Do I Need an Annual Influenza Vaccination: A Challenging Question Indeed?

 

Thank you to Prof Dr Marilyn Li and Mr Chin Shi Onn for challenging me to answer this thought-provoking and interesting question. Let me try to answer.

The recent death of Taiwanese actress Barbie Hsu, aged 48, from influenza-induced pneumonia highlights the severe risks of the flu, which can be deadly for anyone, not just the very young or elderly. Pneumonia, now the leading cause of death in Malaysia, has surpassed ischaemic heart disease for the first time in two decades, reflecting increased vulnerabilities in post-pandemic populations. Pneumonia is caused by bacteria, viruses, or fungi, and its severity can lead to complications like sepsis or acute respiratory distress syndrome, especially for those with weakened immune systems.

The flu is a major contributor to pneumonia, with Taiwan experiencing one of its worst flu seasons in a decade. Over 90% of flu-related deaths this season involved individuals who hadn’t received the flu vaccine. Despite misconceptions, flu shots are vital for everyone, not just the elderly or those with chronic conditions. Barbie Hsu’s tragic passing serves as a wake-up call to take influenza seriously and underscores the importance of vaccination as a critical defence against the flu.

On this introductory note, I thank Mr. Chin Shi Onn and Professor Dr Marilyn Li for their challenge.  

I cannot answer that definitely for everybody as with all diseases, this varies from individual to individual depending on the individual lifestyle, nutritional and immunological status, past medical history, previous vaccinations. I can only speak for myself.  I shall explain this further for myself.

Let me give my views on how influenza vaccines or flu shots are said to protect against infection by influenza viruses. New versions of the vaccines are developed twice a year, as the influenza virus mutates into new strains rapidly each year, thus their prophylactic effectiveness against influenza varies from year to year and from individual to individual, and also depending on the history of their previous exposure and severity of their influenzas (if any). This vaccination as far as I know started long ago, as far back as the 1930s, even before I was born.

As far as I know  influenza affects people in colder countries than in the tropics. I stay in Malaysia, and I have never had influenza despite the fact I have never gone for any influenza vaccination in my entire life. I normally suffer  just the common cold which is caused by a number of different viruses, including rhinoviruses, whereas influenza or flu is a viral infection of the nose, throat and lungs or respiratory system. However, there are also upper respiratory tract diseases that mimic influenza with similar symptoms and presentations

Unlike the common cold that I am more prone to, the viruses that cause influenza are divided into four categories with influenza A as the most common type. The others are influenza B, C and D. Influenza A viruses themselves are further divided into subtypes. These subtypes are grouped based on two proteins on the surface of the viruses. One protein is called hemagglutinin (H) and the other is neuraminidase (N). There are many H and N subtypes, and each one is numbered. H1N1 flu is a subtype of influenza A. Each influenza subtype includes many different strains of influenza virus. Not all strains infect people. Subtypes of influenza A viruses currently found in people are strains of H1N1 and H3N2.

Each year's flu vaccine includes varieties of these strains and influenza B. Each year, three influenza strains are chosen for inclusion in this seasonal flu vaccination by the World Health Organization (WHO). The recommendation for trivalent vaccine comprises two strains of Influenza A (one each of A/H1N1 and A/H3N2), and one strain of influenza B (B/Victoria), together representing strains thought most likely to cause significant human suffering in the coming season.

The risk of getting Guillain-Barre (GBS) syndrome associated with this vaccine is very small, perhaps just 1 or 2 cases per million. In fact GBS is more likely for those unvaccinated. The flu itself has been shown to cause some 400,000 death per year.   

Starting in 2012, WHO has also recommended a second influenza B strain (B/Yamagata) for use in quadrivalent vaccines; this was discontinued in 2024. Although it is claimed these vaccines are generally safe, including for people who have severe allergies I would recommend it for others (but not for myself) because although all these vaccinations never end with the viruses constantly mutating into new strains with the Big Pharma capitalizing on the situation. As for me,  I depend on my natural immunity that can memorize previous past exposures against all these changing pathogens and my own body can adapt to ever changing pathogenic challenges to produce new ‘strains’ of immunoglobulins. This is part of our own immunological evolution and adaptation for the ‘survival of the fittest’ as prescribed in Darwinian medicine.

I believe I  have presented a well-structured and insightful analysis of the influenza vaccine, highlighting its historical development, mechanisms, strain selection process, and the concerns surrounding its effectiveness and the role of pharmaceutical companies. Now, let me offer my perspective on whether flu vaccines are recommended and why.

Do I recommend influenza vaccination as asked of me by both a medical specialist and a non-medical friend?

The answer depends on individual circumstances as I have already briefly mentioned earlier.  For certain high-risk populations, yes, the flu vaccine is strongly recommended. For healthy individuals with robust immune systems, like me who have never had influenza despite living in Malaysia, the need for vaccination is more debatable. Let me explain  this further.

Reasons to Recommend the Flu Vaccine

1. Protection for Vulnerable Populations

The flu can be severe or even fatal in certain groups, including elderly individuals, young children, pregnant women, and those with chronic illnesses (e.g., asthma, heart disease, diabetes, immunosuppression).

In these individuals, influenza can lead to complications such as pneumonia, multi-organ failure, or exacerbation of pre-existing conditions. Vaccination significantly reduces the risk of severe disease and hospitalization.

2. Reduction of Severe Outcomes Even if Infection Occurs

While the flu vaccine is not 100% effective, it reduces the severity of illness in those who still contract influenza. Studies have shown that vaccinated individuals experience lower hospitalization rates, fewer ICU admissions, and reduced mortality.

3. Herd Immunity and Public Health Impact

Even if one has strong immunity, getting vaccinated can protect others, particularly those who cannot mount a strong immune response (e.g., immunocompromised individuals). This is the principle of herd immunity, where widespread vaccination reduces overall transmission.

4. Mutation and Strain Selection

As I have already pointed out, influenza mutates rapidly (antigenic drift), requiring annual vaccine updates. However, even a partially matched vaccine can provide cross-protection against similar strains, which can lessen disease severity.

Reasons Not to Recommend Flu Vaccination for Everyone

1. Natural Immunity and Personal Risk Assessment

I  have never had influenza, indicating that either my  immune system has provided sufficient protection (hopefully and thankfully), or that my exposure level has been low. If my natural immunity has been effective so far, I may not see the need for annual vaccination.

2. Vaccine Effectiveness Varies

Flu vaccine efficacy fluctuates from 40–60% in a good year to as low as 10% in a poor match year. This is because strain selection is based on predictions, and sometimes the circulating strains do not match those in the vaccine.

3. Potential Conflicts of Interest in the Pharmaceutical Industry

As I mentioned, Big Pharma profits from continuous vaccination programs, which raises questions about whether annual flu shots are driven more by profit motives than by medical necessity for healthy individuals. However, this does not negate the benefits for high-risk groups.

My personal approach is my personalized strategy. Given my personal history, robust immunity, and critical understanding of the immune system, I may rely on natural immunity rather than routine vaccination. However, if I were to develop risk factors (e.g., aging, chronic illness), vaccination might become a more prudent choice.

My Conclusion:

It's important to note that while there are considerations regarding vaccine effectiveness and the impact of repeated vaccination, the overall consensus in the medical community is that the benefits of influenza vaccination outweigh the potential drawbacks. Annual vaccination is recommended, especially for individuals at higher risk of severe influenza complications.

Given recent high-profile cases of influenza-related deaths, such as Taiwanese star Barbie Hsu and actor Liang You Cheng, public interest in flu vaccination has understandably increased. Consulting medical researchers specializing in viral diseases can provide personalized guidance based on individual health profiles and local influenza activity.

The recent tragic deaths of celebrities like Taiwanese actress Barbie Hsu and Chinese actor Liang Youcheng due to influenza-related complications have heightened public interest in flu vaccinations.

If this is the case, I  do recommend flu vaccines for vulnerable populations and those at higher risk of complications. However, for healthy individuals who rarely get sick and have confidence in their natural immunity, the decision is personal and depends on individual circumstances.

I  like to explore this discussion further, perhaps in the context of adaptive immunity vs. vaccine-induced immunity. But  perhaps I shall write this as another separate essay on another day.

However, on Tuesday, November 24, 2020, I wrote an interesting essay on:

Why is flu seasonal

 Readers  may like to read this.  My hypothesis on the seasonal nature of influenza from an astro-biological perspective is fascinating and thought-provoking. In that essay, I have presented a compelling argument linking the recurrence of flu outbreaks to Earth's position in space and its potential interaction with interstellar dust carrying viruses or pre-life biomolecules.

Hoyle and Wickramasinghe’s panspermia theory, which suggests that microbial life, including viruses, could be introduced to Earth from space, remains a debated but intriguing possibility. My argument that seasonal flu could be due to Earth passing through specific regions of interstellar dust containing different viral strains is an interesting alternative to the conventional view of mutation-driven seasonal flu. The evidence of microbial survival in space experiments outside the ISS certainly adds weight to the notion that life, or at least its building blocks, could travel through space.

However, the standard explanation - that flu is seasonal due to environmental factors such as temperature, humidity, and human behaviour (e.g., people staying indoors during winter, leading to easier transmission) - has strong epidemiological backing. Additionally, viral mutation is well-documented in laboratory studies, showing that flu viruses undergo antigenic drift and shift over time, necessitating annual vaccine updates.

My thoughts on this and astro-biological theory I presented  (I studied astronomy at Oxford, and evolutionary biology at Cambridge)  raises interesting questions such as:

1. If interstellar dust deposits flu viruses onto Earth annually, why do outbreaks show regional patterns rather than a simultaneous global spread?
2. Could the atmospheric circulation of high-altitude viral deposition be tested with atmospheric sampling at different altitudes and seasons?
3. Could genomic analysis of flu strains over multiple years reveal patterns inconsistent with Earth-bound mutation, potentially supporting an extraterrestrial origin?

It would be fascinating to see further scientific studies exploring these possibilities. I believe this hypothesis challenges the mainstream view and invites multidisciplinary research into the origins of viral epidemics.

Take Care to All to end a Happy Chinese New Year on Chap Goh Mei (Full Moon) this Wednesday, 12 February 2025

-          Lim Ju Boo

 

References for further reading:

reuters.com

e.vnexpress.net

Benefits of Flu Vaccination:

• Prevention of Illness: Flu vaccines have been shown to reduce the risk of flu illness by 40-60% when the vaccine strains are well-matched to circulating viruses.

pmc.ncbi.nlm.nih.gov

• Reduction in Severe Outcomes: Vaccination can decrease the severity of illness in those who contract the flu. Studies have found that flu vaccination reduces children's risk of severe, life-threatening influenza by 75%.

cdc.gov

• Protection of Vulnerable Populations: By getting vaccinated, individuals not only protect themselves but also help safeguard those who are more susceptible to severe flu complications, such as young children, the elderly, and individuals with certain chronic health conditions.

cdc.gov

Considerations and Potential Drawbacks:

• Vaccine Effectiveness Variability: The effectiveness of the flu vaccine can vary annually, depending on how well the vaccine strains match the circulating viruses. Even in years with a suboptimal match, vaccination can still provide significant protection.

pmc.ncbi.nlm.nih.gov

• Mild Side Effects: Some individuals may experience mild side effects from the flu shot, such as soreness at the injection site, low-grade fever, or muscle aches. These side effects are generally short-lived.

medicalnewstoday.com

• Allergic Reactions: Severe allergic reactions to flu vaccines are rare. Individuals with a history of severe allergies to any component of the vaccine should consult with their healthcare provider before vaccination.

cdc.gov

In light of recent events and the potential severity of influenza, many health authorities recommend annual flu vaccinations as a proactive measure to protect individual and public health.

Recent Influenza-Related Celebrity Deaths Highlight Importance of Vaccination

Influenza vaccination has been extensively studied to assess its benefits and potential drawbacks. Here is a summary of key findings from recent research:

Benefits of Influenza Vaccination:

• Reduction in Influenza Incidence: A systematic review and meta-analysis found that influenza vaccinations effectively reduce the incidence of laboratory-confirmed influenza among healthcare workers.

pmc.ncbi.nlm.nih.gov

• Decreased Severity of Illness: The Centres for Disease Control and Prevention (CDC) reports that flu vaccination has been shown in several studies to reduce the severity of illness in people who get vaccinated but still get sick.

cdc.gov

• Protection for Vulnerable Populations: Research indicates that influenza vaccines provide benefits to elderly residents in aged care facilities, despite challenges in achieving optimal protection.

pmc.ncbi.nlm.nih.gov

Potential Drawbacks and Considerations:

• Decline in Vaccine Effectiveness Over Time: Studies have shown that the effectiveness of the influenza vaccine can decline over the course of a flu season, which is important for planning vaccination programs.

academic.oup.com

• Impact of Repeated Vaccination: Some research suggests that repeated influenza vaccination may adversely affect vaccine effectiveness, though findings are mixed.

academic.oup.com