Flu and measles are getting worse as vaccination rates fall

The situation is not good

I know so many people who’ve been laid low by the flu this month, and that’s no coincidence. The CDC currently registers 45 states as experiencing “high” or “very high” levels of flu activity.

Unfortunately, the American government does not track flu hospitalization very precisely in real-time. What we do know, based on the currently available range and the fact that infections have not yet peaked, is that we are almost certainly going to surpass every winter since 2017-2018, and there’s a good chance we blow past that and break every record since the swine flu of 2009. The incidence in the first week of February was actually the worst in 28 years, so it’s possible we’re set to break records going even further back.

This is, to be clear, unrelated to the H5N1 bird flu that is killing chicken flocks and pushing up the price of eggs. Humans are catching bird flu and going to the hospital, but it doesn’t seem to be spreading person to person the way that “normal” flu does. The normal flu season is just more severe than usual.

It’s not entirely clear why that is — flu viruses change in unpredictable ways, and there are a lot of factors at play. But one thing that’s not helping is the falling flu vaccination rate. And that decline is, unfortunately, part of a larger tragedy in which the deployment of the Covid-19 vaccines — the development of which was objectively a scientific and medical triumph — set us back in our efforts to actually get people vaccinated.

While a bad flu season is really bad, and people will die, the strains in circulation are not catastrophic. What’s even more concerning is that the same dynamics have given us a decent-sized measles outbreak (the first casualty was reported yesterday). All signs indicate that we’re on track for more measles outbreaks. And a significant re-establishment of measles as a disease in circulation could be a real disaster, especially in a population that is older than ever and likely equipped with only faded protection from vaccinations they received as kids.

The problem of flu vaccines

A fundamental problem with vaccines is that they really do work best when people just take things on blind faith and do as they’re told.

In the 1950s, when the population was much less educated and more conformist, when the media was dominated by oligopolistic television networks and big city newspapers, and when a huge fraction of the population had recently been conscripted to fight in a war, it was relatively easy to get everyone to agree to take the new polio vaccine. And the cool thing about everyone getting vaccinated is that not only does your vaccine give you some protection, but everyone else’s vaccination makes it less likely that you’ll be exposed in the first place. The vaccination campaign as a whole-of-society effort can be much more effective than the sum of the individual-level impacts of the vaccine.

Relatedly, while children do not enjoy the idea of being taken to the doctor to have a needle stuck in their arm, all parents are in the habit of periodically making kids do things they don’t want to do. The pediatrician says your kid needs XYZ shots, so you take him to the doctor and he whines but gets the shots.

Flu vaccines tend to break all of this logic.

Influenza viruses mutate very rapidly, so for the vaccine to have any efficacy, you need to get a fresh shot every year. The scientists who make the vaccines also need to do a certain amount of guesswork when manufacturing each year’s vaccine, so the efficacy is often not amazing. And while getting the flu is a pain, it’s not like a debilitating illness — except actually, hundreds of thousands of (mostly elderly) people end up hospitalized during flu season and a lot of people die. It would be better if that didn’t happen!

The problem is that the merely so-so nature of the flu vaccine makes it more desirable that everyone get the shot. Cutting down on the number of basically healthy people picking up and circulating germs is the only real way to protect the more vulnerable populations.

But the individual logic cuts in the other direction. To most people, taking time out of your day to get stuck with a needle in order to receive a middling level of protection against an infectious disease that’s not that bad isn’t a compelling proposition. As far as I know, nobody ever proposed making flu vaccines mandatory, but I think the utilitarian logic of doing so is pretty clear.

I used to think sometimes about ways to make the flu vaccine “cheaper than free.” Back when I worked at Vox, they would bring a nurse into the office once a year to vaccinate anyone who wanted a flu shot in a conference room. I got the shot every year, which has definitely not been the case in every year of my non-Vox life. In theory, I think, there should be flu vax squads posted up in every major activity center in America ready to give you a shot and five bucks for your trouble.

But then came Covid and the Covid vaccine.

This is a deadlier illness than the flu, so it felt more urgent to get people vaccinated. But the vaccine side effects are worse, so there is also greater individual reluctance to actually get the shot. I think the Biden administration’s view that the situation warranted a big push to coerce people into getting vaccinated made some sense medically.

But politically it backfired, taking what was initially a good wedge issue for Democrats (“are vaccines good”) and turning it into a good wedge issue for Republicans. Then, as a secondary consequence, the anti-vaccine movement — which had been simmering for years in American society with almost no elite political backing — merged with the conservative movement. Back in 2009, RFK Jr.’s name was floated as a potential Obama administration EPA administrator, but was shot down because he’s too left-wing and nutty. Now, he’s Trump’s Secretary of Health and Human Services.

Less to MAHA than meets the eye

Kennedy, in a way that I find completely perverse, has received credit that he doesn’t even remotely deserve for making the banal observation that lifestyle determinants of health are probably a bigger deal than official medical care.

This has been retconned by people experiencing a weird conjunction of credulousness and paranoia as some kind of deep, dark, forbidden truth about America that “they” don’t want you to know.