Around here we tend to beat the drum in favor of vaccines. With good reason. The research supports the safety, efficacy, and cost-benefit analysis of the standard vaccine schedule. Vaccines work best when we all use them, creating herd immunity, which prevents an infection from getting a foothold in a community and protecting those that are immune-compromised or cannot receive a vaccine[1].

With overwhelming evidence to support the widespread use of vaccines to prevent common, communicable diseases, why do we have such a hard time getting compliance with vaccinations? Declines in childhood vaccine rates get all the press, but we do even worse on adult vaccinations[2], especially those that need to occur annually, like the seasonal influenza vaccination. These rates never even approach herd immunity levels.

Maybe its because we make getting non-childhood vaccines an enormous pain in the ass. Here's the ballad of mrs. rugbyologist's seasonal flu vaccination:

I managed to get the flu vaccine this year thanks to my own persistence with my one year old daughter in tow.  I went to my local Walgreens to get a flu vaccine last week to learn that they had sold out two days before.  I asked if the pharmacist knew of other places where I could get one.  He knew of one Walgreens (which was across town) that he said might have some left.  Since I was going to Dierbergs for groceries anyway and it was just down the street, I decided to try there first.  I was encouraged when I entered the store and was greeted by a sign suggesting that I get a flu shot.  When I went to the pharmacy counter, however, I was told that they were out.  Ok, so my daughter and I bought the chicken we needed for dinner and headed back out into the rain to try the next closest store with a Pharmacy, a local Target.  So, we drive a couple miles to Target, get back out into the rain and ask their pharmacist if they have any flu vaccines.  They did.  My heart sighs relief.  But then I ask my next question, my doctor suggested that I get the preservative free vaccine because I am pregnant. No, they do not have any preservative free vaccines.  Well, at this point, I decide the drive across town the other Walgreens appears to be worth it. So, while driving there I call their pharmacy and am told that they have only 4 vaccines left.  I knew that it was going to be close to my daughter’s nap time, but was concerned that if we didn’t make the trip that I would not get a flu vaccine.  About 20 minutes later, we arrive at their counter, and am again told that they have 4 vaccines.  As I begin filling out the forms, the cashier at the pharmacy counter asks if I am pregnant and tells me that if I am I may not be able to get the vaccine[3]. I know that I can, and the pharmacist confirms this.  The pharmacist does need to call my doctor to confirm.  He makes the call, and I think we are almost done, when he tells me that he will page me when my bill is ready.  Apparently, my flu vaccine was in the queue of the other prescriptions they were filling.  So, my daughter and I start driving her stroller around Walgreens to try to entertain her while we wait.  After 20 minutes of waiting, my name is called.  I go up and pay my bill and think that we are ready to go.  But no, I had to wait again for the pharmacist to fill more prescriptions while I wait for my shot.  At this point, my daughter is nearly inconsolable.  Now two hours after this adventure began, the pharmacist comes out to give me my shot in the waiting room.  I did overhear that they had sold their last vaccine by this point.  The shot itself took about 2 seconds, but when he pulled the needle out my arm started bleeding, and the pharmacist had zero cotton balls in his tray[4].  He had to go back into the pharmacy to get one.  Then he tells me that he wants me to stay at Walgreens for another 10 minutes to make sure I don’t have an allergic reaction.  Is he kidding?  I did stay for 5 minutes, but then took my daughter home to have lunch (not made from the chicken that has now been sitting in the car for a few hours) and a nap.  Shortages and long waits will not encourage people to get appropriate vaccinations. 

Now, mrs. rugbyologist is really Dr. mrs. rugbyologist and comes equipped with, in addition to good looks and culinary skills, an understanding of how vaccines and immunity works, the importance of herd immunity, and our protective role as parents to reduce The Frogger's (also vaccinated) exposure to influenza by not acting as carriers. She went on this quest with an evidence-based commitment to getting the seasonal flu vaccine. That shot was the most important thing she was going to do for her child all week[5].

The above anecdotal account involved vaccine shortages, huge wastes of time, monetary cost, and poor technique for administration that would increase the chance of infection. When would you have given up? Would hearing this anecdote make you want to get a flu shot? Would it be worth it? What if you weren't familiar with the evidence?

Seems like it will be easier to convince people to take the influenza vaccines seriously when it becomes clear that our public health machinery is taking it seriously.

NOTES
1: Not getting your vaccinations? What? You say your are healthy and never get sick? Fine. Personal decision. But, why do you hate babies and old people?
2: Did you know that the best way to prevent your kid from getting whooping cough (pertussis) prior to their vaccination is to make sure that your pertussis booster is up-to-date?
3: While this might be perceived as just providing helpful information, an employee at a pharmacy without technical knowledge should make statement about a medical intervention, as they may be perceived as being knowledgable.
4: The number one side effect of vaccinations, like any needlestick, is infection at the site of the puncture. Poor technique, as described above, dramatically increases this risk.
5: Except for that whole regular feeding thing that they just insist on, loudly.