Why Doesn’t Everyone Get the Flu Vaccine? (Ep. 191)

Listen now:
(Photo: KOMUnews)

(Photo: KOMUnews)

What if there were a small step you could take that would prevent you from getting sick, stop you from missing work, and help ensure you won’t play a part in killing babies, the sick, and the elderly?

That actually exists: it’s called the flu shot. But a lot of people don’t get it. Why? That’s the question we try to answer in this episode of Freakonomics Radio. (You can subscribe to the podcast at iTunes or elsewhere, get the RSS feed, or listen via the media player above. You can also read the transcript, which includes credits for the music you’ll hear in the episode.)

Influenza and pneumonia, which the Centers for Disease Control groups together, have long been among the top-ten annual killers in the U.S. In 2010 (the most recent year for which there is final data), the count was an estimated 53,826 Americans — more than six times the number of worldwide deaths from Ebola last year.

In the episode, you’ll hear Jeff Kwong, an epidemiologist, family physician, and researcher at the Institute for Clinical Evaluative Sciences, explain the science around influenza and its vaccine. In an ideal world, Kwong says, the vaccination rate would be 100 percent. But in reality, as he tells Stephen Dubner, it’s less than half that in the U.S. Why?

KWONG: I think one of the problems with influenza is the perception that it’s not a big deal. And it’s true that for most people it isn’t. … But then the problem is that they could be giving it to their elderly parent, or their young child, or their pregnant wife. And then their infant is born premature as a result of the influenza infection. … So that sort of thing plays out and it doesn’t make headlines, but that’s the reality people don’t appreciate.

Frederick Chen, an economist at Wake Forest University, designed an online game to try and decipher the incentives people need to get vaccinated. While he admits that the game is not “super fun,” he argues that it provides some evidence for the kind of ideas that policymakers should pursue to boost vaccination rates.

Chen thinks one reason many people fail to get a flu shot is because of a psychological shortcut known as the  “availability heuristic”:

CHEN: And so that means, the more salient, or more vivid something is, the easier it is for us to recall. … For instance, if we see an earthquake happening in the news, then somehow, because that’s very vivid, we tend to overestimate the probability of an earthquake occurring. … And so, I think the problem with vaccination in the end comes down to this: When it’s working, it’s not very memorable.  … It’s more newsworthy when we see things not working.  But when a vaccine is working, nobody wants to talk about it.

There’s also a sizable group of people with “vaccine hesitancy,” who generally dislike the idea of immunization. Some of these skeptics hold beliefs about vaccines that are demonstrably wrong — but they are hard to budge. Research by the political scientists Brendan Nyhan and Jason Reifler, for instance, shows that when such people are given scientific information to dispute vaccine myths, they become less likely to get the vaccine.

Vaccine skeptics will hardly be comforted by the bizarre true story of how the CIA used a Pakistani vaccine campaign as cover during the hunt for Osama Bin Laden. You’ll hear all about it from Mark Mazzetti, a Pulitzer-winning New York Times reporter who chronicles the saga in his book The Way of the Knife: The CIA, a Secret Army, and a War at the Ends of the Earth.


I can't get the flu shot, I'm allergic to eggs and they say if your are you should not get it. I did get it in the past but the last time I tried it my arm was inflamed and swollen to the size of a large grapefruit. It hurt to even touch it. I wish I could get it because I have Crohn's and my immune system is compromised. So I try to take extra vitamins and wash my hands a lot throughout the day.



I'm also allergic to eggs. Have doctors ever offered an alternative to you? (such as the spray mist)

I've heard updated vaccines (that don't use eggs) are in progress, but I'm not sure how far off that is.

I'd also like to take a shot, but can't at this time due to the allergy.


Mike Peterson

I am in the same boat and have never had a flu vaccine because of the egg allergy. My doctor said that I can get the vaccine through an allergist. Why you might ask? I suspect it is because they carry insurance for allergic reactions. Either way, I call one up and he said I would get the same flu shot as everyone else (even the mist at the time was not egg-free). The difference was, someone would be standing buy with and Epipen. That prospect does not sound fun at all. Ever. I would rather be sick. Seriously...


I was disappointed that you didn't discuss the suspected link between the influenza vaccine and Guillain-Barré syndrome. Though it is an unlikely outcome, fear of a serious complication might contribute to the decision to skip the shot.


The story in Pakistan has nothing to do with the reasons for westerners avoiding vaccines. The story in Pakistan is an entirely Seperate story. I don't know anyone in the states that would cite the Pakistan story as a reason for not getting the vaccine.

Barbara Morris

I'm disappointed that the podcast has added music. It's very distracting to have music playing under someone's voice, especially when it's almost loud as the speech. I will try to tough it out, since I do like this podcast, but I'm finding it difficult to stop paying attention to the music.


Two important points your podcast/broadcast on this subject missed. One is the specific strain of vaccine hesitancy I see often among African American colleagues and friends that is linked to the Tuskegee experiment and similar medical abuses. The second is that the usurpation of a vaccination campaign in Pakistan by the CIA for military purposes is not only a bad practice, it is a violation of International Humanitarian Law, specifically the common provisions of the Geneva conventions.


because flu shots are less effective over time, many people delay getting shots until the flu season ramps up, in January rather than in October. by then, of course, some simply skip it.

Emily C

I haven't gotten the vaccine for many years, and I don't believe I've had the flu since I was 13 maybe (in my 40's now). But the reason I don't get the vaccine and why I don't get it for my children has to do more with dishonesty from the CDC. I don't think there's a big govt conspiracy, as some do. But the CDC, FDA, EPA...you name it, have repeatedly looked after corporate interests over public interests. The truth is the flu vaccine is not that all effective, yet it does contain Aluminum and for some versions, contains Thimerosal. Both are toxic. So why would I inject myself and my kids for a "maybe might help" with 100% known toxins, esp when they're so little? Efforts are better spent educating them on how they can make their immune systems strong and prevent viruses from spreading. We do get most other vaccines, but each one must be thoroughly researched because again, govt has made it clear public interests don't always come first. Really shameful. I have to look what other less corporate-centric countries do.



Yeah, the truth is out there - but the lies are in your head.

I can't help but wonder: if aluminum is so toxic, why aren't you all being killed off by the foil helmets you use to block those CIA mind control broadcasts?


Thanks to your podcast I got my first flu vaccine in a VERY LONG time. I did in part stop due to all the hype of it causing serious body problems. And another big part was that I usually always got dog sick afterwards. But your podcast really struck a nerve with me and I decided to do a walk-in flu shot. I realized that even if I don't get sick, since I fall into the more healthier spectrum; I am around others I care about and know that their immunes are weaker. That really pushed me to get vaccinated. Great work with your podcast, thanks for giving me the facts.


OK the problem with using a health program to try and find bin laden wasn't that we used it... it's that this classified information got out somehow. Obviously you guys shouldn't know the names of specific CIA operatives or procedures, the fact that such actionable information was released to the public is the real problem here.


They don't mention the preservatives, stabilizers,enhancers and so on that are in the vaccine that are toxic for some. While all the components of a vaccine may be helpful to many, there are some people that experience negative outcomes, some severe. I have personally had a life altering outcome due to a vaccine.