HEALTH-CARE PRIORITIES Flu bug spreads infectious hype BY BETH SCHWARTZAPFEL

With 93 children dead from influenza by early January, the flu got a lot of press this winter. Reports of healthy young kids dying from what most people usually consider a seasonal annoyance was enough to make parents all over the state bang down pediatricians’ doors. "Suddenly, people who would never have dreamed of vaccinating their children wanted the flu vaccine," says Susan Shepardson, the immunization program manager at the state Department of Health. More than 55,000 Rhode Island children received the vaccine this season, an increase of 25,000 over the previous winter. The number would have been even higher had the flu panic not caused a nationwide shortage of vaccine supplies.

On one hand, I am a cynic when it comes to widespread fears about illness. Take SARS. Come on now, surgical masks for the commute to work? Isn’t that a little dramatic, not to mention out of line with the actual threat? Anthrax is a scary disease, but you won’t catch me clearing the Cipro stocks from my local pharmacy just because Tom Daschle got a shady letter or two. On the other hand, an ounce of reasonable prevention is worth a ton of cure, and the benefits of preventive medicine should be available to all people, not just those with health insurance. That brings us to this year’s flu vaccine rush. Was this an irrational widespread panic, or a sensible response with sound scientific backing? In a word, both.

The demand for vaccines often has more to do with whether a particular illness has captured the public imagination than whether it is a real threat. The danger of smallpox, for an average person, is almost nonexistent. However, $2.6 billion in tax dollars have gone to bioterrorism preparedness over the last two years, in part because of fear about smallpox and anthrax. Whooping cough, on the other hand, while it won’t occasion a national emergency, or certain and sudden death, commonly caused cracked ribs, vomiting from excessive coughing, and occasionally death, until a vaccine was developed in the 1940s.

Whooping cough — along with other formerly common illnesses, such as measles, rubella, and polio — has been all but eradicated, relatively quietly, by a calm and steady vaccination effort. In fact, as a direct result of this vaccination campaign, whooping cough has become so distant a memory that parents are starting to opt out of the vaccine, and the "herd immunity" conferred by vaccination in mass numbers has begun to erode in certain areas. "So many parents these days have never seen these terrible diseases," says Shepardson, precisely because "the generation before us did such a good job vaccinating. People don’t know what these diseases really look like."

So, should children get flu vaccinations? Absolutely. Should headlines over flu-related deaths steer federal health dollars away from less flashy, but more important preventive efforts? Absolutely not. What would it take to transfer some of the hype around the flu to other worthy causes? As far as Shepardson is concerned, it would require "good, effective, reality-based publicity. Not scare tactics."