Israel's Doctors Advocate Flu Shots – but Scorn the Needle Themselves

Everyone should get vaccinated, Israeli health-care personnel warmly agree, but some insist: nobody's going to tell them what to do.

Daniel Bar-On

As it does every winter, the Israeli Health Ministry is campaigning heavily to persuade the public to get vaccinated against the flu. Nearly one and a half million people have taken the shot this season, the ministry says. Yet resistance is rearing its head - among doctors and nurses, of all people.

The underlying irony is that while an overwhelming majority of doctors tout the benefits of inoculation for the general public, only 35 percent of medical practitioners get immunized themselves, the Health Ministry admits.

At least they're in good company – studies done in Europe and the United States show similar scorn for the shot among doctors and nurses, ascribed to a combination of "personal attitude" and misinformation. At least in the United States, the situation is changing: now due to regulatory changes, somewhere between 80 to 90 percent of healthcare workers get the shot, says Dr. Arnold Monto, professor of epidemiology at the University of Michigan and a global influenza expert.

Israel's "vaccine refuseniks" cite a twofold rationale: they don't believe they're likely to get sick, and they don't like being told what to do.

"Personally, why don't I take the shot? Because it's my version of anarchism," says one physician in Jerusalem, who spoke on the condition of anonymity. The shot makes him feel sick for days, he adds: Why be sick now rather than take the chance of being sick a few days, later?

Drugstore sign touting flu shots, NY, Oct. 2013
Reuters

Maybe because when it gets bad, influenza can kill. The Jerusalem physician however shrugs that he doesn't belong to a high-risk group, and, he points out, he encourages his family to get the shot.

Flu shots do matter

Medical experts consider immunization, with an attenuated or inactive virus, to be the best way to prevent the spread of influenza. It's particularly important for people with weaker immune systems, like seniors and children.

Moreover, the U.S. Advisory Committee on Immunization Practices specifically urges health care workers to get vaccinated against flu because it "can reduce influenza-related morbidity and mortality among both health care personnel and their patients," it stated in a paper published this August.

It bears saying that working around sick people does not strengthen the doctors' and nurses' immune systems and confer immunity.

Turkey pens at Kibbutz Holot, where avian flu was discovered (2012, Eliahu Hershkovitz)
Eliahu Hershkovitz

One problem with immunizing against influenza is that the flu virus mutates madly, even making inter-species jumps - from animals to humans and vice versa. No one vaccine acts against all strains of flu, and one that worked last year may not work this one. "The influenza vaccine is good, it's not great. Everyone is working on improving it," says Monto.

Yet there is good reason to be vaccinated, he says. "Seasonal influenza kills people every year. But even more importantly, there's concern about a major pandemic, which would be disruptive, and which would be so much worse than Ebola."

The most feared security threat

In a paper published in 2007, the World Health Organization called influenza pandemics "the most feared security threat."

Flu is easy to catch in any case. If a strain develops that is "fully transmissible" –meaning that it infects people fluidly and quickly– the WHO predicts that a quarter of the world population could catch it in a matter of months. That would affect roughly 1.75 billion people.

"Even if the virus caused relatively mild symptoms, the economic and social disruption arising from sudden surges of illness in so many people – occurring almost simultaneously throughout the world – would be enormous," says the WHO report.

It's happened before. In 1918-1919, the so-called "Spanish Flu" pandemic affected approximately one-third of the world population, according to the CDC, resulting in between 50 to 100 million deaths. Today mankind is armed with better knowledge and vaccines, too. But pandemic could recur under the right conditions.

Influenza-related diseases kill 1,386 people a year in Israel, on average. In the winter of 1999-2000, flu season led to 2,242 deaths (which accounted for more than 6 percent of the total morality rate in Israel during that period, according the Israeli Central Bureau of Statistics).

Flu's spread can be facilitated in compact places full of potential disseminators - like overcrowded hospitals. In certain hospitals in Israel, occupancy rates can climb as high as 170 percent.

Yet doctors and nurses still shun the shot, whether because they mistakenly figure they're immunized by sheer exposure – or because they don't feel like it.

Don't shame me, I'm a doctor

Some Israeli hospitals and medical centers urge doctors to wear stickers that read "I also got vaccinated for the flu."

In October, the Ethics Committee of the Israeli Medical Association took a position against the stickers, on the grounds that they were counter-productive. Their use is tantamount to peer pressure to get immunized (and wear the sticker), which could actually diminish the doctors' willingness to actually get the shot, the IMA wrote.

“It makes you feel not respected,” says one pediatrician who works in the Tel Aviv area. “There needs to be a good reason to get immunized. You need to convince me. But to shame me? I’m a doctor.”

On the global stage, Israel is lauded for its efforts on behalf of vaccinating the public: It is one of few places in the world that has such an active campaign to promote vaccination, says Monto. But Israeli health care workers are free to give reign to their libertarian streak, placing a premium on their individual freedom over the collective good.