Influenza is hitting the United States particularly hard this year. The season is a bit earlier than expected, and cases are a bit more severe.
Luckily, we are in many ways well prepared. The flu vaccine is a good match, with an effectiveness of about 62%; it was also available unusually early. The Centers for Disease Control and Prevention have an elaborate surveillance and reporting system, and a plethora of apps, podcasts, brochures, widgets, and who knows what else to convince people to get vaccinated. There are also hundreds of state and local health departments, researchers, and non-profit organizations running free vaccine clinics, conducting outreach and education, and more.
Even still, less than 40% of people had received the flu vaccine by mid-November of this year. Some people may decide with their primary care provider that they shouldn't receive the vaccine. For a lot of people though, that's not the case. The flu vaccine is seen as ineffective, unnecessary, and maybe even dangerous. Never mind that none of those things are particularly true.
Unfortunately, the root of this problem is deep. The problem is that when public health works, it is invisible. It's an insidious, persistent public relations issue that plagues public health. Nobody sees when a chain of disease transmission is broken, or when contaminated food is prevented from reaching the market, or when toxic pollutants don't enter the environment. That's the point: the goal of public health is prevention, not reaction.
What's left for the general public, who have little reason to ponder these were-nots, is the worst sort of confirmation bias. People who did not receive the vaccine and did not get sick feel validated. Those who did receive the vaccine and didn't get sick wonder if they really needed it all, especially if they don't see a lot of other people around them get sick.
The catch is that the more people receive the vaccine, the fewer susceptible hosts the virus has to circulate among. With some infectious diseases, if enough people are vaccinated or immune, the virus won't circulate at all, and everyone is protected. When the system is working best, the need for it is least evident.
What then can be done to counteract these misperceptions? First, public health needs to be more vocal about its successes. This graphic of crude death rates for infectious diseases during the 19th century, for example, should be widely disseminated. A little self-promotion could go a long ways.
I'd also like to see more quantification of everything-that-wasn't. It was recently shown, for example, that closing schools in Texas during the H1N1 outbreak was effective in reducing the number of acute respiratory illnesses and influenza-related emergency room visits. I distinctly remember that at the time, people were critical of the school closures because the outbreak was not as severe as was originally predicted. Perhaps it was more mild because of the interventions. More research of this kind can help people to understand the importance of public health, and will hopefully convince them to embrace prevention practices like vaccine uptake. What else can we do to highlight public health's successes?
"Send me your data - PDF is fine," said no one ever
The public health paradox ("When public health works, it's invisible")
Let's make data a civic right
Scholarly impact of open access journals
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