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The other day I asked a longtime patient of mine, a woman in her 90s, whether she’d like a flu shot. “Absolutely not!” she snapped. You’d have thought I’d proposed major surgery. Actually, I have proposed major surgery to this woman, and she’s accepted it readily. But a flu shot? “Absolutely not!”

Another patient told me that she didn’t want a flu shot because she didn’t believe in putting live germs in her body. I informed her that, in fact, the injectable influenza vaccine contains no live virus. This did not sway her.


Then there was the man who didn’t see why he should have a vaccine to prevent a disease he’d never contracted. I pointed out that he was taking medication for high blood pressure and high cholesterol to prevent heart attack and stroke — also conditions he’d never had. He remained unconvinced.

As I do every year at this time, I’m seeing many patients who refuse the influenza vaccine. This refusal used to frustrate me. OK, it still frustrates me. But I think I understand it better than I used to. I’ve come to realize that deciding not to have a flu shot may have less to do with opposition to the vaccines themselves than with my patients’ desire to regain a measure of control in a health care system that often makes them feel powerless.

The vaccine triggers the immune system to create antibodies, preparing the body for viral battle. Alex Hogan/STAT

Certainly, there are some who believe, mistakenly, that flu shots cause the flu or colds or other illnesses. It takes the rap for all runny noses, coughs, and fevers because the vaccine isn’t 100 percent effective (last year’s flu shot was a relative dud, though this year’s is projected to work better), takes two weeks to kick in, and is given during cold and flu season. But that’s like blaming umbrellas for the rain.


People old enough to remember the swine flu scare of 1976 may have bad associations with influenza vaccines, and even people who weren’t yet born then may have absorbed a vague sense that flu shots are unsafe. (I see a similar wariness about IUDs among women who have heard about the Dalkon Shield, a dangerous version of the contraceptive device that’s been off the market for 40 years).

In “On Immunity: An Inoculation,” an elegant 2014 book about vaccine phobia, Eula Biss points out that as far back as the 18th century, when an early version of the smallpox vaccine was developed, people distrusted the idea of having foreign substances injected into their bodies. She notes that the fact that vaccination is practiced as much for the health of the public as the individual may make it that much harder to accept. The rhetoric of the modern anti-vaccine movement often pits personal liberty against the common good. Indeed, a few of my patients do see the flu vaccine as an intrusion, imposed on them by Big Pharma, the government, and, more and more frequently, their employers. This view finds plenty of validation on the Internet, where people are encouraged to empower and inform themselves (often with dubious medical information) rather than submitting passively to doctors’ orders.

More often than not, though, patients can’t tell me why they don’t want a flu shots, they just don’t. I sense that they’ve made, even if subconsciously, a risk-benefit calculation; for a perceived low risk they get, in return, absolute control over their health care, if only in the small domain of the flu shot. They’ll take their chances on getting the flu because they think it will be like a cold, only a bit worse. They’ll sip ginger ale, binge watch “House of Cards” and wait it out. (The truth is, an actual case of influenza can leave you aching from head to toe, fevered and shivering, and clinging to your damp, roiling mattress for days like a shipwreck survivor. Respiratory distress, dehydration, bacterial superinfection, or other complications of flu send about 200,000 Americans to the hospital and kill thousands every year.)

I first formulated this theory not in my clinic, but, rather, in the hospital cafeteria.

A few years ago, an older woman who worked the midday shift was unflappable as diners — most of them patients and their families — barked their instructions: Not that piece of fish, the other one! Too much mustard!

One day, as she was making my sandwich, I asked her how she kept her cool. “The way I figure it,” she told me, “around here people don’t feel they can control much. Can I blame them for wanting to control lunch?”

I’ve been channeling that wise woman these fall days. Patients may not be able to do much about lousy insurance, pricey medications, or ever-shorter visits with ever-more-distracted doctors — not to mention the human body’s unfortunate tendency to age, sicken, and die. But they can say no to flu shots. I don’t agree with them — but can I blame them?

  • Had my physical Feb 7. I asked the doctor about the shingles vaccine. As sarcastic as she could be she said, “I thought you were the one that DIDN’T get vaccines!” Because I won’t get a flu shot, for all the reasons other posters mention. When the government says “Get in line” you should run the other way. The government puts fluoride and chlorine in our water supply…both of which do great harm….but they will tell you the benefits far outweigh the risk. Check out Then get a water distiller and use it faithfully.

  • People don’t take it because it produces an immune response, such as fever, fatigue, chills, muscle aches, etc. Most people’s experiences with flu are limited to those symptom, while some are at risk of it developing into something worse, such as pneumonia. One could probably get the same result as a flu vaccine by taking prompt action at the outset of a flu infection.

  • The answer for why I don’t want a flu shot is simple, it’s not a true vaccination. If 50% of people got the flu every year (which they don’t) and there was a vaccination that guaranteed 0% could get it for a year (which there isn’t) then a flu shot would make sense. But that’s not what the flu shot it. the flu shot is a guess at what the strain of flu might be which effectively reduces your chance of getting the flu from 2% to 1% all while guaranteeing you 100% were injected with a strain that could actually affect you. Why the heck would i deliberately make myself sick for a chance to maybe be less sick later with something that statistically i was unlikely to encounter in the first place? It doesn’t make sense period!

  • This is a little condescending: the author knows that the flu shot does not provide anything near 100% innoculation for a single flu season, and it is not a “vaccine” in the sense of providing any lasting innoculation – unlike vaccines against smallpox, measles, polio etc. A number of extremely reliable studies have shown diminishing returns from repeated flu shots, and experts admit this is a serious concern: having flu shots in consecutive years dramatically reduces their effectiveness. It is a definite possibility that in having successive annual flu shots, a child or young adult today – or even a more mature 40 or 50 year old – is in fact reducing the potential for more successful innoculation in their later years, when they will be at far greater risk of serious consequences from the seasonal flu. My point is, some of us prefer to read the literature carefully before screwing around with an immune system that so far has served us well.

  • I am 80 years old and have never had the flu or even a bad cold for over 50 years. My doctors keep pushing me to have a flu injection and I’m beginning to think that there is a conspiracy with Medical boards, Doctors, Chemists and big pharmacies! I try to keep away from crowds and people who are coughing.

  • I wish I could get one. Injections attack my nerves and then they hurt for years. I can’t even have dental shots. Many people have legit reasons. We aren’t all control seeking anti-establishment uninformed people. And actually, I care about herd immunity too.

  • The reasons why intelligent, informed people refuse flu shots go much deeper than those mentioned in this article. There is a certain percentage of the population who still have blind faith in big corporate medicine and refuse to think and investigate for themselves. Medical advancements in many areas are truly marvelous, but there is a portion of the big-pharma, medical industrial complex that is increasingly driven by profits and reliance upon cronyism with government health departments to help increase their profits. The actual cure and well-being of individuals is not the top priority of these giant corporations and hasn’t been for a very long time. That is to be expected in the kind of environment we live in today where main stream media and government agencies collude with big corporations for their mutual benefit. It’s not evil in intent, but it’s a fact. The interest of shareholders must always come first.
    People are also well aware that many of the enormous range of vaccines being pushed upon the public today contain preservatives that are unhealthy, or even downright harmful. This should come as no surprise because we have known for many decades that much of our food contains potentially harmful preservatives. It is not a new revelation that large corporations who make things that we put in our bodies are always balancing their profits against the risk they are imposing upon their customers. This approach is clearly not in the best interest of the consumer and many consumers know it. This is why so many people are becoming much more pro-active today with regards to anything they put into, or allow to be put into their bodies.

    • This! The flu shot is not a true vaccination. A real vaccination makes sure you don’t get sick. The flu shot takes your small chance of getting the flu from 2% to maybe 1% but that’s only if they get the strain right, which they basically never do, and then there’s always some garbage excuse for why it was wrong for the 12th time in a row. If i’m meant to die from the flu, i’ll die from the flu, but I can guaran-dang-tee that the flu shot wouldn’t have done diddly for me, if that ever becomes my end.

    • It also has to do with telling medical establishment that I am NOT their lab specimen. I have had 2 allergic reactions to flu shots the last two times I’ve had it, 3 years apart. I did Not get the flu shots those two years in between, nor did I have hives and other symptoms before them, those two years unvaccinated, or any other time, Just after those last two flu shots. (I reported the last one to VAERS, and mentioned the time before in my report)
      The doctors keep pressuring me to get it, because of asthma, and now age, even after the reactions are IN my records! They have a weird idea that I might not have a reaction this time. I have told them there will Be No next time. Hospital Urgent care has told me No more, or they might have to use a crash cart.
      Med school drs are incredibly unconvinced of ANYTHING they have not witnessed themselves. Going to the doctor for a checkup anymore is exhausting, anymore, because of all the explaining, even arguing, I’m having to do each time. They don’t seem to understand Patient Autonomy!!
      We have our right to protect ourselves against being invaded!

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