Sex, Drugs, and Public Health

October 13, 2009

Swine Flu Over the Cuckoo’s Nest 2

Filed under: Uncategorized — cbmosher @ 7:27 pm

“How we gonna get the Coloreds to take the shot?”

Spoken by a Public Health bureaucrat in Georgia State government as Swine Flu loomed.

“Don’t we just make the vaccine available, and let people decide for themselves?”  I asked in my naive, fresh-young-doctor way. It was 1976.

“Look, Sonny. Ah been in Public Health all mah life.  The State boss asked me and you to work on this here vaccine campaign, and the CDC says they want all folks vaccinated. Ah’m close to retirement. Don’t wanna look bad; Ah want big numbahs. But we got a problem with Them.”

‘Them,’ the Black Community (as it was called by some of us at that time), comprised 25% of the State’s population. And the statistics showed that, indeed, they were leery of this quickly produced vaccine. It was mostly Whites lining up to get the shots at the Health Departments and shopping malls. Where the TV cameras frequently prowled for evening photo ops.

The State officials in charge of the vaccine campaign fretted some, then decided to hold a brain-storming session. To, you know, solve The Problem. Think up something they hadn’t thought of yet. Which is to say, think of something that wasn’t just “the way we always done it.”

The brainstorming session encompassed two hours, three pots of coffee, and several good fishing stories to fill in the moments when people fell quiet.

We adjourned, coffee-charged and empty handed, with vague promises to meet again and solve The Problem. “Soon.”

“We’ve got to do something,” my boss told me as we walked down the hall to our office. “We got the dang CDC right here in our backyard. They aren’t going to be happy.”

That afternoon, a knight in shining armor called. The Health Officer of Fulton County (the County encompassing Atlanta) was on the phone. He had convinced Martin Luther King Jr.’s father to take the Swine Flu shot. The Health Officer himself would vaccinate “Daddy King” with multiple TV cameras rolling.

Everyone sighed a puff of relief and smiled. Surely the Black Community would follow Daddy King’s lead.

The day came. The sleeve was rolled up. The cameras rolled. The Health Officer – adequately serious of face – gave the inoculation. And Daddy King never flinched.

We began watching the vaccine statistics to see the ‘bump’ in shots given.

This memory floods back as I read a series of studies on vaccine acceptance. They are done as surveys, reflecting attitudes before the H1N1 vaccine is offered.

The summary of one, analyzed by race, shows a pattern that deja-vu’ed me:

46% of Whites were “worried about the (H1N1) vaccine”;

but a significantly higher percentage  of Blacks (62%) said the same.

Suspicion about a hastily produced vaccine appears to be as intact today as it was in 1976. And that distrust still varies across social and economic lines.

But it’s driven by emotion and beliefs, not by scientific fact and logic. We humans often do that.

As with this, which I heard recently:  “That 1976 Swine Flu shot killed people. Why risk taking the Swine Flu shot again?”.

Just because the H1N1 disease has the same nickname, “Swine,” doesn’t mean the same virus is involved. It’s not. So the two vaccines were made from different viruses, and are not the same. The 1976 vaccine has a tainted reputation from the concern at the time about increased incidence of Guillian-Barre disease. That association, by the way, has been studied for Seasonal Flu vaccine for over a decade, and no definitive connection between G-B disease and vaccine has been consistently shown since 1976. If there is an increased risk of G-B, it’s of the order of one case in a million shots; death from Flu, on the other hand, occurs at the rate of one death out of every thousand cases.

Or “I got sick with vomiting and diarrhea this morning. I’m sure it’s that restaurant where I ate 5 days ago.”

In my career, I’ve never heard anyone say “I think it was my mother’s cooking last night.” People’s belief systems don’t seem to admit that possibility, in spite of epidemiological evidence.

Or, more to the point, when people say “I don’t take the Flu shot. It’ll give you the Flu.”

Can’t happen. The virus in the shot is killed. Dead. What can happen is for a person to be incubating the Flu at the time of the shot. Then we make a mental association between the two events which doesn’t exist.

And, sometimes we are all just the victims of bad timing. As when, 33 years ago, the phone rang again, interrupting our enthusiastic survey of vaccination data, forty-eight hours after Mr. King had gotten his shot,. It was the Fulton County Health Officer.

“We got a problem.”

“Oh?”

“Daddy King seems to have taken ill.”

To this day, I don’t know what illness Mr. King had been incubating at the time of his Flu shot, but I do know that fear and other emotions still drive decisions. And I can’t help but wonder how many ghosts of 1976 Swine Flu Vaccine campaign haunt us, Halloween like, during this vaccine season, as we try to protect folks from the epidemic of H1N1 that has already begun.

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