To Vaccinate or Not to Vaccinate, That is the Question

By Meng Zhang, Cornell University

With the recent arrivals of the first shipments of the H1N1 swine flu vaccine, confusion and debate continue to mount, as shown in various polls conducted reflecting many people’s reluctance to receive the new vaccination. According to a survey conducted by the Harvard School of Public Health on October 2, four out of ten adults are certain they will get the swine flu shot once it becomes available and a little over half of all parents intend to have their children vaccinated.3 Such lukewarm willingness to receive the vaccination, whose development was closely followed and arrival highly anticipated, certainly was not the public response health officials had hoped for. However, it is not difficult to understand the myriad of concerns regarding the vaccine’s safety, as some retrigger past arguments and reinstate fear and uncertainty over the safety of the flu vaccine.

One such concern is the presence of thimerosal in the vaccine, a highly effective preservative containing 49% ethylmercury that has been controversially linked to causing autism in children. Though no scientifically reliable evidence proves such causation, the Centers for Disease Control and Prevention (CDC) report that vaccine manufactures have been striving to reduce thimerosal in vaccines as a precautionary measure.2 Parents, however, are likely to remain ill at ease, especially after recent news concerning the suspension of mercury limits for H1N1 shots in the state of Washington surfaced. State health officials reason that because an insufficient number of doses were packaged thimerosal-free, more mercury-containing vaccine will be distributed than usual in order to insure that more individuals, particularly those in high-risk groups, including pregnant women and children, can protect themselves from the swine flu.1

Though the CDC claims it is safe for both groups to receive vaccines that contain thimerosal because there lacks “convincing evidence of harm,” fear of autism is not the public’s only medical concern. In fact, a similar vaccine used during the 1976 US swine flu outbreak killed more people than did the flu itself due to the onset of Guillain-Barre Syndrome (GBS), a neuromuscular disorder that attacks nerve linings, resulting in paralysis, difficulty breathing, and even death. In all, over five hundred cases of GBS directly related to the 1976 swine flu vaccine were detected, of which twenty five were fatal as a consequence of respiratory failure – compared with one death from the 1976 flu itself. Vaccination was officially halted after only ten weeks, with the government paying millions of dollars to individuals adversely affected by the debacle.6 Although the strain of H1N1 used in the new vaccine differs from the one found in the 1976 vaccine, concerns over the potential increase in Guillain-Barre Syndrome remain, and reasonably so, in people’s minds.

As much as the aforementioned anxieties remain valid, one must question why other vaccines fail to conjure debate and controversy to the same degree. After all, the CDC reports that the majority of vaccines in the US contain thimerosal as a preservative, including the seasonal flu vaccine.2 However, while only one third of adults believe in the safety of the swine flu vaccine, over half trust the seasonal flu vaccine.3 Similarly, Guillain-Barre Syndrome proves to be the most frequent neurological condition related to any flu vaccination according to the Vaccine Adverse Events Reporting System.4 This widely available information thus begs the question of why the current swine flu and efforts to prevent its spread are so carefully scrutinized. One reason is that, interestingly, the most severe cases of swine flu are happening to relatively young and healthy individuals, who are at risk for serious complications, according to studies published in the Journal of American Medical Association.7 An alternative explanation speculates that doubts about the vaccination mainly stem from its rushed development and testing, while others believe the vaccine is simply  unnecessary as the CDC have released a statement affirming that “it is expected that most people will recover [from H1N1] without needing medical care”.5 Still, whether the risks of the inoculation equal or surpass the risks of swine flu is largely open to interpretation. Thus, as the question of to vaccinate or not to vaccinate continues to linger this flu season, it is perhaps a relief to some, and a mental strain to others, to realize that neither choice can be robustly supported nor invalidated.


1 Associated Press, The. 2009. State OKs Mercury in Swine Flu Vaccine. The Seattle Times.

2 for Disease Control and Prevention. 2009. Thimerosal in Seasonal Flu Vaccine. Centers for         Disease Control and Prevention.

3 Cooney, Elizabeth. 2009. People Aren’t Sure They’ll Get Swine Flu Vaccine, Says Poll. The       Boston Globe.

4 Haber, Penina. 2004. Guillain-Barré Syndrome Following Influenza Vaccination. The Journal    of the American Medical Association 292 (20): 2478-2481.

5 Kiger, Genevieve. 2009. People Unsure If H1N1 Vaccine Risk Worth it to Prevent Swine Flu    Symptoms. Examiner~y2009m10d3-People-unsure-if-H1N1-vaccine-risk-worth-it-to-prevent-Swine          Flu-symptoms

6 MacFarlane, Jo. 2009. Swine Flu Jab to Killer Nerve Disease: Leaked Letter Reveals Concern    of Neurologists over 25 deaths in America. The Daily Mail. disease-Leaked-letter-reveals-concern-neurologists-25-deaths-America.html

7 Mann, Denise. 2009. Young People are at Risk for H1N1 Complications, Studies Say. CNN.