Tuesday, January 15, 2013

Shot in the Arm

Though I only spoke Mandarin Chinese growing up, I found it cathartic, whenever I was angry, to curse in strings of expletives in Mandarin, Taiwanese and English under my breath.  But at the age of 10, I gave it all up.  It’s the only resolution I’ve kept 96% successfully for so long, to the point that when I do swear aloud now (usually to quote someone), it sounds stilted and unnatural.  I usually liken my loyalty to flu shots to my non-swearing habit: I get why you’re not like me.  No judgment here.  (Exceptions being doctors, elderly people, and others high-risk folks: the benefits outweigh costs for them and they should almost always get vaccinated). 

Our decisions to engage in protective actions like buckling up and buying insurance depend on the costs and likelihoods of the harm we want to avoid.  For many, their flu shot consideration (however brief) is something like this: 

Effectiveness x Cost of flu shot (pain, time, copay, etc.) > Risk x Cost of flu (medical expenses, lost wages, etc.)

Simply put, people choose not to vaccinate when cost > benefit.  Though getting the flu is miserable, costly, and leads to tens of thousands of deaths annually, it’s usually unlikely to touch healthy, attractive people like you.  However, the flu season is the worst in at least a decade.  Hospitals in Boston were so overwhelmed by influenza patients (more so than during the H1N1 outbreak) that the mayor declared a public health emergency.  The flu is now widespread throughout the US.  For those following the math, the risk of getting the flu is much higher than usual.  If you haven't gotten a shot: it's time to rethink your equation*.  

(The intensity this year surpasses the previous peak from H1N1.  
Click on the map to play with the google trends yourself.)

Of course, the risk of flu isn’t the only part of the equation that changes.  The cost of vaccination can be lowered to make shots more attractive.  Public Health likes that since the more people are vaccinated, the less likely it is for anyone to get the flu.  This is why flu shots are fully covered by many insurers, why employers set up workplace clinics, and why retail pharmacies don’t require appointments.   At Bowdoin College, the health center further sweetened the deal by giving Halloween goody bags with candies and toys, forever changing my attitude toward flu shots.  Whatever incentive works for you, the risk of flu is high this year and the cost of vaccination is low.  So for f*ck’s sake: get a flu shot.

*There is so much straightforward information on flu shots out there that I don't need to argue it here; the shot is effective and will not give you the flu.

Policy Implications:  Though the public benefit of flu shots is greater than that for individuals, incentives can spur individuals toward disease prevention.

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