination for this year is “significantly improved”. No, you can’t get flu from the flu jab. Yes, people are warned about side-effects before they have the jab. And, yes: “Vaccine safety is of paramount importance and under constant review.”
There is a feeling that it is tired of dealing with these questions – yet the message does not seem to be getting through to the sceptics.
The response from the Medicines and Healthcare Products Regulatory Authority (MHRA) provides more detail on side-effects for the injected vaccine: “These typically include a mild fever, aching muscles, tiredness, injection-site reactions (such as a sore arm, swelling and redness) and headaches. These are usually mild and transient.” The nasal spray vaccine, which is the one given to children, “may commonly cause a runny or blocked nose, headache, tiredness and some loss of appetite”. It says that about one in 10 people having the jab can expect some kind of reaction.
So, is there anyone who shouldn’t have the vaccine? According to the MHRA, the only people who should not have it are those who have had a serious allergic reaction to a previous dose, and the nasal vaccine should not be given to anyone with severe asthma or a suppressed immune system.
Asked whether we should be concerned about becoming ill from the vaccine, it cites the public health argument: “Millions of people receive a flu vaccine across the UK every year, with tens of millions more globally. Every year, we hear anecdotes of the ‘vaccine being worse than flu’, and we also receive isolated reports of serious illnesses following vaccination. Such reports are always taken seriously and safety is kept under continual review. But, especially during winter, naturally occurring infections and illnesses can coincide with vaccination, and are a more likely explanation in these cases.”
So, what about Rothwell’s experience? Dr Jeremy Rossman, senior lecturer in virology at the University of Kent, says that, in view of the timing of her illness: “There’s a possibility of coincidence, but I think she probably did have a response to the vaccine.”
But what is important, he says, is a balance of risks. Vaccines are not risk-free. “There are low risks, but there are not no risks. People say they didn’t ‘need’ to get the vaccine, and then it made them feel bad. But what’s less easy to see is that you didn’t get the flu and you could have felt much worse, and it could have been a much more serious illness. Flu has far more serious risks than the vaccine.”
When it comes to public health, then, the flu vaccine, especially for those most at risk, is a no-brainer. At an individual level, however, you simply don’t know whether or not you would have got the disease – and you might get side-effects, although they probably will not be as bad as Rothwell’s. It is easy to be swayed by fears, says Rossman, when social media is swirling with stories of adverse reactions – and, of course, no one ever posts on Twitter to say they had their flu jab last week and it was a complete non-event.
In a straw poll of my household, the young, fit people (especially the males) don’t think they need to be vaccinated. But you don’t only try to escape flu for yourself, points out Simonds: there are also the people around you, who might catch it from you, or who would have to look after you if you were ill. And for freelance workers, a growing group, there is the risk of lost earnings.
Having spent the past few days reading up on the flu jab, I’m off to have mine.
