Over the next several weeks, people across Kentucky will be lining up and rolling up their sleeves to be vaccinated against seasonal flu and the new H1N1 virus.
But Matt Schweder and his family won't be among them.
Schweder, who lives in Lexington, said his family stopped getting immunizations several years ago. He thinks vaccines make people sick instead of preventing disease, insisting that flu shots pose dire risks for the public the news media are ignoring.
"Vaccines do not prevent anything," Schweder said. "We've just been conditioned to believe they do. There is not one study that says flu vaccine is safe. All the studies that say it is were paid for by the pharmaceutical industry."
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Many across the country share similar views. The Associated Press reported this week that more than a third of American parents don't want their children vaccinated against H1N1, commonly called swine flu.
Many fear possible vaccine side effects. Others say they'll avoid vaccination because swine flu isn't a serious risk — even though it has caused more than 600 deaths in the United States. And some who already have taken a seasonal flu shot this year say they won't get the separate H1N1 vaccine because it's too new and unproven — even though the vaccines are made the same way.
The H1N1 vaccine will arrive in Lexington this week, according to the Fayette County Health Department.
Immunization is voluntary. But some Americans always have been leery of vaccines, and concerns are running particularly high this year.
Health officials frustrated
It's frustrating to public health officials, who are trying to get as many Americans as possible inoculated against H1N1 and seasonal flu, which by itself kills about 36,000 Americans in a typical year.
Medical authorities stress that no medication — including flu vaccine — is perfect or without risks. But most fears about seasonal and H1N1 vaccines are groundless, they insist.
Some contend that public fears are being fueled in part by inaccurate or exaggerated claims about immunization risks circulating on the Internet and radio call-in shows.
Dr. William Hacker, Kentucky's state health commissioner, took time during a press briefing Thursday to urge the public to avoid "less scientifically based sources" of information and get the facts about the flu. Those who don't want or trust government sources should look to the American Medical Association, the American Academy of Pediatrics or similar medical organizations, he said.
Hacker said he would recommend the H1N1 vaccine for his own grandchildren.
Dr. Chris Nelson, chief of pediatric infectious disease at the University of Kentucky, said vaccines are one of medicine's greatest success stories, having eradicated or almost eradicated many contagious illnesses that once killed millions.
"These diseases are still killing people in developing countries where they don't have vaccinations," Nelson said. "People who continue to beat the drum that vaccines are bad do a disservice to the public in general."
Washington writer Arthur Allen predicted in an essay months ago that H1N1 vaccine would be controversial once it started to become publicly available. Allen is author of the 2007 book Vaccine: The Controversial Story of Medicine's Greatest Lifesaver.
"There's just a lot of hostility toward all vaccines these days," Allen said. "One reason is that some people don't trust the government. Another is that every person out there who for whatever reason opposes vaccines has access to the Internet. It's an echo chamber where you can hear whatever you want to hear."
Fears of a repeat of 1976
Many vaccine critics point to 1976, when another form of swine flu appeared. The U.S. government rushed a vaccine into production and about 40 million people took it.
Afterward, a few hundred people developed a dangerous condition called Guillian-Barre (pronounced gee-YAN bah-RAY) syndrome and some died. A 2003 federal study concluded there was evidence to suggest a "causal" connection between the illness and the 1976 vaccine, but found no direct link. Researchers say no one knows exactly what happened 33 years ago.
Today, however, medical experts insist that vaccine manufacturing techniques have improved greatly since 1976, and there is very little likelihood of H1N1 vaccine causing Guillian-Barre. If there were a risk from the vaccine, some estimates are it would amount to one additional case of the syndrome in 1 million people.
Allen said there is "pretty strong" evidence that the 1976 vaccine did cause some serious side effects. But he said the federal government will closely monitor the H1N1 vaccine for any signs of Guillian-Barre and act quickly if problems appear.
"I would say that on balance right now, there's no reason to believe it's going to cause Guillian-Barre or anything else," Allen said.
Some say vaccine is too new
Another oft-voiced fear about the H1N1 vaccine is it is brand-new — developed since last spring — and therefore shouldn't be trusted.
But public health officials counter that the country also turns out a brand-new seasonal flu vaccine every year and that millions take it with few if any problems. Flu vaccine must be reformulated each year because the flu virus itself keeps evolving.
"The fact is that the H1N1 vaccine is made exactly the same way that the seasonal vaccines are made," said University of Louisville's Dr. Rick Clover, a member of the National Vaccine Advisory Committee. "We have a good track record for seasonal flu vaccine, so the safety profile for H1N1 should be very similar."
Adjuvants and thimerosal
Another issue often raised by critics is the use of "adjuvants," which are chemical substances sometimes added to vaccines to boost immunity. Some researchers contend adjuvants pose health risks.
But, according to the federal Centers for Disease Control and Prevention, neither the seasonal flu vaccine nor the H1N1 vaccine contains adjuvants.
Still another question concerns a mercury-based preservative in some vaccines called thimerosal. Some groups have argued for years thimerosal in childrens' vaccines causes increased rates of autism. Scientific studies have confirmed no such link and thimerosal has been removed from most vaccines. But the controversy goes on.
According to the CDC, no flu vaccine given to children will contain thimerosal, and the preservative also won't be present in either nasal-spray flu vaccine or single-dose vials of injectable vaccine. The preservative will be used in multi-dose vaccine vials.
State health officials said, however, individuals who don't want to receive vaccine containing the preservative should be able to get thimerosal-free vaccine by shopping around. Ask the provider if the vaccine they have contains thimerosal.
Nelson said he hopes people who refuse vaccine will take other protective steps. Those include washing their hands frequently, avoiding crowds where people are coughing or sneezing, avoiding rubbing their eyes and staying at home if they get sick so they don't infect others.
Schweder, the Lexington man who opposes vaccines, said his family will rely on eating healthy foods, drinking plenty of water, getting plenty of rest and similar steps to keep their immunity strong.
"The flu is not something you catch," he said. "It's a thing that only influences an unhealthy body."